Palpation and courses of Nerves

• Courses and palpations are key to neural mobilization techniques • Be gentle with Palpation , if you think that the harder the better then it will lead to faulty interpretations • Palpate a Nerve in tension - Tighter Nerves reproduce greater symptoms-especially if the symptoms are related to inter neural processes.

Why to learn courses
• Facilitates Neural testing, mobilizations and sensitizations • Facilitates Injury profiling • Neural mapping and blocking ( diagnostic ultrasound / tourniquets • NCV/ EMG / stimulation becomes easier

Uses of Nerve palpations., A) To learn about their
normal responses. 1. All Nerves are not Homogenous in their response i.e Ulnar nerve when palpated, at elbow gives prickling response in its distribution, where as Radial N at, Elbow produces a local tenderness only. and abnormal 1. local pain increases from a irritated N as Compared to opposite side. Also in entrapment or when there is adverse tension . Also when a nerve is mechanically or chemically sensitized it may produce abnormal signs i.e. radial Nerve when sensitized produces neck pain on palpation at elbow 2. May become more harder or softer in swelling i.e. in neuropathies, 3.enlarges in diameter in leprosy / Neuropathies localized enlargement in entrapment. and tumors like Schwannoma .

2. Hard and round-on touch.

3.Can be compared for, size to opposite side.

• Also look where possible for side to side movement of the Nerve . This movement is reduced when Nerve is in tension, aide also partly reduced in adherence to surrounding Structures. B) Tapping a Nerve for tinsel's sign. C) Twanging means gently pulling a nerve and looking for symptoms above or below the Nerve. D) palpations to locate the Nerve for oscillatory pressure massage or to give friction massage to a surroundings adhered fascia. E) To find-anomalies in a Nerve (smaller size or absence)

• The sciatic nerve , 2 cm broad at its origin and the broadest nerve in the body, is the continuation of the upper band of the sacral plexus. • It leaves the pelvis via the greater sciatic foramen below the piriformis and descends between the greater trochanter and ischial tuberosity, along the back of the thigh, dividing into the tibial and common peroneal (fibular) nerves, proximal to the knee. • It corresponds to a line from just medial to the midpoint between the ischial tuberosity and greater trochanter to the apex of the popliteal fossa

Sciatic nerve Mark a point 2.5 cms lateral to a midpoint of line joining the PSIS to ischeal tuberosity Mark a point just medial to a midpoint of line joining the G T to ischeal tuberosity

Mark the apex of popleteal fossa. Tibial -------> put another point on the lower end of popleteal fossa Midpoint between medial malleolus and TA tendon

• Lateral planter N tibial point #  2.5 cms medial to the tubercle of 5th metatarsal  point proximal end of first intermetatarsal space • # medial planter N mark a point in the 1st inter-digital space line backwards at the level of navicular tuberosity .

• Common peroneal N Point on upper angle of popliteal fossa  point on back of head of fibula curve to neck of fibula # Deep Per.N #  mark a point midway B/w the two malleolus . Superficial Per N. #  at junction of upper 2/3 and lower 1/3 from head of fibula to lateral malleolus at anterior border of peroneous longus

Sural N

• It descends lateral to the tendo calcaneus, near the small saphenous vein, to the region between the lateral malleolus and the calcaneus; Center of popleteal fossa to midpoint between calcaneous and lateral malleolus

Femoral N • put a point 1.2 cms medial to midpoint of inguinal ligament • Draw a line 2.5 cms below this Saphenous N • Mark a point 4cms below and lateral to pubic tubercle • Put a point on adductor tubercle • 1inch below and just anterior to medial malleolus.

Palpations in L/L nerves
• Sciatic -Between GT and ischeal tuberosity palpate in prone when leg hanging below the bed using SLR . • Tibial N - patient in prone centrally and posteriorly in knee crease lateral to popleteal A. - At level and posterior to medial malleolus (thin people like tendon on eve.and d.flx. • C. per. N can be palpated medial to the tendon of biceps femoris, down till where it wraps around fibula. • Deep.per.N. dorsum of the foot ,b/w 1st and 2nd metatarsal some 4cms above the first web space (hard round against the softer feel of the tendon of EHL) • Sural lateral aspect of foot – upward and posterior to lateral malleolus and goes up to the calf along the tendon at posterior lateral tubercle of talus

• Femoral N enters the thigh approximately halfway along the inguinal ligament lateral to femoral A pulses . • Saphenous N. B/w the tendons of sartorius and gracalis medial to knee put your hand ( fingers ) from joint line in bend knee and place your thumb in middle of the medial side of tibial surface / medial and anterior to medial malleolus ( about 1cm ) • Lateral cutaneous N of thigh deep in inguinal ligaments 1 cm medial to ASIS . Originates from the plexus and not femoral N - intra abdomen pressure causes meralgia parasthetica .

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