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Intervention techniques > Neurovas / Neurodynam > Flashcards

Neurovas / Neurodynam Flashcards

1
Q

The nervous system moves and must withstand ….

A

mechanical forces while conducting impulses

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2
Q

Purpose of the myelin sheath surrounding a nerve?

if myelin is damaged?

A

allows electrical impulses to transmit quickly and efficiently along the nerve cells

If myelin is damaged, these impulses slow down

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3
Q

The PNS (nerves and ganglia) must be able to slide and glide within the different layers of connective tissue for

A

functional movement activities, to reduce tension within neural system

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4
Q

Peripheral nerves are regularly subjected to (2)

A

compression
and elongation

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5
Q

Unfolding is …..

When there is no tension on a peripheral nerve, the axon typically contains

What causes an axon to unfold?

A

a movement of the PNS

Folds.

Tension

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6
Q

Movement between the nerve and the surrounding tissue (called
extraneural movement). Which movement of the PNS is this?

^ does not cause ….

A

Sliding

^ does not cause significant elongation or tension to develop
within the nerve.

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7
Q

Elongation is?

This can result in? (3)

A

when tension is applied to the unfolded
nerve and there is little to no movement at the mechanical interface.

significant decreases in
the diameter of the nerve, an increase in the tension within the nerve, and an increase in
pressure within the nerve.

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8
Q

Compressive forces of 20 – 30 mmHg have been shown to adversely affect
____________ , and compressive forces of 50 – 70 mmHg can result in a loss of
________, causing ____________. A strain of ______% can be harmful.

A

intraneural blood flow

blood flow

damage to myelin and axons

6-8%

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9
Q

Imaging studies have demonstrated that peripheral nerves slide (extraneural movement)
with

A

movement of the limbs

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10
Q

In areas repeatedly exposed to high levels of tension (such as the median
nerve at the wrist), the nerves are found to contain …….

A

a higher than average amount of
connective tissue

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11
Q

When there is
movement, some parts of the nervous system will undergo ………., whereas other areas undergo
intraneural movements (elongation), resulting in an increase in _______ ________

A

primarily extraneural
movements with little or no development of tension

intraneural tension

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12
Q

The Seddon Classification of nerve injuries is based on

A

mechanical trauma

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13
Q

Neurovascular problems typically result from _________ in which the integrity of the
nerve is maintained (which is a _____ __ injury)

A

microtruama, Class I

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13
Q

(Seddon Classification) There are three
general classes of nerve damage based on anatomy. Injuries in Class II and III are due to

A

macrotrauma that results in some disruption of the integrity of the nerve fiber

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14
Q

Sunderland’s 5 grades of classifications of nerve injuries provide

Grade 1 prognosis?
Grade 5 prognosis?

A

information about the prognosis and interventions

  • normally full recovery in days to weeks without surgical intervention
  • bypass / jump grafting required
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15
Q

Mechanical micro-trauma resulting in nerve entrapment can occur with excessive or
abnormal … (3)

A

friction, compression, or tension

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16
Q

Inflammation and swelling
within a tissue tunnel can produce compression of a nerve, such as

A

the median nerve
within the carpal tunnel

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16
Q

Some nerves are exposed to bony surfaces such as

A

lower cords of the brachial plexus against the first rib

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17
Q

What can develop at the tibial nerve in the popliteal fossa

A

Abnormal tension can develop in nerves where excessive intraneural movement occurs or extraneural movement is restricted

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18
Q

Microtrauma can produce an intraneural lesion, which can result in a decrease of (3)

A

intraneural flow of axoplasm, demyelination, or conduction defects

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19
Q

Intraneural changes can impair or completely block the ability of a nerve to….

This can result in (4)

A

conduct action
potentials

sensory changes, loss of motor function, autonomic
dysfunction, and atrophy of muscle or skin

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20
Q

Axons
that become inflamed, hypoxic, or demyelinated can become _______ which results in ….

