Entrapment Neuropathies & Neuropathic Pain

What are the components of clinical reasoning when treating entrapment neuropathies or neuropathic pain?

• Patient’s pain pie

• Possible pathophysiology

• State of irritability

• Pain experience

What does neuropathic pain result from?

• Lesion or disease of somatosensory system

• Failure of 3 core neurophysiological needs of nerve

What do all nerves need?

• Blood

• Space

• Movement

What are some conduction tests?

• Sensory testing

• Stretch reflexes

• Myotome testing

• Electrodiagnostic studies

What is electrodiagnostic testing?

• Measures the electrical activity of your muscles and nerves to pinpoint the cause of symptoms

• NOT GOOD

What could cause there to be a “space” issue for the nerve?

• Container

• Bony prominences

• Muscle or fascia restrictions

• Anatomical anomaly

• Trauma

• Scar tissue/fibrosis

• Intra/Extra neural edema

What are some tests for container/pathway testing?

• AROM or PROM

• Loading/unloading nerves & tissues

What could cause there to be a “movement” issue for the nerve?

• Pressure changes with movement

• Fibrosis

• Intraneural swelling

What do NDTs detect?

Heightened neural mechanosensitivity

What are some results of neurodynamic intervention?

• Immediate, induced short lasting hypoalgesia

• Potential dispersal of intraneural edema

• Inflammatory effects beyond lesion site

• Activation of endogenous opioid analgesic pathways

• Facilitates peripheral nerve regeneration

How should you perform NDT?

Active before passive

What is a positive result for NDT?

• Reproduction of THEIR symptoms

• Tightness, cramping, paresthesia

• Symptoms alleviate with distal movement (slacking)

Where are nerves more & less sensitive to palpation?

• More sensitive around large joints

• Less sensitive in WB areas

What could cause there to be a “blood flow” issues for the nerve?

• Nerve lengthening

• Nerve pressure

At what nerve length does blood flow slow down?

6 - 8%

At what nerve length does blood flow stop?

15%

At what nerve length does cell death & demyelination occur?

20%

At what nerve pressure does blood flow stop?

30 mmHg

What is the key when treating entrapment neuropathies or neuropathic pain?

MOVEMENT