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MSK 2 > Neural Systems > Flashcards

Neural Systems Flashcards

1
Q

what are the 2 main types of structural components of a nerve

A

neural / conductive tissue
connective / protective tissue

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2
Q

what do neural / conductive tissues in the nerve do

A

take neuro signals to ms

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3
Q

what are examples of neural/conductive tissues

A

axons
schwann cells
myelin sheaths

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4
Q

what does the connective/protective tissue of a nerve do

A

mechanical properties to support and protect the nerve

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5
Q

how does connective/protective tissue vary between the CNS and PNS

A

more connective/protective tissue in peripheral nerves

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6
Q

nervi nervorum vs vasomotor innervation

A

nervi nervorum - intrinsic
- nerve is source of pain itself

vasomotor - extrinsic from autonomic fibers
- innervation of dilation/constriction of blood vessels

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7
Q

what is and where does the blood supply for the nerve come from

A

vasa nervorum

travels internally and externally

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8
Q

how susceptible are nerves to blood loss or ischemic events? why?

A

very

nerves are blood thirsty
- uses 20% of body’s available O2

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9
Q

what is pia mater

A

innermost meningeal layer surrounding spinal cord and forming a barrier b/w CSF and cord

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10
Q

what is arachnoid mater

A

middle layer
encloses sub-arachnoid space containing CSF

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11
Q

what is dura mater

A

outer layer continuous w epineurium

strongest connective tissue in CNS

elastic properties allows for some stretching but prevents too much stretching

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12
Q

what are superior and inferior attachments for dura mater

A

superior - cranial bones
inferior - coccyx

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13
Q

what are lateral attachments for dura matter

A

transverse processes of verebrae via meningo-vertebral ligaments

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14
Q

what ms does dura mater attach to

A

rectus capitus posterior ms b/w occiput and atlas

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15
Q

what are 4 neural tension tests that can put tension across nervous system based on CNS connective tissue attachments

A

slump
ntpt
slr
ccft

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16
Q

why are there more layers of connective tissue in the PNS than the CNS

A

less bony protection like the CNS has

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17
Q

endoneurium: functions

A

supports nerve fibers
transmits capillaries

mechanical properties support both tensile strength and elasticity
- resists some stretching but allows some (more than the CNS)

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18
Q

perineurium: structure, functions

A

encircles form fascicles

high tensile strength and minimal elasticity barrier restricts diffusion, protecting the nerve from chemical insult
- important if there is nearby inflammation

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19
Q

epineurium: structure, function

A

encircles fascicles contains blood (vasa nervorum) and lymph vessels

function is to cushion entire nerve from external compressive forces

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20
Q

what is the overall structure of a PNS nerve and how does this lend to peripheral nerves having less bony protection than CNS

A

on average 1/2 of nerve is connective tissue to protect it
- varies w nerve location as nerves needing to tolerate more compression have more connective tissue

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21
Q

what nerve tolerates compression better without being source of pain

A

sciatic n.

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22
Q

how do mechanical properties of the nerve protect the nerve

A

accommodate to stress and strain of mvmt

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23
Q

describe the concept of the nerve being on slack and its role in protecting the nerve

A

undulations absorb traction forces
- when slack in system can absorb traction force

accommodates lengthening w/o tensing the nerve

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24
Q

how is the course that peripheral nerves take relative to joints protective in their function

A

most nerves travel in a flexor based pattern -> nervous system adapted to be slack when up tall and neutral

some do travel ext based (like ulnar n.)

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25
Q

what are 5 anatomical features which protect the nerve

A

mechanical properties
slack
course
presence of epineurium
ms tone

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26
Q

how does the presence of the epineurium protect the nerve

A

acts as cushion to nerve where peripheral nerves are subjected to compressive forces
- ex: sciatic > ulnar

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27
Q

how does ms tone protect the nerve

A

heightened ms response (flexor withdrawal) is noted when neural tissue is source of nociception
- nerve becomes mechanosensitive

why HS hurts w sciatic n. issues

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28
Q

what is neural tissue provocation testing truly testing

A

ms reactivity, not neural extensibility

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29
Q

why are nerve roots more susceptible to pain compared to peripheral nerves

A

5x less connective tissue
- dura/arachnoid mater, CSF

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30
Q

why is pain likely the first sx w an insult at the nerve root

A

inc susceptibility to stretch, compression injury, and chemical injury
- experience pain before sensory and strength

peripherally: if you sit on foot and falls asleep, sensory and strength sx before pain

31
Q

how does a compressive mechanical insult cause pain/nociception

A
  1. prolonged compression of n. causes dec/loss of blood flow (intraneural microcirculation)
  2. nerve tells vessels (vasa nervorum) to vasodilate and bring in more blood —> brings in acidic inflammatory soup
  3. more fluid = more swelling and intraneural edema
  4. inc endoneurial fluid pressure -> dec in O2 -> ischemia
  5. ischemia leads to more inflammation and eventually nociception
    –>sensitized structure (which is nerve) becomes ischemic and leads to nociception
32
Q

why does tension/traction have a similar effect as compression

A

when you pull, dec space and causes compression

33
Q

what is your patient education for someone who tells you stretching their HS makes their sciatic n. pain better initially and worse later

A

better initially bc get immediate mechanic receptor activation that makes it feel better

but as you stretch, put compression across nerve
- nerve has blood supply
- you cut blood supply off
- less blood = less O2
this process takes longer to get to brain to tell you it isn’t good than it does when the mechanoreceptors tell you the stretch feels good

feels good now, worse in the long run

34
Q

peripheral nerve response to mechanical insult

A

loss of sensation and strength w/o pain + ischemia, eventually ischemia turns into nociception

compression does’t cause pain bc of protective connective tissue, unless compression in prolonged which will trigger an inflammatory cascade

