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Musculoskeletal Exam 3 > Neurodynamic Mobility and Mobilizations > Flashcards

Neurodynamic Mobility and Mobilizations Flashcards

1
Q

What is neurodynamics?

A

the study of the mechanics and physiology of the nervous system

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2
Q

What are the 3 mechanisms that play a role in peripheral nerve adaptation?

A
  • Elongation of the nerve against elastic forces
  • Longitudinal movement of the nerve trunk in the longitudinal direction
  • An increase and decrease of tissue relaxation at the level of the nerve trunk
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3
Q

Nerves can elongate _ cm

A

2

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4
Q

What are the 3 areas called tension sites in which the dura is tethered to the bony canal, providing stability to the spinal cord?

A

C6, T6 and L4

*The elbow, shoulder, and knee have similar sites

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5
Q

Under what circumstances are the areas of adhesion problematic?

A

When the dura becomes adherent, causing excessive stress to be produced in these areas

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6
Q

What are the 5 things that are suspected to contribute to injury processes?

A
  • Posture
  • Direct trauma
  • Extremes of motion
  • Electrical injury
  • Compression
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7
Q

What term refers to the coexistence of dual neuropathies along the course of the same peripheral nerve? Assuming one lesion is proximal and one is distal

A

Double Crush Injuries

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8
Q

In order for double crush injuries to occur what must there be?

A

anatomic continuity of nerve fibers between the two lesion sites

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9
Q

What are the 4 Neurodynamic Mobility Examinations?

A
  • Upper Limb Tension Tests (ULTT)
  • Straight Leg Raise
  • Prone Knee Flexion test
  • Slump Test
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10
Q

What are 3 symptoms for the presence of neuropathic dysfunction?

A
  • Pain
  • Paresthesia
  • Spasm
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11
Q

A positive test for neuropathic dysfunction is represented how?

A

Reproduction of the patient’s symptoms and a decrease in those symptoms with the movement of a distal body part

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12
Q

What 3 positions are combined in the slump test?

A

It is a combination of seated SLR, neck flexion, and lumbar slumping

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13
Q

What does the slump test test for?

A

Adverse nerve root tension caused by

- Spinal stenosis    - Extraforaminal lateral disk herniation    - Disk sequestration    - Nerve root adhesions    - Vertebral impingement
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14
Q

What causes the dura and nerve roots to slacken during the slump test?

A

extension of the cervical spine

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15
Q

What are the 5 progressions to perform when administering the slump test?

A

1) Cervical spine is flexed
2) Slump of thoracic spine, lumbar spine and posterior tilt of pelvis
3) Knee extension
4) Ankle dorsiflexion
5) Gentle cervicothoracic overpressure

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16
Q

If at any point during the slump test the patient’s symptoms are reproduced, what happens next?

A

Ask them to extend the neck

- If cervical extension relieves symptoms, then the test is positive
- If no change occurs, then the test is negative
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17
Q

What are the 6 types of LE Tension Tests?

A
  • Straight Leg Raise
  • Crossed Straight Leg Raise Sign
  • Bilateral Straight Leg Raise
  • Bowstring Test
  • Sciatic Tension Test
  • Prone Knee Bending Test
18
Q

The first __ degrees of the SLR serve to take up the slack in the sciatic nerve

A

30

19
Q

If there is pain during the first 30 degrees of the SLR what may it indicate?

A
  • Acute spondylolisthesis
  • Tumor of the buttock
  • Gluteal abscess
  • Large HNP or extrusion
  • Acute inflammation of the dura
  • Malingering patient
20
Q

What occurs between 30-70 degrees of the SLR range?

A

The spinal nerves, their dural, and the roots of L4-S2 are stretched with an excursion of 2-6mm

21
Q

What occurs after 70 degrees of the SLR range?

A

Other structures such as the hamstrings, glute max, hip, lumbar, and SIJs become involved

22
Q

What is indicative of a positive SLR test?

A

The patient’s ROM is limited to <70 degrees with spasm (pain).

  • Patient’s pain is reproduced and is neurologic in nature
23
Q

What are 3 variations of the SLR test?

A
  • Passive ankle dorsiflexion (Braggard’s test)
  • Passive cervical flexion (Soto-Hall test)
  • Increased IR or Add of the hip
24
Q

If the patient’s symptoms are more irritable when performing the SLR test with ankle dorsiflexion, foot eversion and toe extension what nerve is under stress?

A

The tibial nerve

25
Q

If the patient’s symptoms are more irritable when performing the SLR test with ankle dorsiflexion and eversion what nerve is under stress?

A

sural nerve

26
Q

If the patient’s symptoms are more irritable when performing the SLR test with ankle plantarflexion and inversion what nerve is under stress?

A

Common Fibular nerve

27
Q

What are the 3 crossed SLR signs?

A
  • SLR that produces pain in the contralateral leg but not when the contralateral leg is raised
  • SLR that produces pain in both legs
  • SLR of either leg that produces pain in the contralateral leg
28
Q

Which SLR test is the most significant in terms of its diagnostic powers to indicate the presence of a large disk protrusion?

A

The crossed SLR

29
Q

What 3 test results are strongly predictive of disc herniation?

A
  • Severely limited SLR
  • Positive Crossed SLR
  • Severely restricted and painful trunk movements
30
Q

What type of SLR detects a central disc protrusion?

A

A bilateral SLR

31
Q

What can be done to differentiate between central disc protrusions and various other causes of pain resultant of a positive bilateral SLR?

A

the Bicycle Test of van Gelderen

32
Q

What types of patients can tolerate the bicycle test?

A

Lateral spinal stenosis patient will tolerate this activity.

Central disk protrusion patient usually fairs well IF the lumbar spine remains extended (not if it is flexed)

33
Q

What is a positive bowstring test a strong indicator for?

A

HNP and possible need for surgical intervention

34
Q

When is the bowstring test performed?

A

Only if the SLR is positive with the addition of ankle dorsiflexion

35
Q

What nerve does the prone knee bending test stretch?

A

the femoral nerve

36
Q

What is the prone knee bending test used to indicate?

A

the presence of upper lumbar disk HNP

37
Q

What are the 3Upper Limb Tension Tests (ULTT) in order?

A
  • ULTT 1: Median Nerve
  • ULTT 2: Radial Nerve
  • ULTT 3: Ulnar Nerve
38
Q

Describe the progression of ULTT 1

A

1) Clinician depresses the shoulder girdle
2) Abducts the UE to approx. 110 degrees
3) Supinates the forearm
4) Extends the elbow
5) Extends the wrist
6) Extends the fingers

39
Q

Describe the progression of ULTT 2

A

1) Clinician depresses the shoulder girdle
2) Abducts the shoulder to 30 degrees
3) IR shoulder
4) Pronates forearm
5) Extends the elbow
6) Flexes the wrist and thumb

40
Q

Describe the progression of ULTT 3

A

1) Clinician depresses the shoulder girdle
2) Extends the wrist and fingers
3) Pronate the forearm
4) Flexes the elbow
5) Abducts the shoulder to approximately 90 degrees

41
Q

What are the 5 benefits from neural tension mobilization?

A
  • Facilitation of nerve gliding
  • Reduction of nerve adherence
  • Dispersion of noxious fluids
  • Increased neural vascularity
  • Improvement of axoplasmic flow
42
Q

Describe the treatment parameters for adverse neural nerve mobilization/stretching

A

5-10 gentle repetitions held for 5-10 seconds

Musculoskeletal Exam 3 (6 decks)

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