Neural Dynamics The following patient cases all have neurodynamic issues.

In each case briefly : A) State which nerve(s) is (are) most likely involved B) How could you implicate this(these) nerve(s)? C) Which other structures do you have to rule out? D) Which structural interfaces do you have to be concerned with? E) How would you go about treating this condition? 1) Dave is a 33 year old plumber. He has been working on a very large remodeling job in an old house with very rusty pipes. He has developed pain in the ventral aspect of his right (dominate) forearm which gets worse when he is using a wrench and when he is driving. He denies night pain. He reports he tried wearing a wrist split that his friend had used but it did not help. He notes that he has a decrease in sensation in his palm. A) Median and Ulnar B) location of pain and sensation, ULTT (median vs ulnar), Tinels, Palpation of interface sites, myotomes (FDP 1&2 vs 3&4) C) biceps tendon, UCL, RCL, muscle strain of flexor/extensor mass, fractures, joint restriction of RU, UH, and RH joints. D) bicipital aponeurosis, pronator teres, proximal heads of FDS, FCU, cubital tunnel, ligament Struthers, Guyons canal, carpal tunnel, pec minor, 1st rib and clavicle, scalenes, cervical IVF C5T1 E) STM to interface sites that are involved, neural glides, postural re-education with stretching and strengthening to associated muscle imbalances, movement re-education for involved movements, night splint at elbow if night pain is present, c/s and t/s mobilizations for associated impairments 2) Marilyn is a 56 year old administrative assistant who fell 10 weeks ago and fractured her proximal humerus. She underwent an ORIF and was immobilized for 6 weeks. She has been receiving PT which is currently focusing on regaining ROM. She is now complaining of pain down her arm and into the dorsal aspect of her forearm. She notes her pain is worse when she reaches behind her back to tuck in her blouse. A) Radial and Ulnar N B) location of pain, ULTT (radial vs ulnar), Tinels, Palpation of interface sites as described below, myotomes, location/presence of numbness and tingling C) biceps tendon, UCL, RCL, muscle strain of flexor/extensor mass, fractures, joint restriction of RU, UH, and RH joints, wrist joints, structural interfaces as below D) c/s IVF C5-T1, posterior triangle (TM, long and lat head of triceps), lateral intermuscular septum, brachioradialis, supinator E) STM to interface sites that are involved, neural glides, postural re-education with stretching and strengthening to associated muscle imbalances, movement re-education for involved movements, night splint at elbow if night pain is present, c/s and t/s mobilizations for associated impairments 3) Wilbur is a 52 year computer consultant. He was a passenger in a van which was involved in an accident. He struck his left knee on the dashboard. He initially complained of left medial knee pain. In addition to his knee pain, he is now noticing pain traveling down the medial aspect of his leg to his medial malleolus. He has a fairly large hematoma in the pes region of his knee. He is a soccer ref on

weekends and has not been able to ref games due to his complaints. He attempted reffing and noted his pain was worse when turned to the right while his left leg was planted. A) Proximal tibial N B) SLR (DF and eversion sensitized), Slump test, palpation, Tinels, Bowstring, myotoms, location of sensation, patellar mobilitation, tib-fem mobility C) PFJ, malleolar fracture, PCL tear, pes anersinus tendonitis, meniscal tear, MCL sprain, medial retinaculum, infrapatellar fat pad, tibial plateau fracture, tib anterior (shin splints), posterior tib D) biceps femoris, popliteal fossa, between gastroc and soleus, tarsal tunnel, piriformis, multifidi E) STM to interface sites that are involved, neural glides, postural re-education with stretching and strengthening to associated muscle imbalances, movement re-education for involved movements and dysfunctional patterns (like excessive hip internal rotation), l/s and t/s mobilizations for associated impairments 4) Deanna is a 28 year old female who suffered a grade I inversion ankle sprain 4 weeks ago while playing with her dog in her front yard. She initially had significant swelling and pain. She is very active and likes to run and swim. She has refrained from running but her MD told her she could resume swimming. The swelling has subsided but she is still getting pain. She has increased pain if she wears shoes that are tight across the top of her foot or if she kicks while swimming A) Superficial peroneal nerve B) location of pain, presence of numbness/tingling, Tinels, palpation, SLR (with PF and inversion sensitization), slump test, sensation testing C) ATFL sprain, medial malleoli fracture, TCJ, CCJ, distal tib-fib joint, CF joint, CF lig, peroneal tendinopathy D) l/s IVF (L4-S3), multifidi, piriformis, biceps femoris, popliteal fossa, fibular head (under peroneal) E) STM to interface sites that are involved, neural glides, postural re-education with stretching and strengthening to associated muscle imbalances, movement re-education for involved movements and dysfunctional patterns (like excessive hip internal rotation), l/s and t/s mobilizations for associated impairments 5) Aaron is a 42 year attorney. He presents with complainits of persistent recurring headaches. He notes that the headaches start in the back of his head and travel towards the front. The pain can be incapacitating and typically occurs after working at his computer especially when he's under a lot of stress. He has had an MRI and CT scan to rule out in serious pathology. He reports that he also gets achiness in this mid back and has been bothered by recurrent hamstring tightness in both thighs. A) greater and lesser occipital N, C1-3 B) location of pain, SINS, presence of throbbing, palpation, 5 Ds, CN signs, upper c/s ROM, posture, pain with neck movements, neuro-screen C) upper c/s ligaments, sub-occipital muscles, C1-3 disc, CNS and vascularity of that (cluster, migraines, tension-type), vertebral arteries D) C1-3 IVF, suboccipital triangle (rectus capitis posterior major, obliquus capitis, superios and obliquus capitis inferior) E) STM to suboccipitals, upper c/s traction, joint mobs to upper and lower c/s and t/s, postural reed with stretches and strengthening of association muscle imbalances