Scribd Logo
Upload

Welcome to Scribd!

  • 176 views

    Adverse Neural Tension 2012

    Uploaded by

    ramesh2007-mpt
    The document discusses the anatomy and biomechanics of the nervous system and how adverse neural tension can affect it. It explains that the nervous system is made up of a continuous tract from the brain to the toes. Neural tension tests are described to evaluate tension in specific nerves like the median, ulnar and radial nerves. The document outlines how movement can impact the nervous system both within the nerves themselves and at mechanical interfaces where nerves pass through tissues. Treatment aims to address both extraneural issues involving mechanical interfaces and intraneural issues related to tension and hypoxia.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Adverse Neural Tension 2012

    Uploaded by

    ramesh2007-mpt
    176 views7 pages
    The document discusses the anatomy and biomechanics of the nervous system and how adverse neural tension can affect it. It explains that the nervous system is made up of a continuous tract from the brain to the toes. Neural tension tests are described to evaluate tension in specific nerves like the median, ulnar and radial nerves. The document outlines how movement can impact the nervous system both within the nerves themselves and at mechanical interfaces where nerves pass through tissues. Treatment aims to address both extraneural issues involving mechanical interfaces and intraneural issues related to tension and hypoxia.

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses the anatomy and biomechanics of the nervous system and how adverse neural tension can affect it. It explains that the nervous system is made up of a continuous tract from the brain to the toes. Neural tension tests are described to evaluate tension in specific nerves like the median, ulnar and radial nerves. The document outlines how movement can impact the nervous system both within the nerves themselves and at mechanical interfaces where nerves pass through tissues. Treatment aims to address both extraneural issues involving mechanical interfaces and intraneural issues related to tension and hypoxia.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    176 views7 pages

    Adverse Neural Tension 2012

    Uploaded by

    ramesh2007-mpt
    The document discusses the anatomy and biomechanics of the nervous system and how adverse neural tension can affect it. It explains that the nervous system is made up of a continuous tract from the brain to the toes. Neural tension tests are described to evaluate tension in specific nerves like the median, ulnar and radial nerves. The document outlines how movement can impact the nervous system both within the nerves themselves and at mechanical interfaces where nerves pass through tissues. Treatment aims to address both extraneural issues involving mechanical interfaces and intraneural issues related to tension and hypoxia.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 7

    8/3/2012

    Things to consider

    The Forgotten Soft Tissue The Nerves ADVERSE NEURAL TENSION

    Anatomy, biomechanics and pathology related to neural inury Adverse Mechanical Tension Upper Limb Tension Tests (ULTT)
    Evaluation

    Treatment

    Lower Limb Tension Tests

    Adverse Mechanical Tension


    Abnormal physiological and mechanical responses produced from nervous system structures when their normal range of

    Nervous System
    Continuous tissue tract from brain to toes
    Central nervous system Peripheral nervous system

    movement and stretch capabilities are tested.


    Butler DS. Mobilization of the nervous system, 1991

    Connecting the body for communication of

    information
    Break in transmission breakdown of communication

    The Human Nervous system

    Nervous System
    Continuous tissue tract
    Major function is conducting impulses
    Neurons are interconnected electrically Continuous electrical tract

    8/3/2012

    Nervous System
    Continuous tissue tract Impulse conducting role Capable of responding to a wide range of bodily

    Nervous System
    Continuous tissue tract Impulse conducting role Capable of responding to a wide range of bodily movements Limit of range of movement
    Slump test

    movements
    Impulse conduction
    Stretched / shortened Mobile / immobile

    Elbow
    Ulnar nerve Median nerve

    The Slump Test Lower Limb Neural Tension

    Anatomy of Nervous System


    Dura, arachnoid, pia mater Meningeal attachments in spinal canal Epineurium, perineurium, endoneurium

    The Nervous System

    Movement Responses
    Nervous system responses to lengthening:
    Increased intra-neural or intra-dural pressure Movement

    8/3/2012

    Movement
    Gross movement in relation to mechanical interfaces
    Median nerve sliding through the carpal tunnel Dura mater sliding in relation to a vertebral

    Upper Limb Movement


    In vivo needle insertion of median nerve at mid-arm (n=15) Wrist and finger extension pulled nerve down 7.4mm Elbow flexion pulled nerve up 4.3mm

    segment

    Intraneural in relation to connective tissue


    Axons unfold and move Interfascicular sliding in peripheral nerves

    Active and passive movement equal effect


    McLellan and Swash, J Neurol Neurosurg Psych,

    1976; 39

    Areas of Vulnerability
    Mechanical interface Tension points

    Mechanical Interface
    The most anatomically adjacent tissue to the nervous system that can move independently to the system
    Butler D. Aust J Physiotherapy, 1989; 35

