Neurodynamic Assessment: Difference between revisions

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{{#ev:youtube|TjzYFzvBToE|400}} Physiotutors. Prone Knee Bending Test| Reverse Lasègue Test | Lumbar Radiculopathy. Available from: https://www.youtube.com/watch?v=TjzYFzvBToE
{{#ev:youtube|4VxKyPRq6HA}}Physiotutors.Reversed Lasègue orProne Knee Bending Test. Available from: https://www.youtube.com/watch?v=4VxKyPRq6HA




Revision as of 20:49, 28 September 2017

Original Editor- TheOpen Physioproject.

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Introduction[edit|edit source]

Aneurodynamic assessmentevaluates 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 ofneurodynamic assessment. The main reason for using a ULTT is to check cervical radiculopathy. These tests are both diagnostic and therapeutic. Once the diagnosis ofcervical radiculopathyis 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]

The following video shows ULTT1-4:

[5]

Upper Limb Tension Test 1 (ULTT1, Median nerve bias)[edit|edit source]

  1. Shoulder girdle depression
  2. Shoulder abduction
  3. Shoulder external rotation
  4. Forearm Supination
  5. Wrist and Finger extension
  6. Elbow extension
  7. Cervical side flexion


Seeherefor more info on this test.

Upper Limb Tension Test 2A (ULTT2A, Median nerve bias)[edit|edit source]

  1. Shoulder girdle depression
  2. Elbow extension
  3. Lateral rotation of the whole arm
  4. Wrist, finger and thumb extension

Upper Limb Tension Test 2B (ULTT2B, Radial nerve bias)[edit|edit source]

  1. Shoulder girdle depression
  2. Elbow extension
  3. Medial rotation of the whole arm
  4. Wrist, finger and thumb flexion

上肢张力测试3 (ULTT3,尺神经的偏见)[edit|edit source]

  1. Shoulder girdle depression
  2. Shoulder abduction
  3. Shoulder external rotation
  4. Wrist and Finger extension
  5. Elbow flexion
  6. Shoulder abduction

Musculocutaneous Nerve Tension Test (ULTT musculocutaneous)[edit|edit source]

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

Lower Limb Nerve Tension Tests[edit|edit source]

Slump Test (entire nervous system)[edit|edit source]

  1. Hands behind back
  2. Thoracic flexion
  3. Extend one knee
  4. Dorsiflex foot of extended knee
  5. Cervical flexion
[6]

Femoral Nerve Tension Test[edit|edit source]

  1. Patient is lying in prone position
  2. Affected side: Full knee flexion and maintains position for 45s
  3. If full knee flexion cannot be performed, the hip may be brought into extenstion to futher stress the femoral nerve and nerve roots L2-L4
  4. Postitive test: Shooting pain or reproduction of patient's symptoms



Seeherefor more info on this test.
[7]

Straight Leg Raise (Sciatic nerve)[edit|edit source]

  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. Neck flexion (SC, meninges and sciatic nerve)


Seeherefor more info on this test.
[8]

Reliability and validity[edit|edit source]

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


Presentations[edit|edit source]

https://youtu.be/QuPVnj7XPjY Neurodynamics - upper examination presentation title.png
不良的神经动力学——上肢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.

不良的神经动力学——上肢Examination/ View the presentation
https://youtu.be/BfX65uOkLg0 Neurodynamics - treatment for neck and arm pain presentation title.png
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 (fromPubmed)[edit|edit source]

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References[edit|edit source]

  1. ↑Magee DJ.Orthopaedic physical assessment.5th edition.Elsevier publication.
  2. ↑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.
  3. ↑Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.
  4. ↑Wells P. Cervical dysfunction and shoulder problems. Physiotherapy, 1982; 68: 66-73.
  5. ↑Physiotutors. All Upper Limb Tension Tests | ULTT | ULNT. Available from:https://www.youtube.com/watch?v=rir6x6Iiqc4
  6. ↑Physiotutors. The Slump Test | Neurodynamic Testing. Available from:https://www.youtube.com/watch?v=HFGfP84uwEo
  7. ↑Physiotutors. Reversed Lasègue or Prone Knee Bending Test. Available from:https://www.youtube.com/watch?v=4VxKyPRq6HA
  8. ↑Physiotutors. Straight Leg Raise or Lasègue's Test for Lumbar Radiculopathy. Available from:https://www.youtube.com/watch?v=LdAD9GNv8FI
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