PNS tx Flashcards
demyelination/compression injuries
neurapraxia
degeneration injuries
axonotmesis, neurotmesis
paresthesia, dysesthesia, anasthesia
..
autonomic nerve dysfunction
anhidrosis
exercise intolerance
etc.
With neurapraxia GOAL of tx is to ____
alleviate compression
informed consent for working on area with nerve compression (neurapraxia)
communicate to pt, get consent — inform that working on area might reproduce SSx
when treating and pressing on an area w/ compression (E.g. pronator teres w/ median nerve)
—> If SSx are reproduced ….
when pt says they feel familiar symptoms, then remove pressure on area and wait to see if symptoms are relieved
If however pressure is removed and symptoms PERSIST, then STOP working on area.
If symptoms are relieved within a few seconds, then can still work on that area, perhaps more conservatively, and with patient renewed consent
HEAD OF FIB
watch out for COMMON FIB nerve here —> sensitive —-> EVEN WITHOUT INJURY
attachments on head of fib
soleus, biceps fem, fibularis longus
ATROPHIED MM — what not to do
ALREADY LOW TONE
avoid tehcniques that intend to lower tone even further —> esp deep techniques
DEGENERATION INJURY — touch affected nerve?
NO
some notes about demyelination
Demyelination:
Symptoms present distal to site of compression
Compression in one area makes compression elsewhere along the same nerve more likely
Following compression, the entire nerve can become a source of pain (as opposed to paresthesia)
unopposed antagonist tone leads to ____
contracture
some notes about degeneration
Degeneration:
Symptoms present distal to site of lesion
Unopposed antagonist tone and contracture formation
Sensory function generally returns before motor function
WHICH FUNCTION OF NERVE RETURNS FIRST GENERALLY?
SENSORY FIRST
Before motor function
WHAT is a better way to think about symptoms and reducing “
FREQUENCY vs INTENSITY
Compression in one area makes compression elsewhere along the same nerve more likely
think ulnar nerve dull zingy ache @ elbow (medial head Triceps)
and then followed by dull ache @ wrist (distal ulna)
GRADE 2 MMT
remove gravity –> E.g. side lying
or AAROM (active assisted)
peripheral neve injury acute phase
Acute Phase
Early after injury or surgery - emphasis on healing & preventing complications
May be immobilized - time dictated by MD
Splinting or bracing may be needed to prevent deformities
Recovery Phase
Recovery Phase
When reinnervation occurs - emphasis on retraining & re-education
Motor retraining - eg. being able to hold muscle in shortened position
Desensitization - eg. stroking the skin with different textures for sensory stimulation
Discriminative sensory re-education - identification of objects with, then without, visual cues (stereognosis)
Chronic Phase
When the potential for recovery has peaked and there are significant physical deficits - emphasis on Training compensatory function
May continue to wear splint or brace
CHRONIC PHASE
THE FUNCTION THAT ONE HAS IN CHRONIC PHASE IS GENERALLY WHAT THEY WILL KEEP MOVING FORWARD
PRECAUTION/CI FOR DEGENERATION INJURY / REGENERATING LESION (AXONOTMESIS/NEUROTMESIS)
Do not traction a regenerating nerve
Use segmental techniques proximal to the lesion
Consider “blocking” with the ulnar border of the hand just proximal to the lesion to prevent placing drag on the healing tissue
Do not work on lesion site until regeneration has passed that site – approx. 2 weeks post trauma or 3 weeks post surgery
Flaccid/low tone/unhealthy tissue
PROM can be used to affected joints in the direction that shortens the affected tissue & nerve
NTOE ABOUT ASSESSING REGENERATING NN
NOTE: Acute injuries and tissue that is still regenerating must be handled with extreme caution.
Contact the patient’s MD or Neurologist to confirm if movement assessment & treatment is safe.
