adverse neural tension

Whilst on rural placement I saw a lady who had fallen off a trailer, landing on her shoulder and forearm who was diagnosed with and treated for a distal radial fracture. She had been seeing the OT at the hospital who then referred her to physio due to shooting pain down her upper limb originating in the shoulder.

On assessment I found that she was extremely sensitive to neural tension provocation tests and palpation of the median nerve, with symptoms in this distribution. Her presentation was difficult in that she had a history of bilateral carpal tunnel syndrome from her work in embroidery as well as persistent oedema and pain around the fractured wrist.

Initially I felt overwhelmed by her problems and symptoms, which presented in a very irregular fashion - changing every couple of days when I saw her. I wasn't sure where to start as she was quite irritable and had many likely contributing factors which were difficult to differentiate. I needed to do some reading to find out more about the problem of adverse neural tension, however after doing this I became aware that these fluctuating and highly variable symptoms are quite typical of this problem. Although the evidence is not very specific in terms of treatment parameters, I learnt more about gliding versus tension in the peripheral nervous system and their roles as treatment techniques based on the irritability of the problem.

Having the knowledge of the evidence that is available (much of which has been conducted in the last couple of years, after we covered it) the patient and I were able to make fairly rapid progress with what initially presented as a highly irritable and functionally limiting condition.

This really highlighted for me that even now, before we have graduated, the importance of finding suitable ways to continue learning about the ever-changing best practices to deliver the most effective treatment to our patients. This will virtually always extend beyond PD courses and journal clubs etc as they might not cover the conditions or treatment areas that are specifically required for our clients.