Neural Mobilization Techniques in a Patient with Median and Ulnar Nerve Injuries-A Case Report

正中神經及尺神經損傷病人接受神經鬆動術之病例報告

楊靜蘭(Jing-Lan Yang) ； 林居正(Jiu-Jenq Lin) ； 邱秀苓(Hsiu-Ling Chiu)

《物理治療》 30卷5期 (2005/10) Pp. 223-231

摘要

目的：物理治療對放促進週邊神經損傷之後的動作與感覺功能的恢復，有著重要的地位。本篇病歷報告的目的是探討以神經鬆動術技巧，合併其他物理治療，針對週邊神經受傷之後的療效。病例：病人為五十六歲女性，在工作時發生意外造成右手肘脫位，右邊的正中神經以及尺神經的傷害。病人起初物理治療的項目包括了，神經電刺激、疼痛以及腫脹的控制，動作以及感覺的再教育，關節活動度的運動，以及日常生活的訓練。然而，病人的右手大姆指，以及其他四根手指頭的主動動作，並沒有明顯的進步。因此，在病人神經損傷十三個月後，物理治療加進了神經鬆動術。再經過四週十次的治療之後，病人的大姆指以及其他四根手指頭的主動動作皆有增加，正中神經以及尺神經的神經活動度，病人右手及右前臂的感覺以及日常生活活動方面，皆有明顯的改善。結論：週邊神經損傷接受手術處理之後的病人，神經鬆動術對於他們似乎有著部分的療效，進一步的研究可以隨機控制的實驗來進行探討神經鬆動術對於週邊神經損傷病人的治療效果。

關鍵字

週邊神經損傷 ； 正中神經 ； 尺神經 ； 神經鬆動術

並列摘要

Purpose: This case report described the effect of neural mobilization techniques in conjunction with physical therapy on a patient with median and ulnar nerve injuries. Method: A 56-year-old woman with median and ulnar nerve injuries from blunt trauma received neurorhaphy and neurolysis of the injured nerves. Thirteen months after nerve surgery, electrodiagnostic testing results [neural tension tests, electromyography (EMG), and nerve conduction velocity (NCV) tests] indicated that the patient had median and ulnar nerve entrapment. Thus, the patient was treated with neural mobilization techniques, 10 times over a 4-week period. Results: After 10 sessions of neural mobilization techniques, there were increases in active movements of the flexion, opposition, and abduction of the thumb as well as abduction and adduction (average10 degrees improvement) of the 4 fingers. There were also improvements in the two-point discrimination test for the hand and forearm (volar side: from 3 to 1.7 cm; dorsal side: from 2 to 1.3 cm), and functional activities (severe difficulty to mild difficulty). Conclusion: There seems to be a role for nerve mobilization techniques in the treatment of patients with peripheral nerve injuries following surgical management. Controlled studies regarding the effectiveness of nerve mobilization techniques in the treatment of peripheral nerve injuries following surgical management are warranted.

並列關鍵字

Peripheral nerve injury ； Median nerve ； Ulnar nerve ； Nerve mobilization