You are on page 1of 6

Manual Therapy 16 (2011) 125e130

Contents lists available at ScienceDirect

Manual Therapy
journal homepage: www.elsevier.com/math

Original article

Normal response to Upper Limb Neurodynamic Test 1 and 2A


Monika Lohkamp*, Katie Small
The University of Hull, Department of Sport, Health and Exercise Science, Cottingham Road, Hull HU6 7RX, UK

a r t i c l e i n f o a b s t r a c t

Article history: The aim of this study was to establish normal range of motion (ROM) and sensory responses to Upper
Received 22 September 2009 Limb Neurodynamic Test 1 (ULNT1) and ULNT2A, and to investigate gender and arm dominance inu-
Received in revised form ences. ULNT1 and ULNT2A without and with structural differentiation were tested on both arms of 90
24 February 2010
healthy participants. At end range the elbow angle was measured for ULNT1and the shoulder abduction
Accepted 19 July 2010
angle for ULNT2A. Participants reported where they felt a sensory response and the nature of response.
Results showed a wide range of ROM response. Structural differentiation (STD) signicantly (p < 0.01)
Keywords:
reduced ROM by 7 (ULNT1) and 10 (ULNT2A). Sensory response was felt more proximally during both
Median nerve
Gender
tests with STD. There was a statistically signicant difference of 2 in ROM during ULNT1 (p 0.01)
Arm dominance between dominant and non-dominant arm but not during ULNT2A (p > 0.05). Even though this
Sensory response difference is statistically signicant, it may not be clinically signicant. In the dominant arm less sensory
response was felt and in the non-dominant arm the response was more of neurogenic nature. Gender did
not signicantly (p > 0.05) inuence ROM or sensory response. These results strengthen the evidence
base for clinical practice how to evaluate outcomes from ULNTs.
2010 Elsevier Ltd. All rights reserved.

1. Introduction declare a test positive if symptoms are reproduced (Butler and


Gifford, 1989). Structural differentiation (STD) helps to determine
Neurodynamics has become increasingly popular as part of the if the response is caused by musculoskeletal or neural tissues
assessment and treatment of musculoskeletal injuries (Lewis et al., (Butler, 1989). There are different ways of performing STD for ULNTs
1998). Different tests were developed to assess movement and (e.g. ipsilateral lateralexion of cervical spine, shoulder girdle
mechanosensitivity of nerves with Upper Limb Neurodynamic Tests elevation, straight leg raise), however, in research most frequently
(ULNT) using specic techniques to bias for median, ulnar and contralateral lateralexion of the cervical spine is applied (Van der
radial nerve (Butler and Gifford, 1989). ULNT1 was rst described Heide et al., 2001; Coppieters et al., 2001a, 2002a). Before evalu-
by Elvey in 1979, with ULNT2A later developed as an alternative for ating tests in patients it is essential to have sound knowledge of the
patients unable to place their shoulders into the required position responses in healthy subjects. However, to date there is little
for ULNT1 (Butler, 1991). These tests are thought to add tensile research available providing this information.
stress to the median nerve (Butler and Gifford, 1989). During ULNT1 mean elbow extension angles of 169  14 which
Research has primarily focused on ULNT1 investigating its val- reduced to 144  16 with STD were reported (Coppieters et al.,
idity using cadavers (Lewis et al., 1998; Kleinrensink et al., 2000; 2001a,b; 2002b). The range of extension angles was between 137
Byl et al., 2002), its specicity and sensitivity to diagnose cervical and 185 reducing to 125 e177 with STD (Coppieters et al., 2002b)
radiculopathy (Wainner et al., 2003), the effect of different joint and a different source reported 120 e180 (Pullos, 1986). For
movements (Coppieters et al., 2001a, 2002a), or pain response (Van ULNT2A Reisch et al. (2005) reported mean shoulder abduction
der Heide et al., 2001).ULNT2A is less frequently researched and to angles of 36.7  8.5 (Trial 1) and 38.4  7.0 (Trial 2).
our knowledge only Reisch et al. (2005) investigated the reliability, Limited information is available regarding the area and nature of
range of motion (ROM), and sensory response. sensory response to ULNT1 and ULNT2A. Kenneally et al. (1988)
Clinicians evaluate neurodynamic tests using ROM and sensory reported a deep stretch/ache in the anterior elbow extending to
response (Butler and Gifford, 1989) by comparing sides and/or the hand in 80% of healthy subjects. Other responses were tingling
relating results to normal values (Nee and Butler, 2006). They also in the thumb, rst and second nger (77%) and 10% reported
a stretch along the anterior shoulder (Butler and Gifford, 1989).
With STD the response was felt more proximal to the elbow
* Corresponding author. Tel.: 44 1482 46 3621; fax: 44 1482 46 3855. (Coppieters et al., 2002a). Reisch et al. (2005) reported the response
E-mail address: m.lohkamp@hull.ac.uk (M. Lohkamp). to ULNT2A to be mostly pulling, burning and tingling felt at the

