A Combination of Manual Therapy, Movement Systems, and Biopsychosocial Approaches for the Treatment of Upper Limb Adverse Neural Tissue Tension: A Case Report
Background and Purpose: Peripheral nerve injuries
can result from a multitude of causes including trauma, poor posture, and
altered movement patterns. Adverse neural tension is a possible consequence to
insult to the nervous system which can lead to dysfunction and fear avoidance
behaviors. The purpose of this case report is to demonstrate the use of a
multimodal approach in the physical therapy treatment of a patient who
sustained an occupational upper extremity injury which resulted in adverse
neural tissue tension of multiple peripheral nerves. Case Description: The
patient was a 40- year-old female who
sustained an injury to the second right metacarpophalangeal joint. Impairments
included joint hypomobility, decreased muscle function, and movement system
dysfunction. The patient was treated six times over a two-week period. Intervention: The physical therapy treatment administered to the patient included
manual therapy, exercises focused on improving movement systems impairment, exercise
focused on improving neural excursion, and patient education based on the
biopsychosocial model. The treatments were focused on improving function of
work-related activities to decrease disability to promote regular and full job
duties. Outcomes: Outcome measures include the Numeric Pain Rating Scale
(NPRS), Fear Avoidance Beliefs Questionnaire of Work and Physical Activity
(FABQ-W and FABQ-PA, respectively), and the Quick Disability of the Arm,
Shoulder and Hand (QuickDASH). After six visits there was an NPRS rating of
0/10 with rest and activity; the FABQ-W improved from 17/42 to 10/42; the
FABQ-PA improved from 15/24 to 3/24; the QuickDASH improved from 22% symptom
related disability to 9% and improved from 75% disability with work-related
tasked to 0% disability. Discussion: Interventions of joints mobilization,
neuromuscular reeducation using the movement systems approach, and concepts
focused on the biopsychosocial approach were determined to be an integral
combination in the patient’s successful return to full work-related duties.
Cite this paper
Shinost, C. A. , Pratt, L. E. and Smith, K. (2017). A Combination of Manual Therapy, Movement Systems, and Biopsychosocial Approaches for the Treatment of Upper Limb Adverse Neural Tissue Tension: A Case Report. Open Access Library Journal, 4, e3669. doi: http://dx.doi.org/10.4236/oalib.1103669.
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