Neurodynamics (Guest Lecture) Flashcards Preview

PTRS 845 Midterm > Neurodynamics (Guest Lecture) > Flashcards

Flashcards in Neurodynamics (Guest Lecture) Deck (53):
1

Describe the purpose of pain

Pain acts as a "smoke alarm"

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

2

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

Stubbing your toe 

3

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

Neurodynamics

4

Descibe how the neurosystem adapts to movement

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

5

Give 2 examples of the adaptability of the nervous system

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

6

5 Points of Greater than Normal Nerve Tension

1. C6

2. T6** (due to increased lig attachment at SC)

3. L4

4. Posterior Knee

5. Anterior Elbow

7

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

Tension point

8

CNS Protective Layers

Dura mater

Arachnoid mater

Pia mater

9

PNS Protective Layers (out to in)

Mesoneurium

Epineurium

Perineurium

Endoneurium

10

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

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

11

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

Axoplasm

12

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

Axoplasm

13

Describe the nervous systems need for blood

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

 

14

Describe the effect of elongation on BF to the nervous system

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

15

7 Nerve Pain Generators

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

16

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

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

17

Term: Movement dependent

Thixotropic

18

Decribe the flow of Axoplasm

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

19

Term: Experience symptoms distal to the nerve injury

Double crush 

ex. hitting your funny bone

20

Term: Experiencing symptoms proximal to the nerve injury

Reverse double crush

ex. CTS producing neck/shld pain 

21

Describe how double crush/reverse double crush is possible

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

22

Describe how connective tissue can generate nerve pain 

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

Describe AIGS

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

Describe how Substance P generates nerve pain

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

Describe the what is happening in regards to nerve recovery at 

1. 3 wks

2. 6 wks

3. 6-16 wks

1. Degenerative changes in myelin

2. Collagen deposition in the endoneurium

3. Decrease in fiber diameter or myelinated fibers

26

2 Ways to feel nerves

1. Palpation

2. Neural tension testing

27

3 Good spots to palpation nerves

1. Tunnels (ex. carpal tunnel and median n.)

2. Branches (ex. radial n. at elbow)

3. Hard surfaces (ex. radial n. on radius)

28

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

Peroneal n.

29

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

Peroneal n.

30

Nerve: Posterior to knee and medial to ankle

Tibial n.

31

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

Tibial n.

32

Nerve: Lateral to Achilles tendon and distal to fibula

Sural n. 

33

Nerve: Recurrent ankle problems and Achilles tendonitis

Sural n. 

34

Nerve: near the inguinal ligament

Femoral n.

35

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

Femoral n.

36

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

Saphenous n.

37

Nerve: Most arthroscopic medial knee pain and MCL injuries

Saphenous n.

38

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

Median n.

39

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

Median n.

40

Nerve: Pisiform area at wrist

Ulnar n. 

41

Nerve: Guyon's canal

Ulnar n. 

42

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

Radial n.

43

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

Radial n.

44

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

Comparable sign 

45

Only REALLY concerning precaution to neural tension testing

Unstable condition - ligament damage, vertebral instability, etc.

 

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

46

4-8 Contraindications to Neural Tension Testing

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

SLR that biases peroneal n.

Add PF and inversion

48

SLR that biases sural n.

Add DF and inversion

49

SLR that biases tibial n.

Add DF and eversion

50

4 ways to increase the overall load of SLR

1. IR the hip 

2. ADD the hip

3. Contralateral T/L SB

4. Cervical flexion

51

Describe what the slump test assesses

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

52

Positive Finding from Neural Tension Testing

1. Comparable sign

2. Asymmetrical ROM 

3. Change in sensaiton in nerve distribution

 

53

Documenting Neural Tension Testing

1. Area/sequence of response

2. Restriction of movement

3. Sx characteristics