1356-689X/$ e see front matter 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.math.2010.07.008
126 M. Lohkamp, K. Small / Manual Therapy 16 (2011) 125e130

lateral hand (74%), lateral forearm (74%), cubital fossa (62%) and Table 1
lateral upper arm (7%). ICC, Standard error of measurement and smallest real difference.

When establishing normal values gender and/or arm dominance ULNT1 ULNT1 STD ULNT2A ULNT2A STD
could inuence results, however, limited research has investigated Dominant ICC 3 repeats 0.93 0.94 0.97 0.92
this. Pullos (1986) did not reveal gender differences when 100 SEM 2.18 3.94 1.65 4.33
healthy subjects were examined. Regarding the inuence of arm SRD 6.05 10.93 4.57 11.99
ICC 2 repeats 0.93 0.94 0.96 0.90
dominance, Owen and Brew (2000) reported a signicantly greater
SEM 2.32 3.91 1.96 4.77
elbow ROM (7 ; p < 0.05) in the dominant arm during ULNT1. SRD 6.42 10.83 5.42 13.21
Pullos (1986) similarly found a difference of 8 between both arms, Non-dominant ICC 3 repeats 0.92 0.87 0.95 0.93
however, this was not statistically signicant. Regarding ULNT2A, SEM 3.37 5.80 2.26 3.83
one assessor in the study by Reisch et al. (2005) measured a 9 SRD 9.33 16.09 6.26 10.62
ICC 2 repeats 0.91 0.86 0.96 0.95
increase in ROM in the dominant arm, although the second assessor SEM 3.48 6.02 2.05 3.24
did not nd a difference between arms. This discrepancy may be SRD 9.65 16.70 5.67 8.97
due to the poor (ICC 0.33) inter-tester reliability (Reisch et al.,
ICC Intra-class correlation coefcient, SEM Standard Error of Measurement,
2005). This conicting research shows the need for additional SRD Smallest Real Difference.
supporting evidence that the non-affected arm can be used as
reference for evaluating tests.
One aim of this study was to investigate differences between keep testing time and response to a minimum, tests were repeated
gender, arm dominance, and STD in response to ULNT1 and ULNT2A twice for the main study.
in normal subjects. Prior to this, the reliability of two and three Upper limb bony landmarks (ulnar styloid process, medial epi-
repeated measurements of both, ULNT1 and ULNT2A was estab- condyle of the humerus, and anterior aspect of the acromion
lished. The second aim was to investigate sensory response to process) were marked to use as reference points for the joint angle
ULNT1 and ULNT2A in terms of frequency and nature of response in measurements. To measure joint angles a goniometer (Lafayette
different areas. Differences in sensory response depending on arm Instrument Co., IN, USA) was used, with the display not visible for
dominance and gender were also examined. the investigator during measurements to avoid bias. For the elbow
angle the axis was placed on the medial epicondyle with the
stationary arm pointing to the acromion and the moving arm to the
2. Methods
ulnar styloid process. Shoulder abduction angle was measured by
placing the axis on the acromion, with the stationary arm aligned
2.1. Participants
parallel to the sternum and the moving arm aligned with the ulnar
styloid process.
Inclusion criteria for the study were: aged 18e50 years and free
For all tests participants lay supine, without a pillow, arms along
from upper limb and/or neck injury within the last three months.
the body and legs straight. Tests were carried out slowly and
Subjects were excluded if they reported any contra-indications
