Neurodynamic Assessment
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Introduction[edit | edit source]
A neurodynamic assessment evaluates the length and mobility of various components of the nervous system. They are performed by the therapist placing progressively more tension on the component of the nervous system that is being tested and are divided into upper and lower limb tests.
The Upper Limb Tension Tests (ULTTs) are also known as Brachial Plexus Tension or Elvey Test.[1]These tests are designed to put stress on neurological structures of upper limb. These tests were first described by Elvey[2] and hence also known as Elvey test but most commonly called ULTT. The shoulder,elbow, forearm,wrist and fingers are kept in specific position to put stress on particular nerve (nerve bias)[3] and further modification in position of each joint is done as "sensitizer". The ULTT's are equivalent to the straight leg raise designed for the lumbar spine.
Purpose[edit | edit source]
These tension tests are performed to check the peripheral nerve compression or as a part of neurodynamic assessment. The main reason for using a ULTT is to check cervical radiculopathy. These tests are both diagnostic and therapeutic. Once the diagnosis of cervical radiculopathy is made the tests are done to mobilise the entrapped nerve.
Method[edit | edit source]
Each test is done on the normal/asymptomatic side first. Traditionally for the upper limb, the order of joint positioning is shoulder followed by forearm, wrist, fingers, and lastly elbow. Each joint positioning component is added until the pain is provoked or symptoms are reproduced. To further sensitize the upper limb tests, side flexion of cervical spine can be added[4]. If pain is provoked in the very initial position, then there is no need to add further sensitizers.
If pain or sensations of tingling or numbness are experienced at any stage during movement into the test position or during addition of sensitization maneuvers, particularly reproduction of neck, shoulder or arm symptoms, the test is positive; this confirms a degree of mechanical interference affecting neural structures.
Upper Limb Nerve Tension Tests[edit | edit source]
Upper Limb Tension Test 1 (ULTT1, Median nerve bias)[edit | edit source]
See here for more info on this test.
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Upper Limb Tension Test 2A (ULTT2A, Median nerve bias)[edit | edit source]
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Upper Limb Tension Test 2B (ULTT2B, Radial nerve bias)[edit | edit source]
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Upper Limb Tension Test 3 (ULTT3, Ulnar nerve bias)[edit | edit source]
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Musculocutaneous Nerve Tension Test (ULTT musculocutaneous)[edit | edit source]
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PNF Prone neck flexion
Purpose: To assess the contribution of neural tension to the patient's symptoms.
Test Position: Supine.
Performing the Test: Patient actively performs upper cervical nod. Examiner passively flexes lower cervical spine. A reproduction of pain or other neural symptoms in the thoracic spine is a positive test. A stretching sensation is normal.
Diagnostic Accuracy: Unknown.
Importance of Test: As nerves run through the various tissues of our body, they can become adherent to some of the structures they pass. This test looks to reproduce these symptoms by placing the spinal cord on tension via cervical flexion.[5]
Lower Limb Nerve Tension Tests[edit | edit source]
Slump Test (entire nervous system)[edit | edit source]
Femoral Nerve Tension Test[edit | edit source]
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