Transcript Tanja Rauter Pungartnik, MD, and Dajana Vučič, physiotherapist

INTEGRATION OF
NEURODYNAMICS IN
ORTHOPAEDICS
Tanja Rauter Pungartnik, MD,
specialist of physical and rehabilitation medicine
Dajana Vučić,
physiotherapist
Terme Ptuj
NEURODYNAMICS
• a special technique
• one of the way of patient treatment
• deals with the differential diagnosis of
musculoskeletal pain assessment
• treatment of the peripheral nervous
system.
NEURODYNAMICS
• The concept is based on very precise search of
the causes of a particular clinical problem.
• Incorrect position of the joint, inflexibility of
the nervous system cause poor muscle activation.
NEURODYNAMIC TESTING
• looking for obstruction
• passing the peripheral nerves (passive
movement of upper, lower extremities and
the body)
• to determine if the inferior function of
the musculoskeletal system is a result of
obstructed passing the peripheral nerves.
THE GOAL OF THE THERAPY
to establish an optimal sliding of the peripheral
nervous system and consequently easier to obtain
the full flexibility of the joint and increase muscle
activation.
(Mobilisation of musculoskeletal system,
decompression and break adhesions)
MUSCLE REEDUCATION
• For the ultimate success it is necessary to
include the muscle reeducation
(proper education of individual muscle groups
witout »trick« movements and such associated
reactions).
OUR CASE…
• a 39-year old patient after implantation of the
endoprosthesis in left hip
• date of surgery: 27.8.2015
• Admission date: 30.9.2015
• Anamnesis:
- pain in the area of the postoperative scar (VAS 6-7),
- weakness of the muscles
- no active movement of left leg in left hip -lying position
on back
OUR CASE…
• Status:
walking with the crutches, without crutches very bizarre
she could not elevate the left leg from the bed
when she wanted to elevate the left leg - the appearance of
pain in left groin and in gluteal region on the left side
Range of motion in left hip at the beginning of the
rehabilitation program
1.10.2015
- Flexion
50°, 55°
- Retroflexion
0°, 0°
- Adduction
0°, 5°
- abduction
0°, 10°
- Int.rot.
15°, 20°
- Ext.rot.
0°, 0°
Rehabilitation program
•
•
•
•
•
Hydrotherapy – active exercises in thermal water
Kinesiotherapy – passive movements of the left hip (to
improve the range of motion),
assisted active exercises (to help m.),
exercises with equipments (balls,
elastic tape…)
improve the right pattern of walking)
Magnetotherapy
Electrotherapy
Massage of the lumbar spine
After 10 days…
• the intensity of the pain was the same as in the beginning
(VAS 6-7)
• minimal improvement in the range of motion
• still walking with crutches
• walking without crutches was not functional and efficient
Range of motion in left hip after 10 days of the
rehabilitation program
-
1.10.2015
12.10.2015
Flexion
50°, 55°
Retroflexion 0°, 0°
Adduction
0° , 5°
abduction
0°, 10°
Int.rot.
15°, 20°
Ext.rot.
0°, 0°
65°, 70°
0°, 0°
0°, 15°
0°, 15°
25°, 35°
0°, 5°
•
•
•
•
•
•
1. del (walking with crutches)
2. del (walking without crutches)
3. del (putting on socks)
4. del (testing)
5. del (testing the rotation)
6. del (testing the rotation while the patient is
lying on her stomach)
After 10 days…
No significant improvement in
her clinical status…
• 8.del (testing the n. femoralis and mobilisation)
• 9. del (mobilisation)
• 10. del (testing after the mobilisation)
Range of motion left hip after mobilisation
of the femoral nerve
-
1.10.2015
Flexion
50°, 55°
Retroflexion 0°, 0°
Adduction
0°, 5°
abduction
0°, 10°
Int.rot.
15° , 20°
Ext.rot.
0° , 0°
12.10.2015
65°, 70°
0°, 0°
0°, 15°
0°, 15°
25°, 35°
0°, 5°
13.10.2015
95°, 100°
10°, 20°
20°, 25°
15°, 20°
35°, 35°
5°, 20°
• 11. del (education)
• Thank you for your
attention…