participants were instructed to indicate the point where it was too
and/or precautions (Butler, 1991). Arm dominance was recorded
uncomfortable to continue with the movement (point of pain
and dened as the hand they write with.
tolerance), where angle measurements were taken. Once the test
Twenty participants (10 female, 10 male) were recruited to
was released, the location and nature of sensory response was
assess reliability the elbow extension angle during ULNT1 and
marked on a body chart. Participants were asked as an open
shoulder abduction angle for ULNT2A. Their mean age  standard
question about the nature of sensory response but if difculties
deviation (range) was 27.9  6.2 years (20.0e40.0 years).
nding a descriptor arose they were prompted with the following:
For the main study 90 participants (22.9  6.0 years; range:
stretch, pain, tingling, pins and needles, numbness, and burning.
18.0e49.0 years) from a convenient sample of 100 sport science
Multiple responses to both, area and nature of sensation were
students were included. Ten subjects were excluded due to
allowed.
previous repeated shoulder (sub)luxations. Forty female (age:
The starting position for ULNT1 was 90 abduction and 90
22.3  5.3 years; range: 18e49 years; 85% right-handed) and 50
external rotation of the shoulder, 90 elbow exion, forearm
male participants (23.4  6.5 years; range: 18.0e40.0 years; 88%
supination, and maximum extension of wrist and ngers. One hand
right-handed) completed the study of which 77% regularly took
of the investigator was placed on the scapula to prevent elevation,
part in different sports (e.g. football, running, hockey, lacrosse,
the other hand maintained nger extension. Then the elbow was
cricket, swimming).
slowly extended until the point of pain tolerance and the elbow
angle was measured.
2.2. Procedure For ULNT2A the participant moved to the side of the plinth and
the investigator depressed the shoulder with her thigh. The starting
Ethical approval was granted by the Departmental Ethics position of the arm was no shoulder abduction, shoulder external
Committee from the University of Hull. All participants read an rotation, elbow extension and supination, maximum wrist and
information sheet and signed an informed consent form prior to nger extension. One hand of the investigator ensured nger and
the study. wrist extension, the other elbow extension. From this position, the
For both, the reliability and main study, ULNT1 and ULNT2A arm was slowly abducted until the point of pain tolerance where
were carried out without and with STD on both arms. Test order the angle was measured. When the tests with STD were carried out
was determined randomly and participants had a break (10 min) the participants head was placed in maximum contralateral lateral
mid-testing to ensure that they did not feel persisting response in exion without causing discomfort, followed by ULNT1 or ULNT2A.
the upper limb. All tests were carried out by one investigator (ML)
and measurements conducted by another (KS). 2.3. Data analysis
For the reliability study each test was repeated three times with
30 s rest in between. The results showed that measurements were Reliability of two and three measurements was calculated with
equally reliable when repeated twice or three times (Table 1). To an Intra-class correlation coefcient (ICC (2,1)). The standard error
M. Lohkamp, K. Small / Manual Therapy 16 (2011) 125e130 127

