Pt 6221 - Intro To Ax Of The Ns

Front 1

Pathobiological Mechanisms

Back 1

1. Pain due to input
2. Pain due to CNS Mechanisms or processing
3. Pain due to output and homeostatic systems

Front 2

Pain due to INPUT

Back 2

1) nociceptive pain
-symptoms due to processes in the tissues that NS supplies
-ischaemia and inflammation = main sources

2) Peripherally evoked neurogenic pain
-symptoms originate in neural tissue OUTSIDE dorsal horn
-neuropathic pain
-Radicular symptoms = peripheral nerve root is irritated

Front 3

Pain due to CNS Mechanisms/Processing

Back 3

-due to abnormal sensitivity or connectivity and discharge of CNS neurones
-neurones may become source of symptoms without peripheral input or amplify peripheral input
-symptoms may not behave with same stimulus-response predictability seen in most nociceptive pains
-ALL symptoms powerfully affected by what patient thinks (cognitive) and feels (affective) about their problem

Front 4

Pain due to output and homeostatic systems

Back 4

-autonomic
-neuroendocrine
-immune
-motor
-descending pain control measure

Front 5

Key points about pathobiological mechanisms

Back 5

1. ALL mechanisms involved in any pain
2. What pain mechanisms are in operation?

Front 6

Physical examination of the Nervous System
-We are looking at:
1. Sensitivity
2. Mechanics
3. Overall Health

Points to consider?

Back 6

1. normal? sensitized? turned down?
2. mobile? immobile?
3. blood supply? axoplasmic flow (axonal transport)?

-should already have reasoned judgement in all categories
-provide ADDITIONAL info that supports or rejects hypotheses already made

Front 7

3 ways to examine the NS

Back 7

1. palpating the NS
2. passive and active neurodynamic tests
3. Manual examination of conduction (reflexes, motor power, sensation)

Front 8

Palpation of the NS
-Uses of palpation

Back 8

1. learning peripheral nerve anatomy
2. part of NS physical examination
3. treatment method
4. used to identify an anomaly
5. explains peripheral neurogenic pain to clients

Front 9

NS as a Continuum
1. Main role of the NS?
2. Position of NS?

Back 9

1. communication via electrochemical means
2. Movement affects position of nerve
-extending wrist and elbow causes tension in median nerve and slackens ulnar nerve
-movement of neck can affect nerves in low back

Front 10

Spinal canal adaptation

Back 10

-spinal canal length is 7-10 cm longer in flexion than in extension
-stretches to adapt to flexion motion

Front 11

"Container/Interface Concept"

Back 11

-Unhealthy surrounding tissue may influence NS
-adjacent tissue = interface/neural container/nerve bed
-variable

Front 12

Peripheral Nerve Innervation

Back 12

-All three CT's are innervated
-primary afferent neurones innervate these tissues ("nervi nervorum")

Front 13

Laws of Neurodynamics
-What is it?

Back 13

-challenges the physical health of the nerves by testing based on the relationship of nerves to the joint axis

Front 14

Laws of neurodynamics
-U/L Neurodynamic test 1 (median nerve example)

Back 14

1. extension of fingers
2. wrist extension and forearm supination
3. elbow extension, shoulder abduction and cervical lateral flexion away from test side

Front 15

Laws of neurodynamics
-pinch and elongation (spine example)

Back 15

-tissues adjacent to nerves form a tunnel
-movement of tissues stretch or compress nerves

-spinal flexion increases spinal canal and IV foramina size
-spinal extension decreases size

Front 16

Laws of Neurodynamics
-continuum and accumulation of load

Back 16

-accumulation of load is non-uniform
-structure along length of nerve is not consistent
-due to varying CT content, attachments and variable relationships to the container

Front 17

Laws of Neurodynamics
-Order of movement (slackened vs. tension)

Back 17

-sequence of movement different for each action
-sequence of joint movement may affect tests

-NS in limb slackened = first component of test will maximally test movement of nerve locally and its relationship with surrounding structure BETTER than if NS in limb were tense.

Front 18

Key Principle of the Laws of Neurodynamics

Back 18

-greatest challenge to a segment of neural tissue will occur when joint adjacent to nerve is loaded first in a sequence of testing

Front 19

Neurodynamic Testing
1. Definition
2. Assesses 2 things
3. Measures?

Back 19

1. Series of body movements that produce mechanical and physiological even in the NS
according the movements of the test

2. mechanical function and sensitivity to mechanical functions

3. limitations and thresholds