Neurodynamic Assessment

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Introduction

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.These tests are designed to put stress on neurological structures of upper limb. These tests were first described by Elvey 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) 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

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

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. 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.

Upper Limb Nerve Tension Tests

Upper Limb Tension Test 1 (ULTT1, Median nerve bias)

Shoulder girdle depression Shoulder joint abduction Forearm supination Wrist and finger extension Shoulder joint laterally rotated Elbow extension See here for more info on this test.

Upper Limb Tension Test 2A (ULTT2A, Median nerve bias)

Shoulder girdle depression Elbow extension Lateral rotation of the whole arm Wrist, finger and thumb extension

Upper Limb Tension Test 2B (ULTT2B, Radial nerve bias)

Shoulder girdle depression Elbow extension Medial rotation of the whole arm Wrist, finger and thumb flexion

Upper Limb Tension Test 3 (ULTT3, Ulnar nerve bias)

Wrist and finger extension Forearm pronation Elbow flexion Shoulder girdle depression Shoulder lateral rotation Shoulder abduction

Musculocutaneous Nerve Tension Test (ULTT musculocutaneous)

Shoulder girdle depression Elbow extension Shoulder extension Ulnar deviation of the wrist with thumb flexion Either medial or lateral rotation of the arm could further sensitize this nerve

Lower Limb Nerve Tension Tests

Slump Test (entire nervous system)

Hands behind back Thoracic flexion Extend one knee Dorsiflex foot of extended knee Cervical flexion Extend other leg with cervical flexion

Femoral Nerve Tension Test

Side lying on unaffected side Unaffected side: grasping knee in full hip flexion Affected side: passive hip extension with full knee flexion Thoracic and cervical spine flexed Cervical extension is the desensitizing test

NOTE: Test starts at 1:04!

Straight Leg Raise (Sciatic nerve)

1. Supine
2. Medial hip rotation, then flexion, with knee extended
3. Ankle dorsiflexion (tibial nerve)
4. Ankle plantarflexion and foot inversion (common peroneal nerve)
5. Hip adduction (sciatic nerve)
6. Increasing hip medial rotation (sciatic nerve)
7. Passive neck flexion (SC, meninges and sciatic nerve)

Reliability and validity

The reliability and validity is different for different test which can be seen here.

Presentations

Adverse Neural Dynamics - Upper Extremity Examination This presentation, created by Jason Grandeo, as part of the Evidence in Motion OMPT Fellowship, reviews 1) the biomechanical and pathophysiological properties of nerve,2) the indications for using upper-limb neurodynamic tests, 3) normal sensory responses for each of the upper limb neurodynamic tests, 4) the validity of the upper limb neurodynamic tests, and 5) positive findings with upper limb neurodynamic tests. Adverse Neural Dynamics - Upper Extremity Examination/ View the presentation

Adverse Neural Dynamics - Treatment considerations for neck and arm pain This presentation, created by Jason Grandeo, as part of the Evidence in Motion OMPT Fellowship, 1) reviews the current literature on treating adverse neural dynamics in the upper extremity, 2) describes interventions used to treat individuals with positive neural dynamic tests for median, ulnar and radial nerves, and 3) discusses the need for future research to guide physical therapist clinical reasoning when treating individuals presenting with signs of adverse neural dynamics in the upper extremity. Adverse Neural Dynamics - Treatment considerations for neck and arm pain/ View the presentation

Recent Related Research (from Pubmed)

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