You’ve Got Some Nerve…
Post by Brian Yee, PT, MPhty, OCS, FAAOMPT
People fall. People get hurt. Injuries usually get better… as we would hope. There are many cases, however, when common injuries that we think would get better over time do not. Here’s a case in which I have seen people have traumatic injuries such as slipping and falling on an outstretched arm, causing wrist and forearm pain. Most people, including physicians and physical therapists, would assume it’s a wrist injury such as a ligament sprain or fracture, and in most cases, it probably is.
But let’s say the injured arm now presents with tingling, redness, or swelling. Now what do you think that may be coming from? One structure that is commonly not considered is the involvement of the nerves. With a fall on an outstretched arm, the nerves, primarily the median, radial, and ulnar nerves which start from the neck to the fingertips, can be agitated with such a quick trauma like a fall.
The reason why? Nerves should act like elastic bungee cords, but with quick trauma the nerves can be stretched too quickly and become inflamed and irritated like any other connective tissue in your body. Only problem is when a nerve is irritated, symptoms like numbness, tingling, burning, swelling, color changes, and even changes in sensation or motor strength can occur. Swelling can lead to scar tissue formation and cause the nerves and the tissues around it to become tighter. This can lead not only to more symptoms, but also limit functional movement of the joints and muscles around the irritated nerve.
EMGs and nerve conduction studies do not always show the involvement of the injured nerve. However, there are some specific hands-on techniques that physical therapists can use, called Neurodynamics, that can test someone’s nerve irritation and tensile length. There are also treatment progressions to get nerves to reduce inflammation and pain, as well as restore its normal length and elasticity.
I find that utilizing differential diagnosis skills to determine nerve tension involvement in unresolved pain situations has been very useful in completing a comprehensive evaluation, as well as a more effective treatment plan.