of measurement (SEM) was calculated using the formula 3.1. 3-way repeated measure ANOVA
SEM SD  O(1-ICC) (Weir, 2005) and the smallest real difference
(SRD) by using the formula 1.96  O2  SEM (Beckerman et al., 2001). Results for ULNT1 and ULNT2A did not reveal any interaction
For the main study mean joint angles from the two measure- effect between the three factors (arm dominance, STD and gender)
ments were calculated and used for further analysis. Normal or between any two of the three factors.
distribution QeQ plots showed that data was normally distributed. There was a statistically signicant difference between ULNT1
Descriptive statistics for elbow extension (ULNT1) and shoulder and ULNT1 with STD (143.0  9.9 ; 136.6  11.0 ; p < 0.01) and
abduction (ULNT2A) angles for both arms were reported as mean, for ULNT2A and ULNT2A with STD (72.0  21.7 ; 62.2  17.9 ;
standard deviation (SD) and range. Gender, arm dominance and p < 0.01). The ANOVA revealed a statistically signicant difference
STD were independent variables when applying a 3-way repeated between both arms (dominant: 139.8  10.9 ; non-dominant:
measure ANOVA for ROM during ULNT1 and ULNT2A. 137.9  12.3 ; p 0.01) for ULNT1 but not ULNT2A, and no gender
After data collection all sensory responses were collated on a body differences for either test.
chart and for analysis the body chart was divided into 14 areas where
subjects reported sensory response (Fig. 1). Frequency of sensation in 3.2. Sensory response
the different areas was counted as present or not regardless its nature.
Differences in frequency of response between the tests, addition of Every subject reported a sensory response and the nature of
STD, and arm dominance were investigated using a McNemar test. response tted the six given descriptors. The frequency of
Gender differences were analysed applying a Chi2 test. responses in the different areas for both arms is shown in Table 3.
The nature of sensation was divided into six categories: stretch, The main ndings were that during ULNT2A a sensory response
pain, tingling, pins and needles, numbness, and burning. The was felt more frequently compared to ULNT1, the response was felt
frequency of nature of sensory response between ULNT1 and more proximally with STD and more responses were felt in the
ULNT2A without and with STD was compared as well as gender and non-dominant arm. Gender did not signicantly inuence the
arm dominance differences. sensory response for most tests.
All statistical calculations were carried out using SPSS version Fig. 2 shows the nature of sensory response in the dominant and
16.0 and the level of signicance was set at a < 0.05. Fig. 3 that of the non-dominant arm. The results are reported as
a percentage from all given descriptors. The most frequently
3. Results reported response was stretch (58e63%), followed by pain
(20e27%) and tingling (8e11%). All other descriptors accounted for
Descriptive statistics for elbow extension (ULNT1) and shoulder less than 10%. In the dominant arm (Fig. 2) more frequently pain,
abduction angles (ULNT2A) are presented in Table 2. tingling and pins and needles were reported during ULNT2A than

Fig. 1. Body chart divided in 14 areas where sensory response was felt.
128 M. Lohkamp, K. Small / Manual Therapy 16 (2011) 125e130

Table 2
Descriptive statistics for Range of Motion results during ULNT1 and ULNT2A.

Test Dominant arm Mean  SD (Range) Non-dominant arm Mean  SD (Range)

All Female Male All Female Male


ULNT1 143.0  10.0 144.0  10.2 142.2  9.8 141.1  12.3 141.0  14.2 141.2  10.7
(117.5 e170.5 ) (127.0 e170.5 ) (117.5 e164.5 ) (112.5 e167.5 ) (118.0 e167.5 ) (112.5 e159.0 )
ULNT1 with STD 136.6  10.9 138.4  12.2 135.1  9.7 134.7  12.3 136.0  13.8 133.7  11.0
(117.0 e169.0 ) (117.0 e169.0 ) (118.0 e155.0 ) (106.0 e164.0 ) (110.0 e164.0 ) (106.0 e155.5 )
ULNT2A 72.0  21.7 70.0  24.2 73.6  19.5 71.6  20.7 69.2  22.2 73.6  19.5
(30.5 e119.0 ) (30.5 e119.0 ) (42.0 e113.5 ) (31.0 e116.0 ) (31.0 e112.0 ) (45.0 e116.0 )
ULNT2A with STD 62.2  17.9 61.0  20.4 63.1  15.9 63.5  19.0 60.2  19.8 66.1  18.2
(30.5 e115.0 ) (30.5 e115.0 ) (34.5 e107.5 ) (27.0 e118.0 ) (27.0 e118.0 ) (35.0 e105.0 )

