Online Evening Lecture: Entrapment neuropathies from bench to bedside: Pathophysiology, Assessment and Physiotherapy Management

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Kerry West
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Online Evening Lecture: Entrapment neuropathies from bench to bedside: Pathophysiology, Assessment and Physiotherapy Management Dr Colette Ridehalgh PhD, MSc, BSc (Hons), MCSP, MMACP Dr Annina Schmid

1 Online Evening Lecture: Entrapment neuropathies from bench to bedside: Pathophysiology, Assessment and Physiotherapy Management Dr Colette Ridehalgh PhD, MSc, BSc (Hons), MCSP, MMACP Dr Annina Schmid PhD, MManipTher, MCSP, PT OMT svomp Dr Brigitte Tampin PhD, MSc, Grad.Dip.Manip.Ther,, PT OMT DVMT 26th Oct 2016 This course / lecture is online. Please see your enrolment information for details of accessing the content..

2 Summary This is another of our live interactive evening lectures from 7-9pm which you can listen to and learn from the comfort of your home, or wherever you are! Entrapment neuropathies are the most common peripheral nerve disorders and a condition that is frequently seen by Physiotherapists. They are caused by pressure and/or irritation of peripheral nerves and nerve roots as they travel through narrow anatomical spaces. Common conditions include cervical or lumbar radiculopathies, carpal tunnel syndrome or cubital tunnel syndrome. Diagnosis and treatment of entrapment neuropathies are often challenging. This can in part be attributed to a limited understanding of the pathophysiology of the diverse symptoms and signs (e.g., numbness, pain, allodynia, motor deficits, paraesthesia etc) as well as the conflicting (and often confusing) evidence regarding treatment of these patients. This evening aims to provide a detailed insight into recent scientific advances in regards to pathophysiology, assessment and conservative management of entrapment neuropathies. Content Pathophysiology of entrapment neuropathies Annina Schmind (Chartered Physiotherapist) In the first presentation, Annina Schmid will provide an update on the recent scientific advances in the understanding of the pathophysiology of entrapment neuropathies. Mechanisms including demyelination, axon degeneration and neuro-inflammation will be explained and put in context with common symptoms and signs. Participants will be introduced to the concept of gain versus loss of function, which will facilitate a targeted assessment, and will also have implications for the management and the prognosis patients with entrapment neuropathies. - Participants are aware of common pathomechanisms in patients with entrapment neuropathies and their relation to clinical signs and symptoms - Participants understand the importance of small fibre testing as an essential component of the neurological examination Clinical impact: The increased understanding of the pathomechanisms at play in patients with entrapment neuropathies will enable participants to make a more informed decision on

3 management and prognosis of their patients. The clinical spectrum and presentation of nerve-related pain disorders Brigitte Tampin (Chartered Physiotherapist) In the second presentation Brigitte Tampin will discuss the clinical spectrum of nerverelated pain disorders (nociceptive/neuropathic/mixed pain presentations). She will present clinical tools that assist in identifying and differentiating the underlying pain types and pathomechanisms in patients with nerve-related pain. Participants will learn about bedside neurological testing including sensory testing for loss and gain of function, the grading system for the presence of neuropathic pain and how to interprete positive and negative responses to neural tissue provocation tests/neurodynamic test in the context of nerve -related pain disorders. - Differentiation of neuropathic and nociceptive pain is important - Patients with similar pain characteristics (pain distribution, pain descriptors) may have different underlying pain types (neuropathic/nociceptive/mixed pain) - The presence of clinical signs of heightened nerve mechanosensitivity does not imply the presence of neuropathic pain - Neurodynamic tests can be negative in the presence of nerve damage and associated neuropathic pain Clinical impact Participants will understand how to differentiate the dominant pain types/mechanisms in individual patients using methods beyond the commonly used neural integrity (light touch, reflexes, muscle strength) and neurodynamic tests. They will be aware of the importance of detailed bedside sensory testing as integral part of their clinical patient assessment. Management of nerve related disorders Colette Ridehalgh (Chartered Physiotherapist) In the third presentation, Colette Ridehalgh will provide an overview of the evidence to support the underlying mechanisms and efficacy of physiotherapy management of nerverelated pain disorders. Such mechanisms include neurophysiological effects such as changes to pain, oedema and immune cells and biomechanical effects. The clinical efficacy of Physiotherapy management will focus on patient groups with commonly encountered nerve -related pain disorders such as carpal tunnel syndrome, and cervical and lumbosacral radicular pain. - Participants will be able to understand and appreciate the evidence to support theoretical mechanisms related to physiotherapy techniques of nerve-related disorders. - Understand the current research base with respect to efficacy - Understand the limitations with the current research base on physiotherapy techniques of nerve-related disorders.

4 Clinical impact Participants will be better able to understand the underlying mechanisms which may lead to improvements in nerve health and patient outcome, and understand the current evidence base around efficacy of these techniques in clinical practice. You will be able to send in questions throughout. We hope you are able to join us. All those attending the lecture will be able to access the content again following the lecture along with any handouts and further information. If you book on and can't attend, fear not, you will be able to listen to it afterwards at your leisure. If you can't make it, just book on anyway and we'll give you access to the full recording afterwards. Obviously you won't be able to ask questions on the night but you'll get to hear the gems shared, and we'll give you any further highlights of the information shared on the evening. Objectives Preparation Pre lecture reading is supplied once you have booked on. Day 1 Time Activity Start Pathophysiology of entrapment neuropathies (Annina Schmid) Questions The clinical spectrum and presentation of nerve-related pain disorders (Brigitte Tampin) Questions Comfort break Management of nerve related disorders (Colette Ridehalgh) Question / Discussion time

5 Time Activity Close

Referral Criteria: Carpal Tunnel Syndrome Feb

Referral Criteria: Carpal Tunnel Syndrome Feb 2019 1 5.2. Carpal Tunnel Syndrome Background Carpal tunnel syndrome present with non-traumatic tingling of the fingers due to compression of the median nerve