Course

Reappraising entrapment neuropathies: Pathomechanisms, diagnosis and management

Teacher Annina Schmid
Dates 26-27 June 2021
Max participants 30
Location To be defined, Italy
Certificate / Credits Yes / Yes
Type of course Theoretical & Practical
Course features
Research & Evidence Based
Theoretical foundation
Hands-on/practical sessions
2 days of high quality learning content
Course in English with translation in Italian
Medical Doctors, Physical Therapists, medicine & physiotherapy students and professionals equivalent to PT’s can register for this course
Teacher
PT, PhD, MMACP, Associate Professor Oxford University
Annina Schmid is a Consultant Musculoskeletal Physiotherapist and a Neuroscientist affiliated with the Nuffield Department of Clinical Neurosciences at Oxford University in the UK....
Course program
  • 9:45AM - 10:00AM

    Participants registration

  • 10:00AM - 11:45 AM

    Pathomechanisms of entrapment neuropathies:

    • Loss of function
  • 11:45AM -12:05PM

    Coffee break

  • 12:05PM -1:30PM

    Pathomechanisms of entrapment neuropathies:

    • Gain of function
  • 1:30PM - 2:30PM

    Lunch break

  • 2:30PM - 4:00PM

    Screening, assessment and diagnosis

    • Questionnaires
    • Bedside neurological examination
    • Quantitative sensory testing in a physiotherapeutic setting
  • 4:00PM - 4:20PM

    Coffee break

  • 4:20PM - 6:00PM

    Screening, assessment and diagnosis: continued

    • Neurodynamic assessment and its role in the assessment of patients with entrapment neuropathies
  • 9:00AM -10:00AM

    Continued Assessment

    • To MRI or not to MRI?
    • Masqueraders of entrapment neuropathies, red flag screening
  • 10:45AM – 11:05AM

    Coffee break

  • 11:05AM – 12:30PM

    Management:

    • Efficacy of physiotherapeutic treatments for patients with entrapment neuropathies.
  • 12:30PM – 1:30PM

    Lunch break

  • 1:30PM – 3:00PM

    Management:

    • Case studies and practical sequences
  • 3:00PM – 3:20PM

    Coffee break

  • 3:20PM – 5:00PM

    Management:

    • Surgery, injections, pharmacology: when to refer on?

    Final questions

Course description

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 course aims to provide a detailed insight into recent scientific advances in regards to the pathophysiology, assessment and conservative management of patients with entrapment neuropathies.

In the first part of the course, participants will be updated on recent advances in the understanding of pathophysiological mechanisms underlying entrapment neuropathies. I will discuss the scientific evidence for mechanisms such as neuro-inflammation in the peripheral and central nervous system, myelin and axon degeneration or cortical changes and put them in relation to common symptoms and signs in patients with entrapment neuropathies. An improved understanding of underlying pathomechanisms will not only facilitate a targeted assessment of these patients, but will also have implications for the management and prognosis.

In a second part of the course, we will use the example of spinally referred pain to introduce a clinical framework of classifying different types of neural pain. I will discuss how clinical tests may assist in identifying and differentiating the underlying pathomechanisms if interpreted in the context of loss or gain of function. In practical sequences, participants will learn skills that will go well beyond bedside neurological testing and neurodynamic testing. A focus will be placed on quantitative sensory testing and how it can help diagnosis as well as treatment planning in a therapeutic setting. We will also highlight how these methods and other screening tools (e.g. questionnaires) can help to differentiate neuropathic from non-neuropathic pain in patients with suspected entrapment neuropathies.

The third part of this course concerns the management of patients with entrapment neuropathies. This part will include an update on the scientific evidence for the efficacy and benefit (or lack thereof) of physiotherapeutic interventions in the management of patients with these pain disorders. We will also touch on pharmacological options as well as the decision on when surgical intervention may be indicated.

Upon completion of the course, participants will have a deep understanding of potential pathomechanisms at play in patients with entrapment neuropathies. They will know how to differentiate the dominant mechanisms in individual patients using methods beyond the commonly used neural integrity and neurodynamic tests. Participants will also be competent in designing a targeted intervention for different subgroups of patients with spinally referred pain and can confidently interpret changes associated with the delivered intervention.

Course Objectives:

  • To enable the participants to understand the basic principles of pain physiology associated with entrapment neuropathies and to incorporate this knowledge into their reasoning framework
  • To be familiar with the practical performance and interpretation of bedside neurological testing and quantitative sensory testing methods in the context of entrapment neuropathies
  • To understand the clinical framework for subgrouping different types of spinally referred pain
  • To be competent in designing a targeted intervention for patients with entrapment neuropathies and to interpret changes associated with the delivered intervention