ULNT1. Adding STD to ULNT1 or ULNT2A reduced the frequency of ULNT1 in the present study was 118 e171, similar to that of
stretch response and an increase in pain. In the non-dominant arm, 120 e180 reported by Pullos (1986) and slightly lower than the
during ULNT1 more frequently stretch, numbness and burning was 137 e185 stated by Coppieters et al. (2002b). For ULNT2A the
reported compared to ULNT2A where pain was more frequently present study reported a mean value of 72  21 abduction
named. Adding STD to ULNT1 and ULNT2A in the non-dominant ranging from 31 to 118 . The mean and SD is nearly twice as high
arm resulted in an increase in pain sensation, and in ULNT1 less as that of 36.7  8.5 previously reported by Reisch et al. (2005).
frequently sensations of burning, numbness and pins and needles The test protocols were similar between the studies, however,
were noticed. During ULNT2A with STD less tingling, but more pins Reisch et al. (2005) used different landmarks to measure the
and needles and burning sensations were reported. abduction angle which might explain some of the difference. Also,
Reisch et al. (2005) might have applied a different level of shoulder
4. Discussion depression than the present study which might have contributed to
the different results. The wide range of normal values found in this
The results from this study showed a wide range of normal study together with previous literature strengthen the reasoning
values for both ULNT1 and ULNT2A without and with STD. Arm behind the clinical practice of not solely evaluating tests by
dominance inuenced ROM for ULNT1 only, whereas gender had no comparing ndings to normative values but also compare sides and
inuence for either test. As expected, STD signicantly reduced take symptom response into consideration.
ROM for ULNT1 and ULNT2A. It was expected that the mean ROM for both tests would be
In the present study the mean elbow ROM for ULNT1 was 26 reduced with STD as this elongates the nervous system more,
less than that reported by Coppieters et al. (2001a,b, 2002b) and 7 therefore reducing the nerve movement (Byl et al., 2002). Previous
less for ULNT1 with STD. The discrepancy in results may be linked studies reported a reduction of the mean angle for ULNT1 of 17
to methodological or subject differences. Coppieters et al. (2001a,b, (Coppieters et al., 2002a) and 25 (Coppieters et al., 2001b, 2002b),
2002b) placed the wrist in 70 extension, used and electro- far higher than the 7 observed in the present study. Coppieters
goniometer for angle measurements and included a lower number et al. (2001b, 2002a,b) standardised the degree of cervical exion
(n 35) of male participants with a more narrow age range whereas in the present study the participants were instructed to
compared to the present study. The range of elbow extension for move as far as it was comfortable. This methodological difference

Table 3
Frequency of sensory response in the different areas for the dominant and non-dominant arm.

