Excursion of The Median, Ulnar and Radial Nerves During the Nerve Gliding Exercises Used in The Orthopedic Physiotherapy: A Cadaveric Study

Year 2021, Volume: 12 Issue: 44, 144 - 148, 24.12.2021

İbrahim Duman , Serkan Davul , Hasan Hallaçeli , Yunus Doğramacı , Vedat Uruç

https://doi.org/10.17944/mkutfd.905206

Cited By: 1

Abstract

Objective: The purpose of this study was to assess the measurement of nerve gliding, resulting from joint motion and changes of upper extremity position.
Methods: The upper extremities of ten fresh human cadavers were dissected to delineate relationship between the positioning of upper extremity and gliding distance of nerves. Nerve mobilization – stretching therapy (SMG) techniques are mentioned in the literature for each of the radial, medial and ulnar nerves. Nerve excursion secondary to motion of shoulder, elbow, wrist, and fingers was evaluated at the elbow via SMG application. Initially extremities and the head were positioned with anatomic position. For the median nerve, extremity position was elbow extension, forearm supination, wrist and finger extension. For the ulnar nerve upper extremity position was elbow flexion, full forearm pronation, and wrist and finger dorsiflexion. Finally, the excursion of the radial nerve was observed with the position of elbow extension, forearm pronation, wrist and finger palmar flexion.
Results: The ulnar, radial and median nerves excursion were 13.5, 29.75 and 11.37 mm respectively.
Conclusion: In this study, longitudinal excursion movement of radial, median and ulnar nerves was observed with movements of shoulder, elbow, wrist and finger joints in different positions. SMG techniques can contribute to the mobilization of nerve tissue in orthopedic rehabilitation.

Keywords

Ulnar Nerve, Radial Nerve, Median Nerve, Physical Therapy Techniques, Treatment Outcome

Ortopedik Fizyoterapide Uygulanan Sinir Mobilizasyon Egzersizleri ile Median, Ulnar ve Radial Sinirlerin Ekskursiyonu: Bir Kadavra Çalışması

Abstract

Amaç: Bu çalışmadaki amacımız üst ekstremite pozisyonun değişimi ve eklem hareketlerinden kaynaklanan sinir hareketinin ölçümünü değerlendirmek.Gereç ve Yöntem: On taze insan kadavrasının üst ekstremiteleri, üst ekstremitenin konumlandırılması ile sinirlerin kayma mesafesi arasındaki ilişkiyi tanımlamak için diseke edildi. Radial, medial ve ulnar sinirlerin her biri için literatürde sinir mobilizasyon – germe terapi (SMG) teknikleri bahsedilmektedir. SMG uygulaması ile omuz, dirsek, el bileği ve parmak hareketine bağlı sinir ekskürsiyonu dirsek seviyesinde değerlendirildi. Başlangıçta ekstremiteler ve baş anatomik pozisyonda konumlandırıldı. Median sinir için ekstremite pozisyonu dirsek ekstansiyonu, önkol supinasyonu, el bileği ve parmak ekstansiyonu idi. Ulnar sinir için üst ekstremite pozisyonu dirsek fleksiyonu, tam önkol pronasyonu ve el bileği ve parmak dorsifleksiyonuydu. Son olarak, dirsek ekstansiyonu, ön kol pronasyonu, el bileği ve parmak palmar fleksiyonu pozisyonunda radial sinirin ekskürsiyonu gözlendi.
Bulgular: Ulnar, radyal ve medyan sinir ekskürsiyonu sırasıyla 13.5, 29.75 ve 11.37 mm idi.
Sonuç: Bu çalışma, omuz, dirsek, el bileği ve parmak eklemlerinin farklı konumlardaki hareketleriyle, radial, median, ulnar sinirlerin longitudinal; ekskürsiyon hareketi gözlenmiştir. SMG teknikleri ortopedi rehabilitasyonunda sinir dokusunun mobilizasyonuna katkı sağlayabilir.

Keywords

Ulnar Sinir, Radial Sinir, Median Sinir, Fizik Tedavi Teknikleri, Tedavi Sonuçları

