Tension of the Ulnar, Median, and Radial Nerves During Ulnar Nerve Neurodynamic Testing: Observational Cadaveric Study

Nicole Manvell; Joshua J. Manvell; Suzanne J. Snodgrass; Susan A. Reid

doi:10.2522/ptj.20130536

Figures

Figure 1.

Anterior and lateral views of 2 variations of the current neurodynamic test for the ulnar nerve (ULNT3: scapular depression, shoulder abduction and external rotation, elbow flexion, forearm pronation, and wrist and finger extension). (A) and (B): the current test with addition of horizontal abduction (ULNT3+H.Abd); (C) and (D) the current test with the addition of horizontal abduction and internal rotation (ULNT3+H.Abd+IR). Arrows illustrate the direction of the additional horizontal abduction away from the mid-transverse plane.

Figure 2.

The 3 buckle force transducers in situ attached (from left to right) to the median, ulnar, and radial nerves in the axilla.

Figure 3.

Schematic of the buckle force transducer with a nerve segment.

Tables

Table 2.

Intrarater and Interrater Reliability, SEM, and SDD₉₅ of Tension Measurements for the 5 Neurodynamic Test Positions for the Ulnar Nerve^{^a}

↵^a ULNT3=ulnar nerve upper limb neurodynamic test (scapular depression, abduction and external rotation, elbow flexion, forearm pronation, and wrist and finger extension) as described by Butler¹⁰; ULNT3+IR=ULNT3 with internal rotation; ULNT3+Sup=ULNT3 with forearm supination; ULNT3+H.Abd=ULNT3 with horizontal abduction; ULNT3+H.Abd+IR=ULNT3 with horizontal abduction and internal rotation; ICC=intraclass correlation coefficient; 95% CI=95% confidence interval; SEM=standard error of measurement; SDD₉₅=smallest detectable difference at 95% CI. The second examiner did not record data for ULNT3+IR and ULNT3+Sup.

Table 1.

Five Upper Limb Positions Used to Compare Tension in the Nerves of the Upper Limb^{^a}

↵^a ULNT3=ulnar nerve upper limb neurodynamic test (scapular depression, abduction and external rotation, elbow flexion, forearm pronation, and wrist and finger extension) as described by Butler¹⁰; ULNT3+IR=ULNT3 with internal rotation; ULNT3+Sup=ULNT3 with forearm supination; ULNT3+H.Abd=ULNT3 with horizontal abduction; ULNT3+H.Abd+IR=ULNT3 with horizontal abduction and internal rotation. Movements in bold font have been added to the end position of ULNT3.

Table 3.

Tension (in Newtons) of the Ulnar, Median, and Radial Nerves and Mean Differences in Tension Among the Nerves for Each of the 5 Test Positions^{^a}

↵^a Measurements are expressed as mean (SD) [95% confidence interval]. ULNT3=ulnar nerve upper limb neurodynamic test (scapular depression, abduction and external rotation, elbow flexion, forearm pronation, and wrist and finger extension) as described by Butler⁹; ULNT3+IR=ULNT3 with internal rotation; ULNT3+Sup=ULNT3 with forearm supination; ULNT3+H.Abd=ULNT3 with horizontal abduction; ULNT3+H.Abd+IR=ULNT3 with horizontal abduction and internal rotation.
^b Significantly different mean tension (P≤.01) in this position than in ULNT3.
^c Significantly different tension (P<.05) between 2 nerves (eg, ulnar and median) for a given position (eg, ULNT3).