Neurodynamics UE Flashcards
(26 cards)
definition of clinical neurodynamics
the clinical application of mechanics and physiology of the nervous system as hey relate to each other and are integrated with musculoskeletal function
Neurodynamic tests - examination of neural tissue
Mechanical and physiological features
Neurodynamic tests assess peripheral afferent sensitization
hypersensitivity of neural tissue
Neurodynamic tests - continuous tract
mechanically, chemically, electrically, connective tissue
Causes of neurodynamic pathology
Mechanical
Physiological
Mechanical cause
tension
sliding
compression
Physiological cause
intraneural blood flow
inflammation
mechanosensitivity
Mechanical - dural attachments
Cranium
Joint capsule
PLL
Ligamentum flavum
Mechanical - tension points
points where dura is attached or can become adhered C6 T6 1st rib scalene mm radial head pronator teres flexor carpi ulnaris carpal tunnel
Phsiological mechano-sensitivity
The ease with which the neural tissues become active when mechanical force is applied to them
Subejctive complaints
Radiating pain in involved UE
UE paresthesias, numbness, and weakness may be present
Additional subjective fidnings
Chronic symptoms
Co-existing pathology elsewhere
Impaired movement - pain first and then loss of movement
Contraindications
Irritable conditions Pathology of other structures involved Neurological signs Circulatory changes Malignancy Cord signs
Normal response
Muscle activity
Stretchign sensation
Tingling
Positive objective findings
Comparable sign produced
Test response can be altered by movement distant from site of symptoms
Significant diff in ROM, resistance, and sx involved vs. non-involved side
Adverse response to nerve palpation
Impairments of body function - clinical guidleines
Neck and neck related radiating pain reproduced with cervical extension, SB, and rot toward involved side (spurling)
Upper limb neurodynamic testing
Relieved with distraction
May have UE sensory, strength, or reflexive deficits associated with involved nerves
Practical handling skills
Joint ROM must be assess for limitation prior to nerve testing Cervical lateral flexion Shoulder depression, abduction Elbow extension Full spinal flexion
Intervention - guidelines
Upper quarter and nerve mobilization procedures
Traction
Thoracic mobilization/manipulation
Neurodynamic intervetion
Different intervention =
different effects
Tensioning exercises
Sliding exercises
Manual interventions
Mechanical - tensioning techniques
Lengthening the distance the nerve travels
Nerve glide - movement of one or several joints to elongate the nerve bed and the nerve - inc nerve tension and intraneural pressue, reduces intraneural blood flow
Mechanical - sliding technique
sliding relative to other structures - elongate nerve at one joint balanced by reduction in length of nerve bed at an adjacent site
Nerve slides relative to surrounding strucutres
Longitudinal excursion of the nerve
Mechanical - tensioning techniques - abnormal impulse generation
Trigger ectopic discharges
Exacerbates symptoms
mechanical - sliding technique - dynamic variation in intraneural pressure
facilitate evacuation of intraneural edema
Reduce symptoms
Altered nerve physiology
Neural inflammation
Intraneural blood flow
Mechanosensitivity
