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Flashcards in Neurodynamics Deck (34):
1

Fun Facts

Spinal cord length is 7-10cm longer in flexion than extension

the median nerve must adapt to be 20% longer w/ wrist & elbow flex/ext

2

Common Tension Points

C6, T6, L4, Posterior knee & Anterior elbow

T6 is MOST COMMON

3

Axoplasm

axoplasm = nerve cytoplasm

"transport system" w/n the nerve that carrys cell components to and from cell bodies and terminal ends

Axoplasm is thixotropic - meaning it is movement and circulation dependent so if you are immobilized your axoplasm is not moving either

4

Nerves & Blood

Demands 25% of cardiac output

NS accounts for 7% of body weight

The peripheral nerve can be elongated 8%, after this point the blood circulation is cut off and there can be possible damage to the nerve

5

Pain Generators (7)

blood flow (ischemia), axoplasmic flow (immobilization/ischemia), double crush, connective tissue, Abnormal impuse generating sites(AIGS), Substance P and surrounding tissue injury

Inflammation and ischemia are main causes of neural symptoms

6

Blood Flow - ischemic nerve injury

minor compression (30mmHg) can cause ischemia

edematous stage will occur if venous flow restriction is held long enough

Resulting in a swollen and painful nerve

7

Immobilization - effects on axoplasm & nerve

axoplasm moves up to 100-400mm/day

if there is no motion or ischemia the flow will slow or even stop

Immobilization:
3 weeks --> degenerative changes in myelin
6 weeks --> collagen deposition in th eendoneurium
6-16 weeks --> decrease fiber diameter of myelinated fibers

8

Double Crush

when injury to one area of the nerve can lead to pathology in other sites of the nerve

Double crush = symptoms DISTAL to the site of injury
(hit your funny bone and you feel it in your hand)

Reverse double crush = symptoms PROXIMAL to the site of injury

9

Connective tissue

connective tissue is highly innervated w/ free nerve endings and Pacinian corpuscles (pressure sensors)

surrounded by unmyelinated fibers containing pain neuropeptides

Connective tissue is 50% of diameter of nerve, so major source of pain generator

10

Abnormal Impulse Generating Sites (AIGS)

vascular injury to the axon can cause ion channels to get stuck in the axolemma and begin to fire

when the axoplasm stops moving due to ischemia, the ion channels will remain open creating a persistent issue

the pain is DIRECTLY coming from nerve signals, no underlying tissue injury

SYMPTOMS: n/t, temperature or pressure changes

TREATMENT: movement!

11

Substance P
- normal vs. abnormal pain process

NORMAL - stimulus followed by descending inhibition
- Glial cells quiet, normal amt of substance P released

ABNORMAL - no inhibition from descending pathways
- glial cells activated releasing inflammatory chemicals which increases substance P

--> this response is common in fibromyalgia patients

12

Surrounding tissue injury

can cause nerve injury due to swelling in the area of the injury

May require immobilization

13

Two ways to test neural tension:

1. Palpation
2. Neural Tension testing
- placing the nerve on tension w/ different movement techniques

Positive findings = comparable sign, asymmetrical ROM, change of sensation in the distribution of the nerve being tested

14

Sliders vs. Tensioners

Sliders = flossing the nerve through the surrounding tissue w/o tensing the entire length of the nerve
- acute injury or very irritable symptoms
- i.e. elbow flexion --> extension

Tensioners = tensioning of the entire length of the nerve
- chronic injury or low irritability
- i.e. SLR w/ IR and adduction

15

Principles of Neural Tension Treatment (3)

1. LOW INTENSITY
- allows for fluid movement
- in PAIN FREE range, stop before any symptoms

2. LOW DURATION
- 1 second duration to allow for blood flow

3. HIGH REPETITIONS
- 25-50 repetitions, 3-5x/day
- start lower and work up tolerance

16

Straight Leg Raise (SLR)

Perform test passively, watch for posterior pelvic tilt or stop when symptoms arise

Positive test = comparable symptoms, asymmetrical ROM, change in tissue tension when compared to unaffected side

0-30deg --> sciatic nerve
- due to large disc herniation and nerve tension
- educate about CE syndrome

30-70deg --> lumbosacral nerve roots (L4 - S2)
- to check if neural, slack, then DF the ankle

Anything beyond this would be hamstring or soft tissue

17

Neural testing candidates

nerve root compression
nerve root tension
disc herniation
radiating symptoms
instability --> leading to compression

18

Added Components to SLR

Dorsiflexion = tibial nerve

Dorsiflexion + inversion = sural nerve

Plantarflexion + infersion = peroneals

Hip adduction = lumbosacral plexus

IR = lumbosacral plexus

19

Difference between Slump test and SLR

- Slump is more aggressive (perform last)
- can also pick up anything in the thoracic spine (disc herniations/nerve root compression)
- puts more tension on the dura mater

20

Method of the Slump Test

1. Patient slumps, apply OP to bow the spine
2. Ask patient to take chin to chest, apply OP to CS
3. Extend knee
4. Dorsiflex

Positive test - symptoms must change w/ neck and foot motion
- if only changes w/ foot motion then most likely a lower nerve issue (local) and would not be a positive slump test

21

Prone Knee Bend (PKB)

indication: upper lumbar radiculopathy, anterior thigh/hip/knee pain

puts tension on femoral nerve and L2-L4 nerve roots

Is it tightness in the quads or tension on femoral nerve
- must compare to the other side
- reproduction of symptoms w/n 80-100 degrees of motion (that would be a really tight quad)

22

PKB/Slump

slump test for the femoral nerve (in side-lying)

1. patient lies on side in trunk & neck flexion
2. patient draws lower leg in and pull knee to chest
3. examiner places top foot on their hip and flexes knee (plus hip extension)

must confirm findings w/ head and neck flexion and extension and knee flexion and extension

good test for differentiating nervous system involvement from non-nervous system structures

23

Slump test in Long-sitting

for people who are extremely flexible or if low disc issue to really wind up the lower NS first
- tension in nerves in LE and lower trunk is taken up first

allows for better assessment of thoracic and cervical movements in sitting

1. patient is long sitting
2. trunk flexion + OP and neck flexion + OP

Confirm findings w/ neck flex/ext

May add foot DF as well

24

Median Nerve Testing

Shoulder abduction +
Elbow extension +
Shoulder ER & supination +
Wrist & finger extension

25

Radial nerve testing

Shoulder abduction +
Elbow extension +
Shoulder IR & pronation +
Wrist & finger flexion

26

Ulnar Nerve testing

Abduction +
Shoulder ER +
Elbow flexion +
Pronation +
Wrist extension

27

Common entrapment of peroneal nerve

low LS
piriformis
superior tib/fib
lower limb compartments
ankle extensor retinaculum

28

Common entrapment of tibial nerve

piriformis
recurrent HS injury
plantar fasciitis
heel spurs

29

Common entrapment of Sural nerve

recurrent ankle problems,
Achilles tendinopathy

30

Common entrapment of Femoral nerve

L2-L3 NR syndrome
pinch/hyperextension @ inguinal ligament
hip flexor strain

31

Common entrapment of Saphenous nerve

swollen fat pad
MCL
---> responsible for almost all arthroscopic medial knee pain

32

Common entrapment of Median nerve

C5-C6 NR
Carpal tunnel
post-colles fx

33

Common entrapment of Radial nerve

upper arm, against humerus (post humerus fx)
lateral epicondyle
supinator muscle
DeQuervain's tenosynovitis

34

Common entrapment of Ulnar nerve

Cubital tunnel
Guyon's canal