(1) UQ Neuroprovocation Testing Flashcards
Neurodynamics Definition
Viscoelastic nature of neural tissue allowing for the transfer of mechanical stress throughout NS during trunk or limb movements
Nerve tissue responds to movement by:
Gliding
Lengthening (tension)
Compression (from surrounding tissues)
Adverse Neural Tension Definition
NS response that limits the range or stretch of neurologic tissue / results in neurologic symptoms through available range
Pipe Metaphor for Nerves
Nerves in a sheath similar to water in a pipe
Inflammation / adhesions act as the mud in the pipe
Lack of smoothness is what produces symptoms
Spinal Dura forms a ___ ___ around Spinal Cord.
loose sheath
List the 3 tension sites where Dura is tethered to a bony canal.
C6
T6
L4
Normal Mechanisms vs. Abnormal Mechanisms Related to Neural Mobility
Normal: Tension sites NOT affected by motion or extremities
Abnormal: Adhesions (excessive stress in areas surrounding them) / increased tension and increased length of dura outside normal limit
*Adhesions result in decreased dural / neural mobility and increased distances for tissue to travel
Sites of Peripheral Nerve and Nerve Root Vulnerability
Tunnels
Branches
Hard interfaces
Proximity to the surface
Adherence to interfacing structures
Nerve Vulnerability
/
Tunnels
Hard sided tunnels (carpal tunnel) increase probability of spatial compromise of a nerve (ulnar n.)
Nerve can potentially rub on tunnel structure to create friction
Any trauma / altercation to the tunnel structure can mechanically or chemically compromise nerve
Nerve Vulnerability
/
Branches
More difficult for nerve to move away from forces at points where a nerve branches (e.g., radial n. at elbow)
Nerve Vulnerability
/
Hard Interfaces
Nerve more readily compressed if it lies on a bone OR passes through fascia
(e.g., radial n. in spinal groove of humerus)
Nerve Vulnerability
/
Proximity to the Surface
Superficial nerves (e.g., sensory radial n in forearm) are more vulnerable to external compression
Nerve Vulnerability
/
Adherence to Interfacing Structures
Some areas of nerve are more firmly adherent to interfacing tissues than others (e.g., common fib n. at head of fibula)
Proposed Mechanisms of ANT
Posture: Sustained postures may cause adaptive shortening of neural structures
Direct Trauma: Damage from direct blow / secondary to injury at adjacent structures (fracture / dislocation / tendon rupture)
Extremes of Motion: ULTT / certain movements can place traction on the nerve
Electrical Injury
Compression: Muscle contraction / tight fascia / neoplasms / bony protuberances
Physical Signs of Neural Tissue Involvement
Antalgic posture
Active / passive movement dysfunction
Adverse response to NPT
Mechanical allodynia (painful response to otherwise neutral stimulus) in response to palpation of specific nerve trunks
Ensure all above symptoms are related to similar anatomical area
3 Signs of a Positive NPT
Reproduces pt’s symptoms (concordant pain)
Response altered by movement of distant component (sensitization)
Test differences from L / R side or from normal (differences in pain, ROM)
Research suggests a relationship between ___ and ANT of the ___ nerve (+ Slump Test).
repetitive hamstring strains
Sciatic
Are Double Crush Injuries more common in UEs or LEs?
UEs!
Double Crush Injury Definition
Neurologic dysfunction due to compressive pathology at multiple sites
May impair nerve’s ability to withstand compression at distal site
In the context of Double Crush Injuries, should you tend to the more proximal or distal compression site first?
Proximal!
Can assist with any distal issues / fixing distal first lowers threshold for re-occurence
T or F: Proximal issues must develop before distal issues in the context of a Double Crush Injury.
F
Distal issues CAN develop before proximal
Proximal / Systemic or Metabolic / Distal “Crush” Examples
Proximal: Radiculopathy / Thoracic Outlet Syndrome / Brachial Plexus injury / trauma
Systemic/Metabolic: Diabetes / hereditary neuropathy / autoimmune condition / hypothyroidism
Distal: Distal Compression Neuropathy / trauma / tumor / Carpal Tunnel
What does research state about the relationship between ULTTs and Cervical Radiculopathy?
> or = 3 (+) ULTTs rules in cervical radiculopathy w/ strong LR+ and a high post-test probability
All ULTTs (-) rules out cervical radiculopathy
Cervical Radiculopathy vs. Peripheral Nerve Injury
Cervical Radiculopathy: Symptoms evoked during clearing of c-spine
Peripheral Nerve Injury: Distribution of sensation loss (mind overlap with c-spine dermatomes)
A paresthesia can involve ANY ___.
sensation alteration
When conducting NPT, what side should you always test first?
“good” side
Neurodynamic Mobilizations
Glides: Least aggressive - ideal for highly irritable nerve / oscillatory, alternating on:off positions / 2-3 sets of 10-20 reps
Tensioners: Medium aggression / alternating on:on and off:off positions / 2-3 sets of 10-20 reps
Stretches: Most aggressive / sustained / find sensitized position and hold for 10-15 seconds (3-5 reps) - maintain position of joint proximal to sensitizer during glide
Can start with oscillatory glides and progress to longer duration stretches as symptoms reduce
What is the overall goal of Neurodynamic Mobilizations (Nerve Glides)?
Increase ROM pt can endure before experiencing symptoms (improving nerve’s ability to move and therefore decreasing it’s sensitivity)
Evidence suggests that Slump Stretching may be beneficial in __.
short term (improving disability / pain / centralizing symptoms)
Evidence supports use of Median N. glides to improve ___.
nerve excursion in pts w/ CTS
Arm pain with neck movement would be indicative of a ___ Nervous System problem.
Central
How can you distinguish PNS vs. CNS issue through myotomal / muscle testing?
If all muscles innervated by a spinal level are not affected it is likely a peripheral issue
Provide the spinal levels associated with the following peripheral nerves:
Median N.
Ulnar N.
Radial N.
Median N.: C6, C7, C8, T1
Ulnar N.: C7, C8, T1
Radial N.: C5, C6, C7, C8, T1