Dominant Non-dominant

Area ULNT1 ULNT1 STD ULNT2A ULNT2A STD ULNT1 ULNT1 STD ULNT2A ULNT2A STD
1 14a 13g 21a,d 13d,h 16 19g 21 21h
2 7 5 4 4 5 8 3 2
3 21a,e 20 33a,d,f 18d,h 32b,e 24b 26f 25h
4 18a,e 16 27a,d,f 17d 27b,e 16b 21f 19
5 23a,b 31b 38a,d,f 25d,h 29a 26 22a,d,f 33d,h
6 47a,e 53c 57a,d 47c,d,h 57e 49c 58 64c,h
7 23a,b 33c,b 29a 24c 19a,b 30a,b 28 25
8 4a,b 14b 11a 17 7b 17b 8 13
9 0 4 0 4 5 2 0 4
10 3 6 3d 9d,h 5 5c 0d 17c,d,h
11 1 0 1 2 5 2 1 0
12 3e 4 3d 8d 10b,e 6b 7 6
13 3e 3 6 2 9e 3 5 9
14 0 0 1 0 4 2 1 2
Total 167 202 234 190 230 209 201 240
a
Statistically signicant difference (p < 0.05) between ULNT1 and ULNT2A.
b
Statistically signicant difference (p < 0.05) between ULNT1 and ULNT1 with STD.
c
Statistically signicant difference (p < 0.05) betweenULNT1 with STD and ULNT2A with STD.
d
Statistically signicant difference (p < 0.05) between ULNT2A and ULNT2A with STD.
e
Statistically signicant difference (p < 0.05) between dominant and non-dominant arm for ULNT1.
f
Statistically signicant difference (p < 0.05) between dominant and non-dominant arm for ULNT2A.
g
Statistically signicant difference (p < 0.05) between dominant and non-dominant arm for ULNT1 with STD.
h
Statistically signicant difference (p < 0.05) between dominant and non-dominant arm for ULNT2A with STD.
M. Lohkamp, K. Small / Manual Therapy 16 (2011) 125e130 129

Gender did not inuence the results from the present study for
both, ULNT1 and ULNT2A which is in accordance with Pullos
(1986). This nding indicates that normative values obtained
from mixed gender samples are valid to be used for females and
males equally.
A clear pattern of frequency and nature of sensory response
could not be established for all tests due to high variation. Overall
the areas of sensory response corresponded with those reported by
Kenneally et al. (1988) and Butler and Gifford (1989) who stated the
highest frequency of response to be felt in the area of anterior
elbow extending to the hand. The present study also found
responses in the area of posterior arm and shoulder. These areas are
more extensive than the sensory distribution of the median nerve
which may suggest that sensory response during ULNT1 originates
from the nerve roots rather than the peripheral nerve.
Fig. 2. Nature of sensory response of the dominant arm. Similar areas of response were observed between ULNT1 and
ULNT2A, however, sensory response was reported more frequently
might have resulted in less lateral exion in the present study, during ULNT2A. The nature of response was moreneurogenic
explaining the lower reduction. Armstrong et al. (1998) found that (i.e. pins and needles, burning, tingling) during ULNT2A compared
a change of 7 elbow extension is necessary to be 95% condent to ULNT1. This may indicate that during ULNT2A changes in the
that this change is not due to measurement error. In the present mechanosensitivity of the nerve root may produce sensory
study the SRD was found to be 10.8 (dominant) and 16.7 (non- response and that during ULNT1 other structures, such as muscles,
dominant arm) therefore it could be questioned whether this can be responsible for this. It was shown that the activity of
reduction was caused by STD or measurement error. trapezius, biceps and pectoralis major muscles increased when
No previous study has reported changes in shoulder abduction extending the elbow during ULNT1, indicating a protective mech-
range with STD during ULNT2A. The present results showed anism of the nerves from tensile forces which could cause a sensory
a reduction of 8 for the non-dominant and 10 for the dominant response of stretch (Jaberzadeh et al., 2005).
