Article

The ulnar nerve upper limb neurodynamic test (ULNT3)
uses upper limb
positioning to investigate symptoms arising from the ulnar nerve. It is proposed
to selectively increase tension of the nerve; however, this property of the test
is not well established. The aim of this study was to determine the
upper limb position that results in: (1) the greatest tension of the ulnar nerve
and (2) the greatest difference in tension between the ulnar nerve and the other
2 major nerves of the upper limb: median and radial. This was an
observational cadaver study. METHODS: Tension (in newtons) of the ulnar, median,
and radial nerves was measured simultaneously using 3 buckle force transducers in
5 upper limb positions in 10 embalmed human cadavers
(N=20 limbs).
Repeated-measures analysis of variance (ANOVA) with Bonferroni post hoc tests
determined differences in tension among nerves and among limb positions. RESULTS:
The addition of shoulder horizontal abduction (H.Abd; 12.62 N; 95% confidence
interval [95% CI]=10.76, 14.47) and combined shoulder abduction and internal
rotation (H.Abd+IR; 11.86 N; 95% CI=9.96, 13.77) to ULNT3 (scapular depression,
shoulder abduction and external rotation, elbow flexion, forearm pronation, and
wrist and finger extension) produced significantly greater ulnar nerve tension
compared with the ULNT3 alone (8.71 N; 95% CI=7.25, 10.17). The ULNT3+H.Abd test
demonstrated the greatest difference in tension among nerves (mean difference
between ulnar and median nerves=11.87 N; 95% CI=9.80, 13.92; mean difference
between ulnar and radial nerves=8.47 N; 95% CI=6.41, 10.53). LIMITATIONS: These
results pertain only to the biomechanical plausibility of the ulnar nerve
neurodynamic test and do not account for other factors that may affect the
clinical application of this test. CONCLUSIONS:
The ULNT3+H.Abd is a
biomechanically plausible test for detecting peripheral neuropathic pain related
to the ulnar nerve. In situations where the shoulder complex will not tolerate
the combination of shoulder external rotation in abduction, performing upper limb
neurodynamic tests with internal rotation instead of external rotation is a
biomechanically plausible alternative.
CI - (c) 2015 American Physical Therapy Association.

Langue : ANGLAIS