Neurodynamic Assessment: Difference between revisions
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'''Original Editor '''[[User:Aarti Sareen|: Aarti Sareen]] |
'''Original Editor '''[[User:Aarti Sareen|: Aarti Sareen]] | ||
'''Top Contributors''' - {{Special:Contributors/{{ | '''Top Contributors''' - {{Special:Contributors/{{Scott Buxton}}}}
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== Introduction == | == Introduction == | ||
The | The Upper Limb Tension Tests (ULTTs) are also known as Brachial Plexus Tension or Elvey Test.<ref name="magee">Magee DJ.Orthopaedic physical assessment.5th edition.Elsevier publication.</ref>These tests are designed to put stress on neurological structures of upper limb. These tests were first described by Elvey<ref>Elvey RL: The investigation of arm pain. In Boyling JD, Palastanga N (eds): Grieve’s modern manual therapy: the vertebral column, 2nd ed. Edinburgh, 1994, Churchill Livingstone.</ref> 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)<ref>Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.</ref> 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 == | == Purpose == | ||
These tension | These tension tests are performed to check the peripheral nerve compression or as a part of [http://www.physio-pedia.com/Neurodynamic_Assessment neurodynamic assesment]. The main reason for using a ULTT is to check cervical radiculopathy. These tests are both diagnostic and therapeutic. Once the diagnosis of [http://www.physio-pedia.com/CPR_for_Cervical_Radiculopathy cervical radiculopathy] is made the tests are done to mobilise the entrapped nerve. | ||
== Types == | == Types == | ||
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ULTT 1 for Median nerve, anterior interosseous nerve(C5,C6,C7). | ULTT 1 for Median nerve, anterior interosseous nerve(C5,C6,C7). | ||
ULTT 2 for Median nerve, | ULTT 2 for Median nerve, musculocutaneous nerve, axillary nerve. | ||
ULTT 3 for Radial nerve. | ULTT 3 for Radial nerve. | ||
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ULTT 4 for Ulnar nerve, C8,T1 nerve root. | ULTT 4 for Ulnar nerve, C8,T1 nerve root. | ||
== Method to | == Method to perform == | ||
Each test is done on normal side first. The order for positioning the joint first is shoulder followed by forearm, wrist, fingers and last by elbow. Each sensitizer is added until the pain is provoked or produced. To further sensitize the test side flexion of cervical spine can be added<ref>Wells P: Cervical dysfunction and shoulder problems, Physiotherapy 68:66-73, 1982.</ref>. If the pain comes in the very | Each test is done on normal side first. The order for positioning the joint first is shoulder followed by forearm, wrist, fingers and last by elbow. Each sensitizer is added until the pain is provoked or produced. To further sensitize the test side flexion of cervical spine can be added<ref>Wells P: Cervical dysfunction and shoulder problems, Physiotherapy 68:66-73, 1982.</ref>. If the pain comes 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 the positioning into the test position or during addition of sensitization | If pain or sensations of tingling or numbness are experienced at any stage during the positioning into the test position or during addition of sensitization manoeuvres, particularly reproduction of neck, shoulder or arm symptoms , the test is positive; this confirms a degree of mechanical interference affecting neural structures.<br> | ||
{{#ev:youtube|hJ6ywqxWlkA}} | {{#ev:youtube|hJ6ywqxWlkA}} | ||
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<br> {{#ev:youtube|BCfWimhcvhY}} | <br> {{#ev:youtube|BCfWimhcvhY}} | ||
'''BIKELE'S SIGN:''' Discovered by Evans<ref>Evans RC: Illustrated essentials in | '''BIKELE'S SIGN:''' Discovered by Evans<ref>Evans RC: Illustrated essentials in orthopaedic physical assessment, St Louis, 1994, Mosby-Year Books.</ref>. In a seated position the patient abducts the shoulder to 90 degree with the elbow fully flexed. Extend the arm at shoulder level and then extend the elbow. If radicular pain results the test is positive. | ||
== Reliability and validity == | == Reliability and validity == | ||
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[[Category:Assessment]] [[Category:Cervical]] [[Category:Cervical_Examination]] [[Category:Special_Tests]] [[Category:Neurodynamics]] | [[Category:Assessment]] [[Category:Cervical]] [[Category:Cervical_Examination]] [[Category:Special_Tests]] [[Category:Neurodynamics]] | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | |||
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<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1BUB2BG5RbxJbmmodOv3ELJhZPU3f3yrGHIHBGfBpAj96nSIUn|charset=UTF8|short|max=10</rss>
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Revision as of 12:00, 4 January 2015
Original Editor : Aarti Sareen
Top Contributors - {{Special:Contributors/Template:Scott Buxton}}
Introduction[edit | edit source]
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 assesment. 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.
