9

Ques@ons?

BartonAnderson,DHSc,AT

banderson@atsu.edu@azatprof

AnEvidence-BasedApproachtotheAssessmentandTreatmentofAdverseNeuralTension:Lab

BartonAnderson,DHSc,AT,ATCA.T.S@llUniversity

NeuralTensionAssessment•  Tensiontestscandifferen@atebetweenmuscle@ghtnessandneuraltension– Bothwillrestrictmobility– Bothcanbetreated

NeuralTensionAssessment•  Abnormalresponsesinclude– Replica@onofclinicalsymptoms

•  Pain•  Neurologicalsymptoms

– Limita@onsorasymmetryofmo@on

UpperLimbNeuralTensionTests(ULNTT)•  ULNTT1– MedianNerveDominant

•  ULNTT2– RadialNerveDominant

•  ULNTT3– UlnarNerveDominant

Tes@ngProcedures•  Eachtesthasaspecificprogressionofmovementsandjointposi@ons– Vitalthatwitheachnewmovement,theposi@onsofpreviousmovementsaremaintained•  Allowsforprogressiveaddi@onoftensionwithintheneuralsystem

•  Failuretomaintainposi@onswillresultinslackandpoten@alfalsenega@ves

10

ULNTT1•  MedianNerveDominant•  MovementSequence– Pa@entposi@onedsupineatedgeoftable– Cliniciandepressesandstabilizesscapula/glenohumeraljoint.

– ShoulderABDto90-110degrees•  Elbowflexedto90,shoulderinneutralrota@on

ULNTT1•  MovementSequence

–  ExternalRota@on–  Forearmsupina@on– Wrist/FingerExtension–  ElbowExtension

•  Mustmaintainscapulardepressionthroughout!

ULNTT1•  Differen@a@ngMovements– Lateralcervicalflexiontooppositeside– Monitorpa@entresponse

•  Normal?•  Abnormal?•  Ifabnormal,whereinthesequencedidtheresponseoccur?

ULNTT1•  Abnormalresults–  Earlyinsequence

•  Suggestseitherhyperirritablenerveorrelatedmoretoslidingwithinoneareaoftheneuraltract

–  Laterinsequence•  Suggestsrela@ontotensiondissipa@on

–  Treatwithslidersortensionersorboth

ULNTT2•  RadialNerveDominant•  MovementSequence–  Pa@entposi@onedsupinewitharmatedgeoftable–  Clinicianiseitherseatednexttopa@ent,orstandingfacingpa@ent’sfeet

– Armisin10degreesofabduc@on,slightshoulderextension,elbow90degreesflexion

11

ULNTT2•  MovementSequence

–  Shoulderdepression•  Ifseated,appliedasatrac@onforceorusingapartnertoassist

–  Shoulderinternalrota@on–  Forearmprona@on–  Wrist/thumb-indexflexion

–  Elbowextension

ULNTT2•  Differen@a@ngMovements– Lateralcervicalflexiontooppositeside– Monitorpa@entresponse

•  Normal?•  Abnormal?•  Ifabnormal,whereinthesequencedidtheresponseoccur?

ULNTT3•  UlnarNerveDominant•  MovementSequence– Pa@entposi@onedsupineatedgeoftable– Cliniciandepressesandstabilizesscapula/glenohumeraljoint.

– ShoulderABDto90-110degrees•  Elbowflexedslightly,shoulderinneutralrota@on

ULNTT3•  MovementSequence

–  ShoulderABDto90-110degrees•  Withelbowat0-45degreesextension

–  ShoulderExternalRota@on–  Forearmprona@onorsupina@on

–  Wrist/FingerExtension–  ElbowFlexion

ULNTT3•  Differen@a@ngMovements– Lateralcervicalflexiontooppositeside– Monitorpa@entresponse

•  Normal?•  Abnormal?•  Ifabnormal,whereinthesequencedidtheresponseoccur?

12

NeuralTensionAssessment•  StraightLegRaise– Dorsiflexion–@bialtractofscia@cnerve– Eversion–posterior@bialnerve– DF/Inversion–suralnerve– Plantarflexion/INV–commonperoneal– HipADD–scia@cnerve– HipIR–scia@cnerve,commonperoneal

NeuralMobiliza@on•  Basedontensiontestfindings–  PrimarycomponentisSLR

–  Differen@a@ngmovementsareusedforeitherslidersortensioners

LENeuralMobiliza@on•  TibialtractofScia@cnerve–  SLRwithneutralhip–  Dorsiflexionfordifferen@a@on

LENeuralMobiliza@on•  PosteriorTibialnerve– SLRwithneutralhip– Eversionfordifferen@a@on

LENeuralMobiliza@on•  Suralnerve

–  SLRwithneutralhip–  DFwithINVfordifferen@a@on

•  CommonPeroneal–  SLRwithneutralhip–  PFwithINVfordifferen@a@on

LENeuralMobiliza@on•  Scia@cnerve

–  SLRwithneutralankle–  HipADDfordifferen@a@on

•  Scia@cnerve,CommonPeroneal–  SLRwithneutralankle–  HIPIRfordifferen@a@on

13

LENeuralMobiliza@on•  FemoralNerve– Performedeitherproneorsidelying– Kneeflexionandankleplantarflexion– Hipextensiontodifferen@ate

NeuralTensionAssessment•  StraightLegRaise– Dorsiflexion–@bialtractofscia@cnerve– Eversion–posterior@bialnerve– DF/Inversion–suralnerve– Plantarflexion/INV–commonperoneal– HipADD–scia@cnerve– HipIR–scia@cnerve,commonperoneal