Differential Diagnosis for Nerve Entrapment Syndromes of the Upper Extremity

Course Outline

This two-day intermediate level course provides an in-depth look at nerve compression/entrapment disorders of the upper extremity from the cervical spine to the hand. Extensive “hands on” lab sessions allow participants time to practice safe, effective handling techniques used in evaluation and treatment. Systematic evaluation techniques with an emphasis on neurodynamics/nerve gliding will sharpen clinical reasoning skills and provide a means for differential diagnosis within a therapist’s scope of practice.

Instruction begins by developing a fundamental understanding of the anatomy and physiology of the upper extremity nervous system. Participants will then explore the pathologies leading to the assessment and development of treatment strategies. Lecture addresses effective conservative care for patients with carpal tunnel syndrome, cubital tunnel syndrome, carpal tunnel release and complicated nerve cases by thoroughly covering evaluation of nerve entrapment symptoms and their unique treatments. This course also provides discussion of nerve decompression surgeries (i.e. CTR, ulnar nerve transposition), cumulative trauma/repetitive strain injuries and traumatic nerve crush or laceration injuries. Neurodynamic evaluation and treatment techniques have a strong anatomical knowledge requirement. Participants are encouraged to bring their preferred anatomical text as a reference. The material and lab exercises presented can be immediately applied in the clinical setting. This course is recommended for physical and occupational therapists and CHTs.


Course Objectives

• Describe the basic concepts of neurodynamics/nerve gliding including available movement in the nervous system and vulnerable compression/entrapment sites.
• Describe the pathophysiology of the nervous system as related to nerve compression or entrapment.
• Describe pain mechanisms and how each influences various types of patient problems.
• Demonstrate safe, effective techniques for neurodynamic tests for the upper extremity including proper therapist positioning and patient handling.
• Screen hand patients for more proximal involvement including cervical pathology and TOS.
• Demonstrate provocation tests related to peripheral nerves of the upper extremity and be able to ascertain the areas of nerve compression/entrapment.
• Categorize clinical problems and attempt to make a prognosis based on the type of disorder and pain mechanisms.
• Provide treatment/intervention ideas and progression of clinical treatment for case study or for current patients.

Schedule of instruction

  Day One   Day Two
7:30 8:00 Registration 8:00 10:00 Pain Mechanisms
8:00 8:45 Introduction to Neurodynamics   • Nociceptive pain
  • Movement in the nervous system   • Peripheral, central pain
  • Adaptive mechanisms   • Output mechanisms
  • Vulnerable sites   • RSD/CRPS
8:45 9:30 Anatomy 10:00 10:15 Break
  • Cervical spine 10:15 10:45 Lab: Slump Test
  • Brachial plexus   • Basic concepts
  • Peripheral nerves in the upper extremity   • Relationship to sympathetics
  • Related structures 10:45 11:15 Other Nerve Entrapment/ Compression Syndromes of the UE
9:30 9:45 Break   • Radial nerve/posterior interosseus nerve entrapment
9:45 10:45 Lab: Palpation   • Musculocutaneous nerve
  • Brachial plexus   • Clinical presentation
  • Peripheral nerves of the upper extremity   • Conservative care
  • Related structures   • Surgical options/postsurgical management
10:45 11:15 Physiology 11:15 12:00 Lab: Radial Nerve
  • Nerve conduction   • Nerve gliding for the radial nerve
  • Axon transport   • Provocative tests
  • Ion channels   • Examination of related structures
11:15 12:00 Pathophysiology 12:00 1:00 Lunch (on your own)
  • Classification of nerve injuries
1:00 1:45 Cervical Spine
  • Nerve entrapment/compression   • Screening techniques
  • Stretch or traction injuries   • Differential diagnosis of proximal vs. distal involvement
  • Cumulative trauma 1:45 2:30 Thoracic Outlet Syndrome and Brachial Plexus Injuries
12:00 1:00 Lunch (on your own)   • Examination for TOS
1:00 1:30 Neurodynamics/Nerve Gliding   • Erb’s palsy/Duchenne’s paralysis
  • Basic concepts   • Burners and stingers
  • Indications 2:30 3:15 Lab: Cervical Spine and Brachial Plexus
  • Contraindications   • Cervical spine screening
1:30 2:15 Median Nerve Compression/Entrapment   • TOS tests
  • CTS, anterior interosseus nerve, etc. 3:15 3:30 Break
  • Clinical presentation 3:30 4:00 Treatment/Interventions
  • Conservative care   • Guidelines for use of neurodynamics
  • Surgical options/postsurgical management   • Treatment of related structures
2:15 3:15 Lab: Medial Nerve   • Ergonomics
  • Nerve gliding for the median nerve   • Home exercise program
  • Provocation tests 4:00 4:30 Review (Lab)
  • Examination of related structures   • Use of grade I-IV mobilization with nerve gliding
3:15 3:30 Break   • Sliders and tensioners
3:30 4:00 Ulnar Nerve Compression/Entrapment   • Biasing nerve gliding for optimal results
  • Cubital tunnel syndrome, Gyon’s canal 4:30 5:00 Hands-On Case Studies/
Problem Solving
  • Clinical presentation    
  • Conservative care    
  • Surgical options/postsurgical management    
4:00 4:45 Lab: Ulnar Nerve    
  • Nerve gliding for the ulnar nerve    
  • Provocation tests    
  • Examination of related structures    
4:45 5:00 Case Studies and Review    
       

Downloads

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Course Brochure for Differential Diagnosis for Nerve Entrapment Syndromes of the Upper Extremity

Scheduled Dates and Locations

 

North American Seminars Courses for physical therapy and occupational therapy

 

Course Instructor
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Kimberly Cherry MS, PT, CHT, received her BS in physical therapy from Northern Illinois University (NIU) in 1990 and her MS in physical therapy with an emphasis in orthopedics from Finch University of Health Sciences/The Chicago Medical School in 1995.

Kim has a strong clinical background in orthopedics with a full spectrum of practice settings including private practice, outpatient orthopedics, acute care, and home health. Over the past several years, she has specialized in hand therapy and became a certified hand therapist (CHT) in 2001. She currently works in a physical therapist-owned private practice where her hand therapy caseload includes conservative care, industrial injuries and postsurgical management.

Kim serves as an adjunct faculty member for the physical therapy program at NIU, providing guest lectures in the areas of hand therapy, soft tissue mobilization, splinting and seated workstation ergonomics. In addition, she has provided lectures and consultative services on seated workstation ergonomics for local organizations and industries.

Kim received the “Outstanding Clinical Instructor Award” from the Chicago Area Clinical Educators Forum in 1993. She has presented at annual conferences for the APTA and remains active in professional activities at the local level. Kim serves nationally as an on-site reviewer for the Commission for Accreditation in Physical Therapy Education (CAPTE).
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