A Combination of Manual Therapy, Movement Systems, and Biopsychosocial Approaches for the Treatment of Upper Limb Adverse Neural Tissue Tension: A Case Report

Abstract

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.