Neurodynamic Mobility Flashcards
The nervous system is a electrical chemical and mechanical structure that is
Continuous
Neural tissue Is a form of
connective tissue that has viscoelastic properties
Neural Tissue allows for the transfer of mechanical stresses
throughout the system during movement
Movements are passive and
related to surrounding tissues
Elongation of the nerve and cliding in relation to surrounding tissues
up to 2 cm sliding / 10%elongation
The dura forms a loose sheath around the spinal cord from the
foramen magnum to the coccyx
Tethered to the spinal canal to provide stability for the spinal cord
foramen magnum, coccyx
c6, t6, l4elbow shoulder and knee
Neural tissue adapts to movements of
joints and muscles
Moves in relationship to
tension sites and joint axis
Adhesions can result in
excessive stress in that area
Sites of nerve vulnerability; tunnels
compression, friction, response to other tunnel contents
Site of vulnerability: Branches
less mobility at sites of branching
Site of vulnerability: Hard Interfaces
nerve is more easily compressed against a bone r passing through fasica
site of vulnerability: Proximity to the surface
more vulnerable to external compression
Neural tissues respond to injury as any other connective tissue
Inflammatory cascade
Pain with stress
Formation of fibrous tissue
adhesions in the nerve sheath or surrounding tissues
Nerves and their microcirculation can be affected
by tension, friction, compression
Double Syndrome
Proximal compression/ irritation of a nerve may make the nerve more susceptible to compression distally
- -cervical radiculopathy could precipitate carpal tunnel on the same side
- -Due to disruption of the axons, impaired axonal transport, endoneural edema, or ischemic changes in the nerve.
Test are designed to stretch the dura to assess the contribution of the neural tissues to the patient’s concordant sign.
Slump test Straight Leg Raise Well Straight Leg Raise (Crossed SLR) Upper Limb tension Test 1 Upper Limb Test 2 Upper Limb Test 3
Slump test
sensitivity and specificity about the same
Pt sits with arms behind back
instruct the patient to slump the back into full thoracic and lumbar flexion
apply overpressure across the patients shoulders
Pt actively flex the cervical spine (chin to chest) and
apply overpressure to the back of the head to maintain flexion
Dorsiflex the foot
Instruct the patient to actively extend the knee as much as possible
If unable to fully extend the knee, release overpressure of the cervical spine and allow patient to extend the neck
If the patient is able to extend the knee further with cervical extension or symptoms are reduced, the test is positive implicating dural, cord, or nerve root restriction
The slump test is for
lumbar radiculopathy (may also be a way to pick up a central stenosis or disc herniation that does not present individually with pain)
Straight Leg Raise
more sensitive .97
For lumbar radiculopathy:pain before 70” (at 30” acute Disk herniation)
Sensitizers are: (add in to add tension to the test and can be used as treatment technique)
Dorsiflexion
Cervical Flexion
Hip Internal rotation
Well straight Leg Raise
most specific -1.00
Most specific of test for the lower extremity:
Raising the uninvolved side and reproducing pain on the involved side.
Lumbar HNP(Herniated Nucleus Propulsus)/radiculopathy
If picking one test to see what is really going on as far as lumbar radiculopathy
SLR and Well Straight Leg Raise
Cluster for HNP
Severely limited SLR
+ Well SLR
severely restricted and painful lumbar rotation
Upper Limb Tension Test 1 (ULTT 1)
Median Nerve Pt Position: supine Depress the shoulder girdle extend the wrist and fingers supinate the forearm abduct the shoulder 110" then externally rotate extend the elbow
UTLL 2
Radial Nerve Scapular depression elbow extension/ pronation medial rotation finger and thumb flexion wrist flexion then ulnar deviation
UTLL 3
Ulnar Nerve Bias Scapular Depression Shoulder abduction, ER Forearm pronation Wrist and finger extension elbow flexion full shoulder abduction