arm. The SRD for ULNT2A with STD was 9 and 13 for the non- Adding STD to ULNTs increases the tension in the median nerve
dominant and dominant arm, respectively, therefore, the changes (Byl et al., 2002), resulting in reduced ROM (Coppieters et al.,
with STD may not be caused by the addition of STD but 2001a,b) and might change the sensory response. Results showed
by measurement error. Maybe using a different movement that with STD the frequency of response signicantly increased in
(e.g. shoulder elevation) as STD would produce different results and the areas proximal and decreased distal to the elbow which is in
might be more appropriate to use in clinical practice. More research accordance with ndings from Coppieters et al. (2002A). This
should be carried out to establish more supporting evidence for observation might be caused by either increased tensile force of the
clinical application of STD. nerve, causing decreased circulation (Ogata and Naito, 1986) or by
To determine if a test is positive or not bilateral comparison is a change in trapezius activity due to lengthening of the muscle (Van
recommended in clinical practice (Nee and Butler, 2006). Current der Heide et al., 2001).
ndings indicate a signicant difference in ROM between both arms The present study found a difference in sensory response
for ULNT1 which clinicians should take into consideration when between the dominant and non-dominant arm which needs to be
evaluating results. However, only a 2 difference was observed taken into consideration by clinicians when evaluating the tests.
which may not be clinically signicant and considering the SRD of 6 During ULNT1 with and without STD and ULNT2A with STD sensory
(dominant arm) and 9 (non-dominant arm) these results might be responses were reported more frequently in the non-dominant.
due to measurement error.Owen and Brew (2000) and Pullos (1986) This may be due to less frequent and maybe reduced movement of
found a difference of 8 which was claimed to be statistically the non-dominant arm during daily living, thus, making the nerves
signicant by Owen and Brew (2000) and non-signicant by Pullos more sensitive to stretch. This might also explain the more frequent
(1986). These conicting results show the need for further research neurogenic sensation in the non-dominant arm.
in this area to be able to give clear recommendations to clinicians. The most frequently reported nature of response during all tests
was a stretch followed by pain. Participants frequently reported
painful stretch which was analysed as pain and stretch separately
and may explain the high prevalence of these responses. These
results are in accordance with ndings by Kenneally et al. (1988) who
stated that up to 99% of participants felt a stretch during ULNT1. They
also reported a response up to 77% to be tingling in compared with
around 10% in the present study. The addition of STD did not
consistently change the nature of sensory response in the present
study which might be linked to the chosen method of STD. The lack of
neurogenic responses in the present study might be because healthy
subjects were included and therefore the point of pain tolerance was
not determined by neural tissues but by other tissues causing
a stretch or painful response. Moses and Carman (1996) demon-
strated that nerves attach to vertebral bodies, intervertebral discs
and the posterior longitudinal ligament which may also be the cause
the pain. To date it is not clear which anatomical structures cause the
end range and sensory response during ULNT1 and ULNT2A in
Fig. 3. Nature of sensory response of the non-dominant arm. healthy subjects which should be investigated further.
130 M. Lohkamp, K. Small / Manual Therapy 16 (2011) 125e130