    Mechanical Interface
    Osseous
    Fibro-osseous Solely soft tissue

    Mechanical Interface
    Extraneural or extradural examples
    Supinator muscle and the posterior interosseous

    nerve passing through it


    Ligamentum flavum and posterior aspect spinal

    dura
    Fibro-osseous tunnels

    8/3/2012

    Mechanical Interface
    Pathological interface examples
    Osteophytes

    Tension Points
    Points along the nervous system which have minimal or no movement in relation to interfacing structures

    Osseous or fibro-osseous tunnel


    Edema and hemorrhage

    Extraneural scarring of the sciatic nerve following hamstring injury


    Tight cast or wrap
    Pneumatic thigh cuff

    Tension Points
    No movement of the spinal cord and meninges to spinal canal at C6, T6 and L4 Median nerve at the elbow Results of
    Connective tissue interface Blood supply interface

    Peripheral Nerve Injuries


    Friction Compression Stretch Inflammation
    Secondary injury

    Basis of Symptoms
    Nervous system pathology
    Mechanical factors Vascular factors

    Mechanical Factors
    Nerve fiber disruption
    Intraneural and extraneural blood vessel rupture

    8/3/2012

    Vascular Factors
    Persistent pressure results in:
    Hypoxia Edema Fibrosis

    Nervous System Movement Disorders


    Classify by signs and symptoms
    Extraneural Intraneural

    Intraneural
    Alters ability of nerve to stretch

    Extraneural
    Alters ability of nerve to glide in its bed

    Extraneural Pathology
    Involves
    Mechanical interface Gross movement component

    Intraneural Pathology
    Involves
    Hypoxic nerve fibers Tension component

    Symptoms
    Catch or twinges of pain Short duration of symptoms Lines of pain Mid or through range Symptoms provoked by tension test
    Eased by tension at other end

    Symptoms
    Persistent Increased duration of symptoms Blocks of pain End range pain and resistance with tension tests
    Tension applied from both ends

    Neurological changes

    Treatment Approach
    Maitland grading system
    Grade II Large amplitude within midrange Grade III Large amplitude up to point of

    Treatment by Classification
    Extraneural
    Through range

    (Grade II, III, passive physiological)


    Attention to mechanical interface

    limitation Grade IV Small amplitude movement at the very end of movement

    (joint, muscle, fascia)

    8/3/2012

    Treatment by Classification
    Intraneural
    End range tension

    Key to Successful Treatment


    Mobilize the nervous system Implies movement and/or tensioning Prevention is the key
    Do not wait until symptoms develop

    (Grade III, IV, passive physiological)

    Evaluative Process
    Hx and physical Reflex, strength, sensory testing Nerve conduction studies Neural tension tests Nerve palpation

    Neural Tensioning
    Clinical observations
    Range of combined movements Resistance at the end range

    Symptom response

    Trying to reproduce the patients symptoms complaint and location

    Upper limb tension testing


    ULTT1 median nerve bias
    ULTT2a median nerve bias ULTT2b radial nerve bias ULTT3 ulnar nerve bias

    ULTT 1 Median Nerve Bias


    Scapular depression (hold scapula with one hand while

    performing motion of the arm with the other hand) Shoulder abduction (110) Elbow extension Forearm supination Wrist and finger extension

    Sensitizer: cervical side flexion to the contra-lateral side

    8/3/2012

    ULTT 2a Median Nerve Bias


    ULTT 2b Radial Nerve Bias


    Shoulder depression Shoulder abduction (10) Forearm supination Wrist extension Finger and thumb extension Shoulder lateral rotation

    Shoulder depression Shoulder abduction (10) Elbow extension Forearm pronation Wrist flexion and ulnar deviation Fingers and thumb flexion Shoulder medial rotation

    Sensitizer: cervical side flexion to the contra-

    lateral side

    Sensitizer: cervical side flexion to the contra-

    lateral side

    ULTT 3 Ulnar Nerve Bias


    Shoulder depression Shoulder abduction (10 to 90 - hand to ear) Elbow flexion Forearm supination Wrist and finger extension and radial deviation Shoulder lateral rotation Sensitizer: cervical side flexion to the contra-

    lateral side

    You might also like