35
Q

nerve root response to mechanical insult

A

compression or chemical irritation causes pain d/t lack of protective connective tissue
- first sx = primary neurogenic pain

w sustained compression can get radiculopathy

36
Q

what does it mean that neural tissue can become mechanosensitive

A

neural tissue is innervated and can be source of nociception
- when mechanically and/or chemically compromised

37
Q

what does NTPTs assess

A

mechanoresensitivity of neural tissue by eliciting protective ms reactivity

38
Q

what is pain behavior of neural tissue

A

latent response / worse at night
mvmt patterns avoid stretching nerve

primarily neurogenic pain patterns
- NR = dermatome
- peripheral = nerve map

39
Q

how will ROM present w neural tissue on stretch

A

AROM = PROM

40
Q

if there is pain w ROM, what do you want to do

A

try to sensitize the ROM
- move the neck/back, or moving distally

41
Q

what are common palpatory findings in neural tissue as primary source of pain

A

hyperalgesic to nerve palpation and surrounding cutaneous tissues

42
Q

what are 7 neural assessments

A

slump
slr
femoral n. tension test
median n. ntpt
ulnar n. ntpt
radial n. ntpt
nerve palpation

43
Q

how is median n. ntpt sensitized

A

elbow ext

44
Q

how is radial n. ntpt sensitized

A

elbow ext

45
Q

how is ulnar n. ntpt sensitized

A

elbow flex

46
Q

what landmark does the radial n. run through at the wrist

A

anatomical snuffbox

47
Q

what landmark does the ulnar n. run through at the wrist

A

guyon’s canal

48
Q

where does the median n. cross the wrist and describe nearby ms

A

just prox to carpal tunnel
b/w FCR and PL

49
Q

why are active treatments typically not productive in neural treatment

A

may lead to central pain
- not changing threshold, just putting more input
- SHOULD NOT THINK no pain no gain

50
Q

how can you change the compliance of the nervous system during neural treatment

A

put nerve on slack

51
Q

what are neural treatment aims

A

protect the nerve - ed
improve compliance of NS
change mechanical interface
- avoid stretching the nerve
change pain pressure threshold
- think ab neurophysio response

52
Q

what are 5 contraindications for neural treatment

A

progressive neuro condition
neuropathies
systemic disorders
treatment causes pain/ inc distal sx
nerve conduction deficit

53
Q

what about progressive neuro conditions make it a contraindication for neural treatment

A

compression hasn’t been resolved and getting worse
- progressive myotomal weakness
- not changing no matter how much protection

54
Q

why are neuropathies a contraindication for neural treatment and what is an example

A

pathologic changes to the nerve itself
- ex: diabetic neuropathy

55
Q

what are examples of systemic disorders that are contraindications for neural treatment

A

MS
ALS
CA
HIV

56
Q

why is neural treatment a contraindication if it causes pain or inc distal sx

A

don’t want to peripheralize sx
- always want to centralize sx

57
Q

why is nerve conduction deficits a contraindication to neural treatment

A

if enough damage to nerve that there is dec EMG findings, then waiting for axonal growth and stretching/straining isn’t going to work
- axonal growth is slow

58
Q

what are the main strategies to treating neural tension

A

education
change neurophysio response
med intervention

59
Q

what do you educate the patient on when treating neural tension

A

position of ease/tape
- avoid positions which inc tension
active rest
avoid aggravating activities
- usually includes stretching

60
Q

what are interventions we use to change the neurophysiological response

A

manual therapy
self treatment / neural glides
ms rehab
- patterning
- isolated activation (DNF, TrA, multifidi)

61
Q

manual therapy treatment glides

A

gently mob structures near n.
pt in unloaded neural position
gentle slow oscillations - no sx
technique short of reactivity
- grade 1-2, joint mob for pain

62
Q

when you assess ROM after a few reps what should you see and why

A

should make changes quickly bc its neurophysio effects

63
Q

what TBC group isn’t appropriate for manual neural glides

A

sx modulation

64
Q

manual neural treatment: neurophysio mechanism

A

modulates pain by activating descending inhibitory CNS to dec perception of pain

65
Q

manual neural treatment: physio mechanism

A

motion helps to rebalance the pressure gradient intraneurally

aids in restoration of circulation and axoplasmic transport

normal motion, rebalances pressure gradient

66
Q

manual neural treatment: mechanical mechanism

A

breaks adhesions (formed likely bc of chronicity) but is unable to do so until ms response and sensitivity are dec by inc threshold

67
Q

flossing vs gliding

A

flossing - take tension from one side, dec tension from other side

gliding - repetetive tension
- ie bending and straightening elbow for median n.

68
Q

what other ms rehab should be done w neural treatment (4)

A

isolated activation
patterning restore normal mvmt patterns
aerobic
stretching ? maybe

69
Q

what ms should you work on isolated activation and why

A

DNF
TrA
multifidi

deep ms tend to be inhibited

70
Q

what should be done throughout muscle rehabilitation in conjunction w neural treatment

A

reassessment of neural tissue compliance

71
Q

what does it mean to patterning restore normal mvmt patterns

A

restoration of normal motion after is important bc it can cause a cycle which keeps aggravating pain
- you change the way you move bc of pain

72
Q

what type of pain is aerobic activity best for

A

chronic

73
Q

why is stretching often not indicated as an intervention

A

provocative and contraindicated if causes peripheral sx
- tends to make pt worse
- usually not indicated

MSK 2 (20 decks)

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