References

• Millesi H, Zoch G, Rath T. The gliding apparatus of peripheral nerve and its clinical significance. Ann Hand Surg 1990; 9: 87-97. https://doi.org/10.1016/S0753-9053(05)80485-5
• Lundborg G, Dahlin LB. Anatomy, function, and pathophysiology of peripheral nerves and nerve compression. Hand Clin 1996; 12: 185-193. https://doi.org/10.1016/S0749-0712(21)00303-6
• Grewal R, Xu J, Sotereanos DG, Woo SL. Biomechanical properties of peripheral nerves. Hand Clin 1996; 12: 195-204. https://doi.org/10.1016/S0749-0712(21)00304-8
• Topp KS, Boyd BS. Structure and biomechanics of peripheral nerves: nerve responses to physical stresses and implications for physical therapist practice. Phys Ther 2006; 86: 92-109. https://doi.org/10.1093/ptj/86.1.92
• Boyd BS, Puttlitz C, Gab J, Topp KS. Strain and Excursion in the rat sciatic during a modified straight leg raise are altered after traumatic nerve injury. J Orthopaedic Res 2005; 23: 764-770. https://doi.org/10.1016/j.orthres.2004.11.008
• Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, Macdermid JC. Effectiveness of Hand Therapy Interventions in Primary Management of Carpal Tunnel Syndrome: A Systematic Review. J Hand Ther 2004; 17 : 210-228. https://doi.org/10.1197/j.jht.2004.02.009
• Brown C, Gilbert K, Brismee JM, Sizer P, James C, Smith P. The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study. J Man Manip Ther 2011; 19: 26-34. https://doi.org/10.1179/2042618610Y.0000000003
• Jepsen JR, Thomsen G. Prevention of upper limb symptoms and signs of nerve afflictions in computer operators: The effect of intervention by stretching. J Occup Med Toxicol 2008; 7: 3:1. https://doi.org/10.1186/1745-6673-3-1
• Wright TW, Glowczewskie F JR, Cowin D, Wheeler DL. Radial nerve excursion and strain at the elbow and wrist associated with upper-extremity motion. J Hand Surg Am 2005; 3: 990-996. https://doi.org/10.1016/j.jhsa.2005.06.008
• Wright TW, Glowczewskief, Wheeler D, Miller G, Cowin D. Excursion and strain of the median nerve. J Bone Joint Surg Am 1996;78 :1897-1903.https://doi.org/10.2106/00004623-199612000-00013
• Wilgis EF, Murphy R. The significance of longitudinal excursion in peripheral nerves. Hand Clin 1986; 2: 761-766. https://doi.org/10.1016/S0749-0712(21)00622-3
• Bay BK, Sharkey NA, Szabo RM. Displacement and strain of the median nerve at the wrist. J Hand Surg 1997; 22: 621-627. https://doi.org/10.1016/S0363-5023(97)80118-9
• Wright TW, Glowczewskie F JR, Cowin D, Wheeler DL. Ulnar nerve excursion and strain at the elbow and wrist associated with upper extremity motion. J Hand Surg Am 2001; 26: 655-662. https://doi.org/10.1053/jhsu.2001.26140
• Grewal R, Varitimidis SE, Vardakas DG, Fu FH, Sotereanos DG. Ulnar nerve elongation and excursion in the cubital tunnel after decompression and anterior transposition. J Hand Surg Br 2000; 25: 457-460. https://doi.org/10.1016/S0266-7681(00)80012-1
• Dilley A, Greening J, Lynn B, Leary R, Morris V. The use of cross-correlation analysis between high-frequency ultrasound images to measure longitudinal median nerve movement. Ultrasound Med Biol 2001; 27: 1211-1218. https://doi.org/10.1016/S0301-5629(01)00413-6
• Mclellan DL, Swash M. Longitudinal sliding of median nerve during movements of the upper limb. J Neurol Neurosurg Psychiatry 1976; 39: 566-570. https://doi.org/10.1136/jnnp.39.6.566
• Coppieters MW, Alshami AM. Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome. J Orthop Res 2007; 25: 972-980. https://doi.org/10.1002/jor.20310
• Coppieters MW, Butler DS. Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther 2008; 13: 213-221. https://doi.org/10.1016/j.math.2006.12.008
• Brown CL, Gilbert KK, Brismee JM, Sizer PS, Roger James C, Smith MP. The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study. J Man Manip Ther 2011; 19: 26-34. https://doi.org/10.1179/2042618610Y.0000000003
• Beneciuk JM, Bishop MD, George SZ. Effects of upper extremity neural mobilization on thermal pain sensitivity: a sham-controlled study in asymptomatic participants. J Orthop Sports Phys Ther 2009; 39: 428-438. https://doi.org/10.2519/jospt.2009.2954
• Oskay D, Meric A, Kirdi N, Firat T, Ayhan A, Leblebicioğlu G. Neurodynamic Mobilization In The Conservative Treatment Of Cubital Tunnel Syndrome: Long-Term Follow-Up Of 7 Cases. J Manipulative Physiol Ther 2010; 33: 156-63. https://doi.org/10.1016/j.jmpt.2009.12.001
• Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther 1998; 11: 171-179. https://doi.org/10.1016/S0894-1130(98)80035-5
• Hough AD, Moore AP, Jones MP. Reduced Longitudinal Excursion of Median Nerve in Carpal Tunnel Syndrome. Arch Phys Med Rehabil. 2007; 88: 569-576. https://doi.org/10.1016/j.apmr.2007.02.015
• Clark WL, Trumble TE, Swiontkowski MF, Tencer AF. Nerve tension and blood flow in a rat model of immediate and delayed repairs. J Hand Surg 1992; 17: 677-687. https://doi.org/10.1016/0363-5023(92)90316-H
• Ellis RF, Hing WA, Mcnair PJ: Comparison of Longitudinal Sciatic Nerve Movement With Different Mobilization Exercises: An In Vivo Study Utilizing Ultrasound Imaging J Orthop Sports Phys Ther 2012; 42: 667-675. https://doi.org/10.2519/jospt.2012.3854