PHTY206 Lecture Notes - Lecture 3: Spasm, Radial Nerve, Supinator Muscle
Neurodynamics and neurological assessment
• Physical examination of the NS
o Observation – Antalgic postures, muscle wasting
o Neurological examination LMNL – reflexes, myotomes, dermatomes
o UMNL-Babinski and clonus
o **Tests nerve conduction**
o Nerve palpation
o Neurodyai testig: aout of eural tissue oeet ad its respose to
movement.
o **Tests nerve movement**
• List the aims and indications for the lower limb Neurological Examination
o Lower limb neurological assessment
o Tests for impairment of lower and upper motor neuron function:
o Lower motor neuron - peripheral nerves and spinal nerve roots
o Upper motor neuron - CNS e.g. brain and spinal cord
o **Tests nerve conduction**
o Aims
• Confirm/clarify findings in history thought to be related to neurological
symptoms
• Establish baseline/assess progress
• Clarify whether peripheral signs and symptoms are due to local problem or
indicative of spinal nerve root involvement
• Differentiate CNS lesions from PNS lesions
• Identify contraindications and precautions to treatment
o Indications
• Lower Motor Neuron (Spinal nerve/Nerve root)
▪ Spinal pain extending beyond hip/buttock
▪ Pins and needles and/or numbness in leg
▪ Weakness/clumsiness in leg
• Upper Motor Neuron (CNS)
▪ Bilateral symptoms in a diffuse non-dermatomal distribution
▪ Disturbances of gait, balance, co-ordination
▪ Disturbances of bladder/ bowel
▪ Saddle anaesthesia
• "do you have any problems going to the toilet?"
• "do you have any pins and needles?"
• Describe the difference between upper motor neurone and lower motor neurone lesions
• Describe the components of a neurological examination (reflexes, strength, sensation)
o Myotome testing (muscle power)
o Lower limb reflexes
o Dermatome testing (sensation)
o Tests for Cord/CNS
• Babinski
• Clonus
o Recording the neuro examination
• Strength: record using 0-5 sale or oet o eak, ery eak et.
• Reflexes: record as 0 - 4+
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• Light Touch
▪ Record as normal, decreased e.g. %, increased, absent or in some cases
allodynic (light touch = painful) or dysesthesia (abnormally increased
response to a painful sensation)
• Sharp/Blunt discrimination:
▪ Ability to discriminate between light and deep pressure
▪ Record as normal or altered and mark on body chart
▪ Alteratiely, a use √√ if oral
• Babinski and Clonus: record as negative or positive
• Define neurodynamics
o A neurodynamic test aims to test the mechanics and physiology of a part of the
nervous system, to see how sensitive to movement it is.
o Being provocative tests, they are often also called Neural Tissue Provocation Tests
(NTPTs)
o There are two parts to neurodynamic assessment:
• Nerve Palpation
• Neurodynamic Base Tests (or NTPTs)
o **Tests nerve movement**
o Mechanical function of the NS
• Move and withstand forces that are generated by daily movements.
• Nerve must:
▪ Slide in its container
▪ Be compressible
▪ Withstand tension
o Physiological function of the NS
• Although the primary physiological function of the NS is impulse conduction, it
must be able to do this in any posture or during any activity.
• The NS has to be able to move, shorten, lengthen as required.
• Adapts to movement by intraneural movement, movement of the nerve in
relation to the interface and by development of tension.
o NS anatomy
• Mechanical interface (nerve bed)
▪ Consists of anything next to the NS – tendon, muscle, bone,
intervertebral discs, ligaments, fascia, blood vessels, lymph system.
▪ Lower limb examples: Inguinal ligament and femoral nerve, piriformis
and sciatic nerve
• Innervated tissue:
▪ Any tissue innervated by the NS
▪ Provides the therapist with a way of moving the nerves.
o Pain from the NS
• Repetitive mechanical forces:
▪ Compression
▪ Tensile
▪ Friction
▪ Vibration
• Can result in
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▪ Ischemia (i.e. Compression) - reduced blood flow
▪ Inflammation (i.e. Inflammatory mediators/ inflammatory substances
from adjacent tissues)
• These can cause irritation of neural tissue
• Mechanosensitivity – pain provoked by mechanical stimuli (i.e. Movement,
postures, palpation)
• List the aims and indications for a lower limb Neurodynamic Examination
o Aims
• Challenge the physical capabilities of the NS
• Use multi-joint movements of the limbs and/or trunk to alter the length and
dimensions of the nerve bed (interface) surrounding the neural structures of
interest
• Allows for assessment of the sliding and elongating abilities of the neural
structure plus the ability of the nervous system to cater to changes in the
interfacing structures.
• Designed to detect abnormal mechanical (mechanosensitivity) and
physiological responses produced from neural system structures being
selectively stressed
o Indications
• Area of symptoms
▪ Neuro-anatomically logical
▪ Pain may be in lines or clumps
▪ At vulnerable sites
• Quality of pain
▪ Burning, lancinating, shooting, cramping
▪ Superficial or deep depending on nerve/area involved
▪ Other symptoms may be present:
• Sensory loss: paraesthesia (pins and needles), anaesthesia
(numbness)
• Dysaesthesia (unpleasant sensations e.g. ants crawling)
• Hyperalgesia vs. allodynia
• Behaviour
▪ Conventional (mechanical) or unconventional
▪ Prooked or spotaeous id of its o
▪ Latency (e.g. whiplash)
• Mechanism/past history
▪ Understand the causative event (sometimes straightforward, other
times not)
▪ History – MSK injury or event related to onset of symptoms (traumatic
or insidious).
▪ Differentiate from non-MSK (i.e. Red flags, diabetes, tumour, post
herpetic infections)
• Physical examination findings
▪ Antalgic postures (tension relieving positions – protective to reduce
mechanical load on sensitised nerve tissue by shortening anatomical
distance nerve trunk travels)
• e.g. standing with hip/knee flexed
▪ Active and passive movements, i.e. symptoms with movements that:
• Move and/or
• Elongate and/or
• Compress the NS in that body part
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