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
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
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