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PTRS 845 Midterm > Neurodynamics (Guest Lecture) > Flashcards

Neurodynamics (Guest Lecture) Flashcards

1
Q

Describe the purpose of pain

A

Pain acts as a “smoke alarm”

It allows the brain to conclude that there is actual or potential damage and that action is required

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2
Q

Give an example that show there is not a direct relationship between pain and dysfunction

A

Stubbing your toe

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3
Q

Term: Study and relationship of the nervous system mechanics and physiology

A

Neurodynamics

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4
Q

Descibe how the neurosystem adapts to movement

A

It just move and stretch all while performing complex eletrochemical processes. Lack of adaptation would result in injury

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5
Q

Give 2 examples of the adaptability of the nervous system

A

SC lengthens 7-10 cm or 3-5 inches with flexion

The median nerve increases it’s length by 20% from wrist/elbow flexion to extension

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6
Q

5 Points of Greater than Normal Nerve Tension

A
  1. C6
  2. T6** (due to increased lig attachment at SC)
  3. L4
  4. Posterior Knee
  5. Anterior Elbow
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7
Q

Term: Point where there is no movement of the nervous system in relation to the tissue/dura interface

A

Tension point

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8
Q

CNS Protective Layers

A

Dura mater

Arachnoid mater

Pia mater

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9
Q

PNS Protective Layers (out to in)

A

Mesoneurium

Epineurium

Perineurium

Endoneurium

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10
Q

Describe how the connective tissues supporting the nervous system can cause sx

A

The connective tissues are innervated, inflammation and/or ischemia in these tissues stimulates their free nerve endings resulting in sx

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11
Q

Structure: nerve cytoplasm that acts as a transport system being nourishment to cells

A

Axoplasm

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12
Q

Structure: movement and circulation dependent, 3-5x thicker than water

A

Axoplasm

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13
Q

Describe the nervous systems need for blood

A

They are blood suckers! While they make up 7% of our BM they use 25% of our Q

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14
Q

Describe the effect of elongation on BF to the nervous system

A

At 8% elongation BF can become compromised which can lead to nervous tissue damage

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15
Q

7 Nerve Pain Generators

A
  1. Blood Flow
  2. Axoplasmic Flow
  3. Double Crush
  4. Connective Tissue
  5. Abnormal Impulse Generating Sites (AIGS)
  6. Substance P
  7. Surrounding Tissue Injury
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16
Q

Descibe the amount of compression need to stop BF and the affect on nerves

A

30 mmHg of pressure can occlude BF resulting in a swollen nerve

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17
Q

Term: Movement dependent

A

Thixotropic

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18
Q

Decribe the flow of Axoplasm

A

Axoplasm moves 100-400 mm a day. Immobilization or ischemia can slow or even stop flow. This flow is movement dependent (thisotropic)

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19
Q

Term: Experience symptoms distal to the nerve injury

A

Double crush

ex. hitting your funny bone

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20
Q

Term: Experiencing symptoms proximal to the nerve injury

A

Reverse double crush

ex. CTS producing neck/shld pain

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21
Q

Describe how double crush/reverse double crush is possible

A

Because the nervous system is a closed system injury in one area of a nerve can lead to pathology in other nerve sites

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22
Q

Describe how connective tissue can generate nerve pain

A

CT makes up 50% of the diameter of a nerve and it is highly innervated (free nerve endings, pacinian corpuscles) as well as surrounded by unmyelinated fibers containing pain neuropeptitides

23
Q

Describe AIGS

A

Axons transmit messages, the ion channels used to transmit an AP typically are recycled every 2 days. However, if there is vascular injury these channels can get stuck in the axolemma and fire at random in both directions. These miss fires can manifest as N/T, burning, pressure, etc. Without axoplasm flow this can persist.

