Chapter 4: Diagnosis of Specific Dysfunctions

This is a Chapter 4 summary of “Clinical Neurodynamics” by Michael Shacklock. Mechanical Interface Dysfunction In early stages of closing dysfunctions, symptoms present as aches and pains. This presentation is due to the musculoskeletal tissues being more affected than the neural tissue. As severity increases, neurological symptoms such as pins and needles, tingling, and burning are more likely to occur. The severest end of the spectrum includes numbness and weakness; indicating further compromise to the neurovascular structures. Interface dysfunctions behave with changes in posture and movement. Oftentimes cardinal signs of inflammation can be present, along with night pain/morning stiffness. Typically you will see a painful arc throughout movement. During the physical exam, patients will show an inability to move in opening or closing directions. You can also find altered pain production, soft tissue thickening, or hypermobility/instability. Neurological changes will usually be present only in severe interface dysfunction. There are four basic types of interface dysfunctions 1)      Reduced closing 2)      Excessive closing 3)      Reduced opening 4)      Excessive opening In reduced closing dysfunction, closing movements such as squeezing or cervical extension provoke symptoms. Assessment may show a protective deformity developing in the opening direction so pressure is reduced on the nervous system. Symptoms will often not be reproduced unless neurodynamic testing is combined with interface testing. Excessive closing is when, well, interfaces are closing too much. An example of this dysfunction is excessive lumbar lordosis present with low back pain that increases with standing, walking, and running. A patient’s history will often show

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