Neurodynamics Flashcards
Mechanical Features of Nerve and their Function
Mesoneurium, epineurium and perineurium interact with loosely coupled perineurium and endonerium.
Allowing nerves to straighten without bearing significant stress while maintaining functional and structural integrity.
Mechanical Interface
Anatomical structures surrounding nerve.
May affect nerve properties (entrapment…)
Nerve Biomechanics - Convergence
Elongating nerve bed and nerve glides towards moving joint, towards the tension.
Nerve Biomechanics - Divergence
Reduced tension on nerve bed and glides away from moving joint.
Changes in Nerve Properties (immobilization, carpal tunnel syndrome, lumbar radiculopathy)
Immobilization: Affecting myelin sheet and fiber diameter.
Carpal tunnel: Affecting longitudinal excursion, stiffness.
Lumbar radiculopathy: affecting cross-sectional area.
Nerve Injury - cycle
Impaired fascicular gliding -> edema -> ischemia -> impaired axonal transport -> mechanosensitivity -> adhesions ->
Neurodynamic Tests - Characteristics (4)
Testing mechanosensitivity of nerve.
Assessing gain of function.
Positive: partial reproduction of neurogenic pain in neck and arm.
Increased/decreased symptoms with differentiation maneuver.
Neurodynamic Test as Treatment - Sliders and Tensioners
Sliders: elongating at one end, releasing tension at the other.
Tensioners: elongation at both ends.
Neurodynamic Test Guidelines (7)
- instruct patient, actively perform movement.
- Follow a logic sequence of movements.
- Non-affected side tested first.
- Bilateral comparison
- Maintain each movement before adding a new one.
- Take your time, ask constant feedback.
- Perform structural differentiation.
Differentiation Maneuver - Definition
Adding a movement distal to the location of symptoms without affecting non-neural tissue local to area of symptoms.
Sensitizing Maneuver - Definition
Additional movements that will increase load on a specific neural structure.
Entrapment Neuropathies (4)
Cervical radiculopathy
Carpal tunnel syndrome
Cubital tunnel syndrome
Radial nerve entrapment
Loss of Function - Signs and Symptoms
Neurological deficit -> Radiculopathy
Weakness > atrophy
Reduced deep tendon reflex
Hypoesthesia > anaesthesia
Loss of Function - Assessment
Dermatomes: light touch, pinprick, thermal.
Myotomes: muscle activity
Deep tendon reflexes: biceps, triceps, brachioradialis, quads (patella) L2-L4, achilles L5-S2.
Loss of Function Assessment - Myotomes (C1-T1)
C1: upper cervical flexion
C2: upper cervical extension
C3: cervical lateral flexion
C4: shoulder girdle elevation
C5: shoulder abd
C6: elbow flexion
C7: elbow extension
C8: thumb ext. finger flex.
T1: finger abd. add.
Loss of Function Assessment - Myotomes (L2-S1)
L2: Hip flexion
L3: Knee extension
L4: Dorsiflexion
L5: Hallux extension
S1: Plantarflexion
Gain of Function - Signs and Symptoms (9)
No neurological deficit. Somatic referred pain, nerve mechanosensitivity, neuropathic radicular pain.
Pain
Paraesthesia
Nerve mechanosensitivity
Hyperalgesia
Allodynia
Dysesthesia
Gain of Function - Assessment U.L. (4)
Upper Limb Neural Test 1: median nerve
ULNT 2A: Modified median nerve
ULNT 2B: Radial nerve
ULNT 3: Ulnar nerve
Gain of Function - Assessment L.L. (4)
Straight leg raise:
+ dorsiflexion : sciatic nerve
+ dorsiflexion and eversion : tibial nerve
+ plantarflexion and inversion : peroneal nerve
+ abd. and internal rot. : sup. inf. gluteal nerves
Slump test : sciatic nerve
Prone knee bend test : femoral nerve
Slump knee bend test: middle and upper lumbar radiculopathy
Radiculopathy - Definition/Pathophysiology (4)
Compression or irritation of nerve root. Neural conduction problem.
- Nerve root distortion
- Intraneural oedema
- Localized inflammatory response
- Focal nerve ischemia
Radiculopathy - Causes (4)
Herniated disc
Degenerative changes in disc
Hypertrophy of ligament Flavum
Osteophyte formation
Radiculopathy - Symptoms (2) and Examination (5)
Neuropathic pain and neurological deficit.
Quality and Location of pain.
Neurological examination.
Provocative maneuvers:
- Spurling (Cx) Kemp’s (Lx)
- Distraction
- Neurodynamics