24
Q

Describe how Substance P generates nerve pain

A

When a nerve processes information abnormally, substance P and excitatory amino acids are released in excess. This stimulates glial cells to release inflammatory agents (NO, cytokines, prostaglandins) which inturn stimulate further release of substance P

25
Q

Describe the what is happening in regards to nerve recovery at

  1. 3 wks
  2. 6 wks
  3. 6-16 wks
A
  1. Degenerative changes in myelin
  2. Collagen deposition in the endoneurium
  3. Decrease in fiber diameter or myelinated fibers
26
Q

2 Ways to feel nerves

A
  1. Palpation
  2. Neural tension testing
27
Q

3 Good spots to palpation nerves

A
  1. Tunnels (ex. carpal tunnel and median n.)
  2. Branches (ex. radial n. at elbow)
  3. Hard surfaces (ex. radial n. on radius)
28
Q

Nerve: Medial to biceps femoris at the head of the fibula

A

Peroneal n.

29
Q

Nerve: Lower L-spine, piriformis, superior tibiofibular joint, lower limb compartments, ankle extensor retinaculum

A

Peroneal n.

30
Q

Nerve: Posterior to knee and medial to ankle

A

Tibial n.

31
Q

Nerve: Plantar fasciitis, heel spurs, recurrent HS injury, piriformis

A

Tibial n.

32
Q

Nerve: Lateral to Achilles tendon and distal to fibula

A

Sural n.

33
Q

Nerve: Recurrent ankle problems and Achilles tendonitis

A

Sural n.

34
Q

Nerve: near the inguinal ligament

A

Femoral n.

35
Q

Nerve: Hip flexor strain, pinch/hyperext at inguinal ligament, L2-3 nerve root syndrome

A

Femoral n.

36
Q

Nerve: Infrapatellar branches on the head of the tibia and main nerve between gacilis and sartorius at the knee joint

A

Saphenous n.

37
Q

Nerve: Most arthroscopic medial knee pain and MCL injuries

A

Saphenous n.

38
Q

Nerve: Upper arm, medial to biceps tendon, indirectly at carpal tunnel

A

Median n.

39
Q

Nerve: CTS, s/p Colles fx, C5-6 nerve root entrapement

A

Median n.

40
Q

Nerve: Pisiform area at wrist

A

Ulnar n.

41
Q

Nerve: Guyon’s canal

A

Ulnar n.

42
Q

Nerve: Mid humberus and radial sensory nerve onthe lateral aspect of the forearm

A

Radial n.

43
Q

Nerve: DeQuervain’s, tenosynovitis, s/p humeral fx, C5-6 nerve root entrapment

A

Radial n.

44
Q

Term: When assessing nerve looking to see if tension is reproducing pain/sx. that pt. came to be treated for

A

Comparable sign

45
Q

Only REALLY concerning precaution to neural tension testing

A

Unstable condition - ligament damage, vertebral instability, etc.

Other precautions include: elderly, circulatory disturbance, pregnancy, causes dizziness, pathology to nervous system

46
Q

4-8 Contraindications to Neural Tension Testing

A
  1. Tethered cord syndrome
  2. SCI
  3. Cauda equina
  4. Recent neurological changes
  5. Malignancy
  6. Instability in vertebral column
  7. Recent worsening neurological sx
  8. Unstable disc lesion
47
Q

SLR that biases peroneal n.

A

Add PF and inversion

48
Q

SLR that biases sural n.

A

Add DF and inversion

49
Q

SLR that biases tibial n.

A

Add DF and eversion

50
Q

4 ways to increase the overall load of SLR

A
  1. IR the hip
  2. ADD the hip
  3. Contralateral T/L SB
  4. Cervical flexion
51
Q

Describe what the slump test assesses

A

It is a more aggressive test to assess the posterior leg particularly in pt. who have minimally irritable sx.

52
Q

Positive Finding from Neural Tension Testing

A
  1. Comparable sign
  2. Asymmetrical ROM
  3. Change in sensaiton in nerve distribution
53
Q

Documenting Neural Tension Testing

A
  1. Area/sequence of response
  2. Restriction of movement
  3. Sx characteristics

PTRS 845 Midterm (13 decks)

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