Journal of Hand Therapy
Volume 22, Issue 4 , Pages 344-354 , October 2009

Upper Limb Neurodynamic Test of the Radial Nerve: A Study of Responses in Symptomatic and Asymptomatic Subjects

  • Cheryl M. Petersen, PT, DPT, DHS

      Affiliations

    • Corresponding Author InformationCorrespondence and reprint requests to Cheryl M. Petersen, PT, DPT, DHS, Concordia University Wisconsin, 12800 North Lake Shore Drive, Mequon, WI 53097

References 

  1. Dilley A, Lynn B, Pang SJ. Pressure and stretch mechanosensitivity of peripheral nerve fibres following local inflammation of the nerve trunk. Pain. 2005;117(3):462–472
  2. Greening J, Dilley A, Lynn B. In vivo study of nerve movement and mechanosensitivity of the median nerve in whiplash and non-specific arm pain patients. Pain. 2005;115:248–253
  3. Michaelis M, Blenk K-H, Janig W, Vogel C. Development of spontaneous activity and mechanosensitivity in axotomized afferent nerve fibers during the first hours after nerve transection in rats. J Neurophys. 1995;74(3):1020–1026
  4. Chacur M, Milligan ED, Gazda LS, et al. A new model of sciatic inflammatory neuritis (SIN): induction of unilateral and bilateral mechanical allodynia following acute unilateral peri-sciatic immune activation in rats. Pain. 2001;94:231–244
  5. Elisav E, Herzberg U, Ruda MA, Bennett GJ. Neuropathic pain from an experimental neuritis of the rat sciatic nerve. Pain. 1999;83:168–182
  6. Bove GM, Ransil BJ, Lin HC, Leem JG. Inflammation induces ectopic mechanical sensitivity in axons of nociceptors innervating deep tissues. J Neurophysiol. 2003;90:1949–1955
  7. Eliav E, Benoliel R, Tal M. Inflammation with no axonal damage of the rat saphenous nerve trunk induces ectopic discharge and mechanosensitivity in myelinated axons. Neurosci Lett. 2001;311:49–52
  8. Chen C, Cavanaugh JM, Song Z, Takebayashi T, Kallakuri S, Wooley PH. Effects of nucleus pulposus on nerve root neural activity, mechanosensitivity, axonal morphology, and sodium channel expression. Spine. 2003;29(1):17–25
  9. Elvey RL. Physical evaluation of the peripheral nervous system in disorders of pain and dysfunction. J Hand Ther. 1997;10(2):122–129
  10. Sarhadi NS, Korday SN, Bainbridge LC. Radial tunnel syndrome: diagnosis and management. J Hand Surg [Br]. 1998;23:617–619
  11. Uchihara T, Furukawa T, Tsukagoshi H. Compression of brachial plexus as a diagnostic test of cervical cord lesion. Spine. 1994;19:2170–2173
  12. Devor M. The pathophysiology of damaged peripheral nerves. In:  Wall PD,  Melzack R editor. Textbook of Pain. Edinburgh, UK: Churchill Livingstone; 1994;
  13. Sauer SK, Bove GM, Averbeck B, Reeh PW. Rat peripheral nerve components release calcitonin gene-related peptide and prostaglandin E2 in response to noxious stimuli: evidence that nervi nervorum are nociceptors. Neuroscience. 1999;92:319–325
  14. Coppieters M, Stappaerts K, Everaert DG, Staes FF. Addition of test components during neurodynamic testing: effect on range of motion and sensory responses. J Orthop Sports Phys Ther. 2001;31(5):226–237
  15. Coppieters M, Stappaerts K, Janssens K. Reliability of detecting ‘onset of pain’ and ‘submaximal pain’ during neural provocation testing of the upper quadrant. Physiother Res Int. 2002;7(3):146–156
  16. Quintner JL. A study of upper limb pain and paraesthesiae following neck injury in motor vehicle accidents: assessment of the brachial plexus tension test of Elvey. Brit J Rheumatol. 1989;28:528–533
  17. Sweeney J, Harms A. Persistent mechanical allodynia following injury of the hand. Treatment through mobilization of the nervous system. J Hand Ther. 1996;9:328–337
  18. Coppieters MW, Kurz K, Mortensen TE, et al. The impact of neurodynamic testing on the perception of experimentally induced muscle pain. Man Ther. 2005;10:52–60
  19. Selvaratnam PJ, Matyas TA, Glasgow EF. Noninvasive discrimination of brachial plexus involvement in upper limb pain. Spine. 1994;19:26–33
  20. Elvey RL, Quintner JL, Thomas AN. A clinical study of RSI. Aust Fam Physician. 1986;15(10):1314–1320
