Final - Neurodynamics

Question 1

Common Peripheral Nerve Injuries

Answer 1

• Axillary n
• Femoral n
• Posterior tibial n (tarsal tunnel)
• peroneal n (foot drop)
• medial n (carpal tunnel, pronator teres)
• ulnar n (cubital tunnel)
• posterior interosseous n (PINS)
• anterior interosseous n (AINS or kilo-nevin syndrome)
• radial nerve (saturday night palsy)

Question 2

Clinical Presentation

Answer 2

• localized or referred pain
• numbness, tingling, electric shock, burning feelings
• muscle weakness
• muscle wasting

Question 3

Classification of Peripheral Nerve Injuries

Answer 3

Neurapraxia
Axonotmesis
Neurotmesis

Question 4

Neurapraxia

Answer 4

physiologic block of nerve conduction without anatomical interruption (more sensory symptoms)

Question 5

Axonotmesis

Answer 5

• Anatomic disruption of the axon, connective tissue intact

- treated conservatively hoping for axon regeneration

Question 6

Neurotmesis

Answer 6

• anatomic disruption of the axon and connective tissue

- Recovery system of low

Question 7

Clinical Relevance of Findings

Answer 7

• Physiologic
• Clinical physiologic: something is off but no reproduction of symptoms
• Neurogenic: people we are treating w neural mobs bc we determined there IS involvement of neural system

Question 8

Level 0 patient

Answer 8

NDT contraindicated

Question 9

Level 1 patient

Answer 9

• limited, irritable
• pain easily provoked and takes a long time to settle after movement
• latent pain: pain that develops a long time after physical testing
• modification to the standard NDT/treatment (may start more remotely with sequence)

Question 10

Level 2 Patient

Answer 10

• Standard
• Not irritable, intermittent, stable
• will use standard NDT

Question 11

Level 3 patient

Answer 11

• Advanced
• Pain is difficult to evoke, high expectations in physical function, standard test is normal or does not reveal sufficient information
• Modification to the standard NDT/treatment (may start sequence more faced on problematic area)

Question 12

Goal of treatment

Answer 12

reduce the mechanosensitivity of the nervous system and restore its normal capabilities for movement

Question 13

indications for neuromobilization technique

Answer 13

• clinical reasoning hypothesis for neurogenic pain
• aggravation of symptoms by a functional position or ADL that resembles a base test (getting in car)
• positive conduction test suggesting neural involvement

Question 14

Contraindications to neuromobilization techniques

Answer 14

• increasing neurologic signs or neurologic injury
• severe injury of the interfacing tissue of the nervous system (fracture or soft tissue injury that is unstable)
• red flags found with neurologic examination
• inflammatory, infectious, viral conditions
• tethered spinal cord
• severe pain

Question 15

Indirect Intervention

Answer 15

• mobilization of the nervous system by addressing restrictions of the tissues that surround or move the nerve
• joints, muscles, fascia, skin, subcutaneous tissues
• nerve is not there in isolation (joint mobs, stabilizing, etc)

Question 16

Direct Intervention

Answer 16

mobilization of the nervous system using neuromobilization techniques

Question 17

Sliding/Flossing Technique

Answer 17

• as tension is added to one end of the system, slack is given to the other end
• less aggressive, used with more acute or irritable patients

Question 18

Tension technique

Answer 18

• tension is added to both ends of the system at the same time
• more aggressive technique, used with more chronic or less irritable patients

Question 19

Considerations for mobilization of the nervous system

Answer 19

• interventions should be performed without or with minimal symptom reproduction
• techniques can be used at various parts of the range
• modifications can be made to the amplitude, range, or speed of the movement
• techniques may be performed actively, passively, or a combination of the two
• progression to functional movements should be incorporated as quickly as appropriate
• if a number of tests are provocative, mobilize the less provocative first
• HEPs focused on self mobilization should be incorporated with pt ed

Question 20

How to set dosage

Answer 20

• number of repetitions, sets, and amount of nerve tension should be determined by the health of the nervous system and the response of the patient
• continual reassessment and monitoring of the patient is necessary to provide appropriate intervention

Question 21

Some guidelines for dosage

Answer 21

• duration: 5-10 sec hold, 5-10 sec rest
• repetition: 1-10 times based on irritability, multiple sets possible
• frequency: 1-5 times per day based on irritability
• progression can include increasing repetitions, sets, frequency, or amplitude

Question 22

Level 1 Patient Progression

Answer 22

• Using other side to unload affected side
• if patient is too irritable for standing sliding or tensioning
• use contralateral limb to assist with off loading tension on the nerve root

Question 23

Level 1 Patient Progression

Answer 23

1. ipsilateral limb on slack, contralateral limb positioned on tension
2. ipsilateral limb on slack, contralateral limb moved into tension
3. ipsilateral limb placed into some tension, contralateral limb moved into tension
4. contralateral limb positioned on tension, ipsilateral limb moved into tension
5. contralateral limb positioned in less tension, ipsilateral limb moved into more tension

Question 24

Key point for contralateral mobilizations

Answer 24

when contralateral limb is placed in a position of tension, it causes a reduction in tension on the ipsilateral side (system is continuous)

Question 25

Level 1 patient progression considerations

Answer 25

- need to have assessed contralateral side to ensure that there are no neurologic sxs - in some instances (large disc protrusions) the contralateral limb may increase pain in ipsilateral limb and contralateral limb mobs would not be indicated - may produce stretching in contralateral limb but no pins and needles or other neuro symptoms

Question 26

Thoracic Outlet Syndrome

Answer 26

- collection of syndromes brought about by abnormal compression of the neuromuscular bundle by bony, ligamentous, or muscular obstacles between the cervical spine and lower borer of the axilla

Question 27

Common places for TOS compression to occur

Answer 27

between scalenes between first rib and clavicle between pec minor and coracoid or ribs

Question 28

Symptoms of TOS

Answer 28

deep aching pain in the neck and shoulder, paresthesia, muscle atrophy, weakness, stiffness, temperature and color changes, swelling, skin changes, fatigue

Question 29

Treatment for TOS

Answer 29

decrease mechanical pressure, increase mobility of tissue, decrease compressive load, strengthen, address postural impairments, control inflammatory response, activity modification

Question 30

Slump Test

Answer 30

1. ask pt to keep feet on the floor, hands behind back, slump 2. ask to bring head down, place hand on back of neck 3. straighten knee 4. DF ankle

Question 31

Straight Leg Raise - Tibial

Answer 31

DF, Evert Grab ankle, forearm along plantar and forearm everts to let go, release DF and evert into opposite direction but little motion

Question 32

SLR- Fibular

Answer 32

PF, Invert | go under and fingers grab toes to curl them down and in

Question 33

SLR- Sural

Answer 33

DF, Invert | Wrap around medial side and grab around big toe to invert and DF

Question 34

Median Nerve

Answer 34

Elbow at 90, shoulder abduction, scapula stabilization, supination, wrist ext, shoulder ER, elbow ext **pistol grip

Question 35

Ulnar Nerve

Answer 35

Match hands, wrist ext, pronation, elbow flex, scar depress, shoulder depression, shoulder ER, shoulder abd