A

hyperexcitable, the production of pathological pain

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20
Q

Friction, compression, and tension can produce microtrauma that results in

for example, fibrosis can

A

both
intraneural and extraneural pathology

fibrosis can produce a substantial reduction in the ability of a nerve to slide within the tissue
tunnel and a substantial increase in the tension within the nerve

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21
Q

The appears to play a significant
role in the pain associated with peripheral nerve pathologies

A

The dorsal root ganglion

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22
Q

the use of scalene for
ventilation during quiet breathing instead of using diaphragmatic breathing

this is found to be present in those with

A

a paradoxical breathing patterns

present in those with upper extremity
cumulative trauma disorders

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23
Q

The pain and
symptoms associated with MSK injuries or peripheral nerve pathology can include changes
that are the result of an alteration in the

A

ANS

24
Q

the sites of peripheral nerve and nerve root vulnerability are

some nerves can have ____ ____

A

tunnels,
branches, hard interfaces, proximity to the surface, and where a nerve is fixed to the
interfacing structure

multiple factors

25
Q

Example of where a nerve is fixed to the intersurfacing structure

A

the common peroneal at the fibular head

26
Q

Damage to a single nerve root as a result of
compression or tension

A

radicular syndrome

27
Q

Symptoms of radicular syndrome include (6)

A

pain in the area innervated by the nerve root, sensory abnormalities, effects on pain sense, motor function loss, possible disturbances of paravertebral sensation, sympathetic dysfunction

28
Q

What does the spinal accessory nerve supply? (2) (CN XI)

This nerve is vulnerable to ________ resulting in

What usually develops soon after injury?

If the nerve does not recovery ………….. can be performed surgically

A

SCM
Tra

blunt trauma or traction injury, resulting in atrophy or paralysis of the trap

weakness, dull ache in the shoulder girdle

scapular stabilization
procedures or transfer of the levator scapulae

29
Q

Long thoracic nerve supplies (C5, 6 AND 7)? This is essential for?

This nerve is vulnerable to?

Where can it be entrapped?

How is it commonly injured?

A

serratus ant, scapular stabilization and protraction

blunt trauma

in the scalenus medius or as it runs through the clavicle and second rib

traction or compression of a backpack strap

30
Q

How does a traction injury occur to the long thoracic nerve?

A

combined head flexion rotation and lateral flexion away from the injury side and shoulder flexion

31
Q

Paralysis of serratus has been reported as an

A

overuse injury in sports such as basketball or golf

32
Q

The prognosis for is good if injury of serratus is due to overuse – treated with …..

Compression injuries carry the worse prognosis – if strength and endurance do not fully recovery with conservative management over 24 months …..

A

rest and exercise to maintain range of motion

then surgical stabilization is
considered

33
Q

Most common mechanism of injury to the long thoracic nerve?

A

vulnerable to blunt
trauma as it passes from the brachial plexus across the base of the neck and, more distally, where it lies against the chest wall

34
Q

Most common mechanism of injury to the axillary nerve?

A

acute anterior shoulder dislocation or its
reduction.

35
Q

What is the spinal accessory nerve vulnerable to?

Injury can result in?

A

injury
from blunt trauma or a traction injury.

atrophy and paralysis of the
trapezius

36
Q

What is the most common cause of femoral nerve nueropathy?

A

Diabetic amyotrophy

37
Q

Compression of the tibial nerve as it passes through the popliteal fossa is
typically caused by an enlarged

A

bakers cyst

38
Q

Common peroneal injuries should also be considered as a probable consequence of

A

grade III ankle sprains or fractures.

39
Q

Sliders

A

Sliders involve application of
movement/stress to the nervous system proximally while releasing
movement/stress distally and then reversing the sequence

40
Q

Tensioners

A

Tensioners are the opposite of sliders in that movement/stress is applied proximally
and distally to the nervous system at the same time and then released.

41
Q

Any specific physical dysfunction
(whether it be neural, muscular, or skeletal) that presumes to physically challenge the
normal functioning of the nervous system.

A

Neurodynamic impairments

41
Q

A neural tension test is designed to examine the
mechanical abilities

A

the nervous system (abnormal physiologic and mechanical
responses )

42
Q

True or False
Active motions should be performed before the passive neurodynamic tests.

