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.
