Neural tension testing Flashcards
Describe the sensory neurons and where they are found
- dorsal root ganglia
- afferent
- joints
- blood vessels
Describe the sympathetic neurons and where they are found/innervate
- in sympathetic ganglia
- afferent
- viscera
- blood vessels
- glands
Describe the CT of neurons
- Epineurium: whole nerve
- Perineurium: fascicles/bundles of nerves
- Endoneurium: axons or individual nerves
What is degree of viscoelasticity
- passive movement in connective tissue of the nerve
Mobility of a nerve
- forces that are placed on it and how it moves
- traction forces are distributed over the length of the nerve
- ability to deform 5-10 mm
- Tolerate limited tension, compression stress
- adapt to positions of limbs and trunk
LMN peripheral nerve injury to nerve root
- occurs in spine at VI foramen
- myotomal, dermatomal and reflex changes
LMN peripheral sites along nerve path injury
- motor, sensory changes in peripheral nerve distribution
- Signs and symptoms: muscle weakness, pain/abnormal sensation where nerve innervated (not dermatome)
how can trauma, injury or surgery cause nerve injury?
Healing, nerve entrapment in scar tissue and adhesions (lose mobility)
Nerve tension and compression forces
- Tensile force/traction - extremes of motion
- Compression from:
Posture: adaptive shortening, muscle fascia, liga, capsules
Muscle hypertrophy, contraction, overuse
Space occupying lesion: disc, tumor, one, swelling etc
When do you use neural tension tests?
when peripheral nerves appear to be involved
What is a positive test of a neural tension test?
- Reproduction of pt’s symptoms
- pain/paresthesia peripheral nerve pattern
- Difference from uninvolved
- Differentiate from stretching discomfort
What is the sensory distribution of Median nerve
Palm of hand on the thumb to half the ring finger
Motor component of median nerve
- Wrist finger flexors (excluding FCU and ulnar side of FDP)
- Pronators
- Hand median muscles
- thenars
- 1-2 lumbricals
What is the course of the median nerve
- Lateral and medial cords
- Medial arm
- Anterior elbow
- Anterior forearm
- Pronator teres (through)
- Carpal tunnel (through)
What can occur with damage to the median nerve
- ape thumb deformity
What are the steps to the median ULTT
- Depress and retract scapula
- Abduction, ER of GH joint
- Extend wrist
- Extend elbow
- CS SB away
Ulnar nerve sensory component
½ ring and little finger
Palm and dorsal sides
Ulnar nerve motor component
Motor:
FCU
Ulnar FDP
Ulnar intrinsics:
Lumbricals 4,5
Interossei
Adductor pollicis
Hypothenar muscles
What is the course of the ulnar nerve
Course:
Median branch
Medial arm
Cubital tunnel (through on posterior elbow)
Medial forearm
Anterior wrist
Tunnel of guyan (through)
what is the deformity that can occur with the ulnar nerve
Deformity: Benediction hand
ULTT: ulnar nerve
elbow is extended to begin
1. Depress and retract scapula
2. Abduct and ER GH
3. Extend, RD wrist
4. Flex elbow
5. CS SB away
Radial nerve sensory
Sensory: Posterior arm
Posterior forearm
Hand dorsal radial side (not including tips of index and middle finger)
motor of the radial nerve
Motor:
Triceps
Anconeus
Brachioradialis
Supinator
Wrist, finger, and thumb extensors
Course of the radial nerve
Course:
Posterior cord
Posterior arm
Triangular interval
Anterior to lateral epicondyle
Branches into
Deep: thru supinator to posterior forearm (becomes posterior interosseous)
Superficial branch: sensory to the dorsal wrist and hand