A

True

43
Q

Atrophy of the hypothenar muscle with an aching pain in the palm

who is at risk

A

Guyon’s canal

those who are using crutches, motorcyclists
who firmly grasp the hand control

44
Q

The nerve is vulnerable to
compression injuries from a direct blow, a lower leg cast, or sustained pressure at the point where the nerve passes around the head of the fibula

A

common peroneal

45
Q

The median nerve is compressed at the wrist at the transverse
carpal ligament.

A

carpal tunnel syndrome

46
Q

As seen on the slide, the superior transverse ligament closes the notch.
The nerve can be entrapped by this ligament, often in conjunction with a tight bony notch

A

Suprascapular nerve

47
Q

What is the thoracic outlet bordered by

Thoracic outlet syndrome is commonly seen in

A

scalene muscles, first rib, and clavicle

The
syndrome is most often observed in individuals who perform repetitive motions with the
shoulder at the extreme of abduction and external rotation (e.g. swimming).

48
Q

The 3 spaces that can be the source of compression in thoracic outlet syndrome

symptoms?

A

interscalene, and costclavicular, coracopectoral

pain in the neck, radiate to back of head - shoulder girdle - little finger, loss of power of arm and hand, dull feeling and parasthesia in area of supraspinatus and upper trap

49
Q

A few structures that are involved in thoracic outlet compression sydrome

A

upper thoracic spine, the cervical rib, if present, the first rib, the clavicle, scapula, brachial plexus

50
Q

What are the sensitizing movements for the different neural tension tests?

ULTT1 (SH(2)<F<W<F&T<EL<CERSPIN(senvs diff, which nerve?)

A

elev/abd/er
sup
exten
exten
exten
contra side
ipsi side

median

51
Q

What are the sensitizing movements for the different neural tension tests?

ULTT2a (SH(2)<F<W<F&T<EL<CERSPIN(senvs diff, which nerve?)

A

depress/abd/er
sup
exten
exten
exten
contra
ipsi

median

52
Q

What are the sensitizing movements for the different neural tension tests?

ULTT2b (SH(2)<F<W<F&T<EL<CERSPIN(senvs diff, which nerve?)

A

depress/abd/ir
pron
flex/uln dev
flex
exten
contr
ipsi

radial

53
Q

What are the sensitizing movements for the different neural tension tests?

ULTT3 (SH(2)<F<W<F&T<EL<CERSPIN(senvs diff, which nerve?)

A

depress/abd/er (hand to ear)
pron
exten/rad dev
exten
flex
contra
ipsi

ulnar (C8 and T1 nerve roots)

54
Q

What differentiates a radicular condition from the pseudoradicular syndrome?

A

This syndrome is characterized by referred pain sensation, not caused by stimulation of
one or more nerve roots. Can occur without damage or irritation of peripheral nerves or nerve roots

55
Q

A positive
neurodynamic test (4)

A

one that reproduces symptoms, is changed by the movement of a
body segment away from the site of symptoms, has side-to-side differences in the test
response, or has differences from what is known to be normal in asymptomatic individuals

56
Q

Base tests include

A

the major neural pathways and the major sensitizing
movements.

57
Q

Only perform a neurodynamic base test if

Test the _____ side first

Watch for _______ movements

Repeat test ….

A

there is a clinical rationale to doing so

non painful or if there is no difference do left side first for consistency

compensatory

repeat test gently a number of times before recording measurement

58
Q

Management of patients with a neurodynamic problem should focus on

interventions include

A

reducing
mechanosensitivity and restoring normal movement to both the nervous tissue and its
mechanical interface

joint mobilization/manipulation, stretching, soft tissue work, and therapeutic
exercise

59
Q

The application
of either technique (sliders or tensioners) should involve

Starting with one to three sets of ___ oscillations is useful

A

smooth, controlled, gentle, large amplitude movements

10

59
Q

Patients with irritable conditions tend to
tolerate

sliders should not be

A

sliders more than tensioners

provocative

Intervention techniques (10 decks)

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