1
Q
Common Peripheral Nerve Injuries
A
- Axillary n
- Femoral n
- Posterior tibial n (tarsal tunnel)
- peroneal n (foot drop)
- medial n (carpal tunnel, pronator teres)
- ulnar n (cubital tunnel)
- posterior interosseous n (PINS)
- anterior interosseous n (AINS or kilo-nevin syndrome)
- radial nerve (saturday night palsy)
2
Q
Clinical Presentation
A
- localized or referred pain
- numbness, tingling, electric shock, burning feelings
- muscle weakness
- muscle wasting
3
Q
Classification of Peripheral Nerve Injuries
A
Neurapraxia
Axonotmesis
Neurotmesis
4
Q
Neurapraxia
A
physiologic block of nerve conduction without anatomical interruption (more sensory symptoms)
5
Q
Axonotmesis
A
- Anatomic disruption of the axon, connective tissue intact
- treated conservatively hoping for axon regeneration
6
Q
Neurotmesis
A
- anatomic disruption of the axon and connective tissue
- Recovery system of low
7
Q
Clinical Relevance of Findings
A
- Physiologic
- Clinical physiologic: something is off but no reproduction of symptoms
- Neurogenic: people we are treating w neural mobs bc we determined there IS involvement of neural system
8
Q
Level 0 patient
A
NDT contraindicated
9
Q
Level 1 patient
A
- limited, irritable
- pain easily provoked and takes a long time to settle after movement
- latent pain: pain that develops a long time after physical testing
- modification to the standard NDT/treatment (may start more remotely with sequence)
10
Q
Level 2 Patient
A
- Standard
- Not irritable, intermittent, stable
- will use standard NDT
11
Q
Level 3 patient
A
- Advanced
- Pain is difficult to evoke, high expectations in physical function, standard test is normal or does not reveal sufficient information
- Modification to the standard NDT/treatment (may start sequence more faced on problematic area)
12
Q
Goal of treatment
A
reduce the mechanosensitivity of the nervous system and restore its normal capabilities for movement
13
Q
indications for neuromobilization technique
A
- clinical reasoning hypothesis for neurogenic pain
- aggravation of symptoms by a functional position or ADL that resembles a base test (getting in car)
- positive conduction test suggesting neural involvement
14
Q
Contraindications to neuromobilization techniques
A
- increasing neurologic signs or neurologic injury
- severe injury of the interfacing tissue of the nervous system (fracture or soft tissue injury that is unstable)
- red flags found with neurologic examination
- inflammatory, infectious, viral conditions
- tethered spinal cord
- severe pain
15
Q
Indirect Intervention
A
- mobilization of the nervous system by addressing restrictions of the tissues that surround or move the nerve
- joints, muscles, fascia, skin, subcutaneous tissues
- nerve is not there in isolation (joint mobs, stabilizing, etc)
16
Q
Direct Intervention
A
mobilization of the nervous system using neuromobilization techniques
17
Q
Sliding/Flossing Technique
A
- as tension is added to one end of the system, slack is given to the other end
- less aggressive, used with more acute or irritable patients
18
Q
Tension technique
A
- tension is added to both ends of the system at the same time
- more aggressive technique, used with more chronic or less irritable patients
19
Q
Considerations for mobilization of the nervous system
A
- interventions should be performed without or with minimal symptom reproduction
- techniques can be used at various parts of the range
- modifications can be made to the amplitude, range, or speed of the movement
- techniques may be performed actively, passively, or a combination of the two
- progression to functional movements should be incorporated as quickly as appropriate
- if a number of tests are provocative, mobilize the less provocative first
- HEPs focused on self mobilization should be incorporated with pt ed
20
Q
How to set dosage
A
- number of repetitions, sets, and amount of nerve tension should be determined by the health of the nervous system and the response of the patient
- continual reassessment and monitoring of the patient is necessary to provide appropriate intervention
21
Q
Some guidelines for dosage
A
- duration: 5-10 sec hold, 5-10 sec rest
- repetition: 1-10 times based on irritability, multiple sets possible
- frequency: 1-5 times per day based on irritability
- progression can include increasing repetitions, sets, frequency, or amplitude
22
Q
Level 1 Patient Progression
A
- Using other side to unload affected side
- if patient is too irritable for standing sliding or tensioning
- use contralateral limb to assist with off loading tension on the nerve root
23
Q
Level 1 Patient Progression
A
- ipsilateral limb on slack, contralateral limb positioned on tension
- ipsilateral limb on slack, contralateral limb moved into tension
- ipsilateral limb placed into some tension, contralateral limb moved into tension
- contralateral limb positioned on tension, ipsilateral limb moved into tension
- contralateral limb positioned in less tension, ipsilateral limb moved into more tension
24
Q
Key point for contralateral mobilizations
A
when contralateral limb is placed in a position of tension, it causes a reduction in tension on the ipsilateral side (system is continuous)
25
Level 1 patient progression considerations
- need to have assessed contralateral side to ensure that there are no neurologic sxs
- in some instances (large disc protrusions) the contralateral limb may increase pain in ipsilateral limb and contralateral limb mobs would not be indicated
- may produce stretching in contralateral limb but no pins and needles or other neuro symptoms
26
Thoracic Outlet Syndrome
- collection of syndromes brought about by abnormal compression of the neuromuscular bundle by bony, ligamentous, or muscular obstacles between the cervical spine and lower borer of the axilla
27
Common places for TOS compression to occur
between scalenes
between first rib and clavicle
between pec minor and coracoid or ribs
28
Symptoms of TOS
deep aching pain in the neck and shoulder, paresthesia, muscle atrophy, weakness, stiffness, temperature and color changes, swelling, skin changes, fatigue
29
Treatment for TOS
decrease mechanical pressure, increase mobility of tissue, decrease compressive load, strengthen, address postural impairments, control inflammatory response, activity modification
30
Slump Test
1. ask pt to keep feet on the floor, hands behind back, slump
2. ask to bring head down, place hand on back of neck
3. straighten knee
4. DF ankle
31
Straight Leg Raise - Tibial
DF, Evert
Grab ankle, forearm along plantar and forearm everts
to let go, release DF and evert into opposite direction but little motion
32
SLR- Fibular
PF, Invert
| go under and fingers grab toes to curl them down and in
33
SLR- Sural
DF, Invert
| Wrap around medial side and grab around big toe to invert and DF
34
Median Nerve
Elbow at 90, shoulder abduction, scapula stabilization, supination, wrist ext, shoulder ER, elbow ext
**pistol grip
35
Ulnar Nerve
Match hands, wrist ext, pronation, elbow flex, scar depress, shoulder depression, shoulder ER, shoulder abd
