UE Ortho Adverse Neural Tension

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compression of the nerve can cause inflammation and scarring. These scarring can be located _______ or _______ where each would affect__________

Intraneural which would compromised inherent elongation

Extraneural: nerve excursion within nerve bed limited

Adverse neural tension is communal associated with _____

peripheral neurogenic pain.

Effect of nerve movement

enhances nerve health b/c they were made to move.

how can we assess Adverse neural tension?

Active and passive motion dysfunction
peripheral nerve hyperalgesia (palpating nerve directly or indirectly)
local tender points
local dysfunction via c/s mobilization

What to observe during a neural examination?

look for guarding, pain, antalgic postures

Expected responses of ANT assessment (Butler)

Physiologic response:
tissues respond to movement, normal response

Neurogenic response:
patient complaint reproduced locally or remotely

Clinical Physiologic response:
pain but not the pain

Expected responses of ANT assessment (Elvey)

reproduction of sx
response altered by distal components
different response when comparing L to R

Normal response for ULNT: Median nerve

may feel pain in the anterior shoulder
deep stretch/ache in cubital fossa which may extend down anterolateral forearm/hand
tingling in median nerve digits
lateral neck flexion away increase sx, while toward decrease sx.

Tension vs glide and when to use both

tension max length of nerve/vascular supply. used in patients with non-irritable conditions or low irritability

glide allows tension in one component and release another, us in patients with irritable conditions

Glide with Intraneural/extraneural

Intraneural: increase mobility away from site with intramural fibrosis

extraneural: treat interfacing tissue in conjunctionw ith glide or slide b/c immobilized

Treatment and progression of ANT

monitor sx; watch for delayed responses
gradual increase in reps/duration
add components to increase tension
reassessment
no clear guidelines

Precautions

irritable conditions
spinal cord signs (bilat sx, LE weakness)
nerve root signs
severe unremitting night pain - lacking a dx
recent paraesthesias
CRPS type I/II
Mechanical spine pain with peripheralization
Pregnancy

Contraindications

recently repaired peripheral nerve
malignancy (local)
active inflammatory condition
neurological: acute inflammatory disease - Guillain barre and lye vs. demyelinating disease

What does nerve gliding not do

relieve external compression
alter nerve CT viscoelastic properties

What does nerve gliding do

restore normal physiologic environment
potential to increase excursion
potential to decrease mini compartment syndrome
maintain post op excursion
relieve sx

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