5. Conclusion Coppieters MW, Stappaerts KH, Everaert DG, Staes FF. Addition of test components
during neurodynamic testing: effect on range of motion and sensory responses.
Journal of Orthopaedic & Sports Physical Therapy 2001a;31(5):226e37.
The results of the present study provide more evidence for large Coppieters MW, Stappaerts KH, States FF, Everaert DG. Shoulder girdle elevation
individual differences as response (ROM and sensory) to ULNT1 and during neurodynamic testing: an assessable sign? Manual Therapy 2001b;6
ULNT2A which highlights the need for bilateral comparison. (2):88e96. doi:10.1054/math.2000.0375 [accessed 7.10.09].
Jaberzadeh S, Scutter S, Nazeran H. Mechanosensitivity of the median nerve and
However, there are differences in ROM, frequency and nature of mechanically produced motor responses durin g Upper Limb Neurodynamic
sensory response between the dominant and non-dominant arm Test 1. Physiotherapy 2005;91:94e100. doi:10.1016/j.physio.2004.09.021
which can be normal and need to be acknowledged by the clinician [accessed 7.10.09].
Kenneally M, Rubenach H, Elvey R. The upper limb tension test: the SLR test of the
when evaluating results from neurodynamic tests. arm. In: Grant R, editor. Physical Therapy of the cervical and Thoracic spine.
Sensory response in healthy subjects does not only occur in the New York: Churchill Livingstone; 1988. p. 167e94. ch10.
area of median nerve distribution but also in other areas of the arm. Kleinrensink GJ, Stoeckart R, Mulder PG, Hoek G, Broek Th, Vleeming A, et al. Upper
limb tension tests as tools in the diagnosis of nerve and plexus lesions.
The nature of response in healthy subjects was mainly a stretch and Anatomical and biomechanical aspects. Clinical Biomechanics 2000;15
pain, therefore not predominantly neurogenic and hence the (1):9e14.
source of sensory response in healthy subjects might not be solely Lewis J, Ramot R, Green A. Changes in Mechanical Tension in the Median Nerve:
possible implications for the upper limb tension test. Physiotherapy 1998;84
nervous tissue. (6):254e61.
Moses A, Carman J. Anatomy of the cervical spine: implications for the upper limb
References tension test. Australian Journal of Physiotherapy 1996;42(1):31e5.
Nee RJ, Butler D. Management of peripheral neuropathic pain: integrating neuro-
biology, neurodynamics and clinical evidence. Physical Therapy in Sport
Armstrong AD, MacDermid JC, Chinchalkar S, Stevens RS, King GJW. Reliability of
2006;7:36e49. doi:10.1016/j.ptsp.2005.10.002 [accessed 20.08.09].
range eof-motion measurement in the elbow and forearm. Journal of Shoulder
Ogata K, Naito M. Blood ow of peripheral nerve effects of dissection, stretching
and Elbow Surgery 1998;6(7):573e80.
and compression. Journal of Hand Surgery 1986;11(1):10e4.
Beckerman H, Roebroeck ME, Lankhorst GJ, Becher JG, Bezemer PD, Verbeek ALM.
Owen TJ, Brew J. A single Blind Investigation into the potential differences in Passive
Smallest real difference, a link between reproducibility and responsiveness.
range of movement at the elbow, between dominant and non-dominant arm
Quality of Life Research 2001;10:571e8.
when using the upper limb tension test 1. Physiotherapy 2000;86(1):40.
Butler DS. Adverse mechanical tension in the nervous system: a model for
Pullos J. The upper limb tension test. The Australian Journal of Physiotherapy
assessment and treatment. Australian Journal of Physiotherapy 1989;35
1986;32(4):258e9.
(4):227e38.
Reisch R, Williams K, Nee RJ, Rutt RA. ULNT2 e Median nerve bias: examiner
Butler DS. Mobilisation of the nervous system. Edinburgh: Churchill Livingsone;
reliability and sensory responses in Asymptomatic subjects. The Journal of
1991. ch5, pp. 104e106.
Manual & Manipulative Therapy 2005;13(1):44e55.
Butler D, Gifford L. The concept of adverse mechanical tension in the nervous
Van der Heide B, Allison GT, Zusman M. Pain and muscular responses to a neural
system. Physiotherapy 1989;75(11):622e9.
tissue provocation test in the upper limb. Manual Therapy 2001;6(3):154e62.
Byl C, Puttlitz C, Byl N, Lotz J, Topp K. Strain in the median and ulnar nerves during
doi:10.1054/math.2001.0406 [accessed 20.08.09].
upper-extremity positioning. The Journal of Hand Surgery 2002;27A:1032e40.
Wainner R, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, AllisonReliability S, et al.
Coppieters MW, Stappaerts K, Janssens K, Jull G. Reliability of detecting onset of
Accuracy of the clinical Examination and patient Self-Report measures for
pain and submaximal pain during neural provocation testing of the upper
cervical radiculopathy. Spine 2003;28(1):52e62.
quadrant. Physiotherapy Research International 2002a;7(3):146e56.
Weir JP. Quantifying rest-retest reliability using the intraclass Correlation coef-
Coppieters MW, van de Velde M, Stappaerts KH. Positioning in anesthesiology.
cient and the SEM. Journal of Strength and Conditioning Research 2005;19
Towards a better understanding of stretch-induced perioperative neuropathies.
(1):231e40.
Anesthesiology 2002b;97:75e81.

You might also like