Types[edit | edit source]
The test is divided into 4 types and examine the different nerve.[1]
ULTT 1 for Median nerve, anterior interosseous nerve(C5,C6,C7).
ULTT 2 for Median nerve, musculocutaneous nerve, axillary nerve.
ULTT 3 for Radial nerve.
ULTT 4 for Ulnar nerve, C8,T1 nerve root.
Method to perform[edit | edit source]
Each test is done on normal side first. The order for positioning the joint first is shoulder followed by forearm, wrist, fingers and last by elbow. Each sensitizer is added until the pain is provoked or produced. To further sensitize the test side flexion of cervical spine can be added[4]. If the pain comes 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 the positioning into the test position or during addition of sensitization manoeuvres, particularly reproduction of neck, shoulder or arm symptoms , the test is positive; this confirms a degree of mechanical interference affecting neural structures.
All test are done in supine lying and while applying the shoulder depression it should be maintained even while applying shoulder abduction.
ULTT 1: for Median nerve, anterior interosseous nerve
Shoulder |
Depression and abduction (110 degree) |
Elbow |
Extension |
Forearm |
Supination |
Wrist |
Extension |
Fingers and thumb |
Extension |
Cervial spine |
Contralateral side flexion |
'ULTT 2': 'Median nerve, musculocutaneous nerve, axillary nerve
Shoulder |
Depression and abduction (10 degree) |
Elbow |
Extension |
Forearm |
Supination |
Wrist |
Extension |
Fingers and thumb |
Extension |
Shoulder |
Lateral rotation |
Cervial spine |
Contralateral side flexion |
ULTT 3:Radial nerve
Shoulder |
Depression and abduction (10 degree) |
Elbow |
Extension |
Forearm |
Pronation |
Wrist |
Flexion and ulnar deviation |
Fingers and thumb |
Flexion |
Shoulder |
Medial rotation |
Cervical spine |
Contralateral side flexion |
ULTT 4: Ulnar nerve
Shoulder |
Depression and abduction (10-90 degree) hand to ear |
Elbow |
Flexion |
Forearm |
Supination |
Wrist |
Extension and radial deviation |
Fingers and thumb |
Extension |
Shoulder |
Lateral rotation |
Cervical spine |
Contralateral side flexion |
BIKELE'S SIGN: Discovered by Evans[5]. In a seated position the patient abducts the shoulder to 90 degree with the elbow fully flexed. Extend the arm at shoulder level and then extend the elbow. If radicular pain results the test is positive.
Reliability and validity[edit | edit source]
The reliability and validity is different for different test which can be seen here.
References[edit | edit source]
- ↑ 1.0 1.1 Magee DJ.Orthopaedic physical assessment.5th edition.Elsevier publication.
- ↑ Elvey RL: The investigation of arm pain. In Boyling JD, Palastanga N (eds): Grieve’s modern manual therapy: the vertebral column, 2nd ed. Edinburgh, 1994, Churchill Livingstone.
- ↑ Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.
- ↑ Wells P: Cervical dysfunction and shoulder problems, Physiotherapy 68:66-73, 1982.
- ↑ Evans RC: Illustrated essentials in orthopaedic physical assessment, St Louis, 1994, Mosby-Year Books.