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According to a new Spine Journal Study: “Symptomatic nerve roots are wider than asymptomatic nerve roots due to the presence of edema. Peripheral nerves develop edema, fibrosis, and changes distal to the affected nerve.”(1)

 Nerves are dynamic structures that need the ability to glide and stretch. (2) Edema and fibrosis can impair this normal nerve movement and often translate into neurogenic complaints. “Nerve flossing” aims to restore normal neurodynamics and may help to resolve the associated symptoms. Check out the following video demonstration of three simple nerve flossing exercises to help you manage upper extremity complaints.

 

The Presentation 

According to the double-crush syndrome hypothesis, the peripheral nerves arising from irritated nerve roots are more sensitive to pressure.”(1) This cumulative nerve irritation is well recognized in neuropathies like carpal tunnel syndrome but is also thought to contribute to other musculoskeletal complaints like tennis elbow or shoulder impingement – as evidenced by the (remarkably reliable) arm squeeze test. (3)

 

The Diagnosis 

How do we confirm that a nerve is irritated? In the lower extremity, it is relatively uncomplicated – straight leg raise for the sciatic nerve and Yeoman (aka Femoral nerve stretch test) for the femoral nerve. However, the upper extremity has more potential candidates, and the associated nerve tension tests are not generally as familiar. For a refresher, check out this ChiroUp tutorial video of three simple nerve tension tests to help you differentiate upper extremity neurogenic complaints.

 

The Solution

Nerve tension tests place a nerve under maximum stretch in order to elicit irritation; however, these maneuvers should not be confused with nerve flossing treatments. Flossing entails tensioning one end of the nerve while simultaneously releasing tension on the other end. This repetitive motion glides the nerve back and forth through its path and aims to release adhesions that have developed along the way. Nerve flossing can be performed in-office by the clinician, or as part of a home-based program. To learn more about either variety, check out the following tutorial videos.

Nerve

Provider Treatment
Patient Home Care

Radial Nerve

Provider Treatment
Patient Home-Care

Median Nerve

Provider Treatment
Patient Home-Care

Ulnar Nerve

Provider Treatment
Patient Home-Care

Automating the Solution 

 

If you appreciate this type of evidence-based information, you’ll love the ChiroUp subscriber website. It simplifies the delivery of clinical excellence and allows us to help each other prepare for the fee-for-outcome revolution. Don’t be left behind. If you’re not yet a member, start your free trial today.

 

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References

  1. Okmen BM. et al. Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography. SPINE. 43(14):E798–E803, JUL 2018
  2. Wilgis EF, Murphy R. The significance of longitudinal excursion in peripheral nerves. Hand Clin. Nov 1986;2(4):761-6.
  3. Gumina S, Carbone S, Albino P et al. Arm squeeze test: a new clinical test to distinguish neck from shoulder pain. European Spine Journal 2013; 22: 1558-63.

 

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