  21. Hall TM, Elvey RL. Nerve trunk pain: physical diagnosis and treatment. Man Ther. 1999;4(2):63–73
  22. Shacklock MO. Positive upper limb tension test in a case of surgically proven neuropathy: analysis and validity. Man Ther. 1996;1(3):154–161
  23. Kleinrensink GJ, Stoeckart R, Vleeming A, Snijders CJ, Mulder PGH. Mechanical tension in the median nerve. The effects of joint positions. Clin Biomech (Bristol, Avon). 1995;10(5):240–244
  24. Coppieters MW, Stappaerts KH, Wouters LL, Janssens K. The immediate effects of a cervical lateral glide treatment techniques in patients with neurogenic cervicobrachial pain. J Orthop Sports Phys Ther. 2003;33:369–378
  25. Coppieters MW, Stappaerts KH, Staes FF, Everaert DG. Shoulder girdle elevation during neurodynamic testing: an assessable sign. Man Ther. 2000;6(2):88–96
  26. Cowell IM, Phillips DR. Effectiveness of manipulative physiotherapy for the treatment of a neurogenic cervicobrachial pain syndrome: a single case study—experimental design. Man Ther. 2002;7:31–38
  27. Cyriax J. Orthopaedic Medicine Volume One: Diagnosis of Soft Tissue Lesions. London, UK: Bailliere Tindall; 1978;79–80
  28. Calvin WH, Devor M, Howe JF. Can neuralgias arise from minor demyelination? Spontaneous firing, mechanosensitivity, and afterdischarge from conducting axons. Exp Neurol. 1982;75:755–763
  29. Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anaesthesia. Orthop Clin North Am. 1991;22:181–187
  30. Asbury AK, Field HL. Pain due to peripheral nerve damage: a hypothesis. Neurology. 1984;34:1587–1590
  31. Butler DS. The Sensitive Nervous System. Unley, South Australia: NoiGroup Publications; 2000;
  32. Shacklock M. Clinical Neurodynamics: A New System of Musculoskeletal Treatment. Edinburgh, UK: Elsevier Butterworth Heinemann; 2005;
  33. Greening J, Lynn B. Minor peripheral nerve injury: an underestimated source of pain?. Man Ther. 1998;3:187–194
  34. Ogata K, Naito M. Blood flow of peripheral nerve: effects of dissection, stretching and compression. J Hand Surg [Br]. 1986;11:10–14
  35. Lundborg G, Rydevik B. Effects of stretching the tibial nerve of the rabbit. J Bone Joint Surg [Br]. 1973;55:390–401
  36. Rydevik B, Lundborg G, Bagge U. Effects of graded compression on intraneural blood flow: an in-vivo study on rabbit tibial nerve. J Hand Surg. 1981;6:3–12
  37. Rempel D, Dahlin L, Lundborg G. Pathophysiology of nerve compression syndromes: response of peripheral nerves to loading. J Bone Joint Surg Am. 1999;81:1600–1610
  38. Dyck PJ, Lais AC, Giannini C, Engelstad JK. Structural alterations of nerve during cuff compression. Proc Natl Acad Sci USA. 1990;87(24):9828–9832
  39. Kleinrensink GJ, Stoeckart R, Mulder PGH, et al. Upper limb tension tests as tools in the diagnosis of nerve and plexus lesions: anatomical and biomechanical aspects. Clin Biomech (Bristol, Avon). 2000;15:9–14
  40. Yaxley GA, Jull GA. Adverse tension in the neural system. A preliminary study of tennis elbow. Aust J Physiother. 1993;39(1):15–22
  41. Keanneally M, Rubenach H, Elvey RL. The upper limb tension test: the SLR of the arm. In:  Grant R editors. Physical Therapy of the Cervical and Thoracic Spine. New York, NY: Churchill Livingstone; 1988;p. 167–194
  42. Selvaratnam P, Cook S. Matyas T. Transmission of mechanical stimulation to the median nerve at the wrist during the upper limb tension test. In: Proceedings of the 10th Biennial Conference of the Manipulative Physiotherapists' Association of Australia, Melbourne 1997, pp. 182–8.
  43. Carlan D, Pratt J, Patterson MM, Weiland AJ, Boyer MI, Gelberman RH. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg [Am]. 2007;32(8):1177–1182
  44. Kato N, Birch R. Peripheral nerve palsies associated with closed fractures and dislocations. Injury. 2006;37:507–512
  45. Frykholm R. The mechanism of cervical radicular lesions resulting from friction or forceful traction. Acta Chir Scand. 1951;102:93–98
  46. Smith C. Changes in length and position of the segments of the spinal cord with changes in posture in the monkey. Radiology. 1956;66:259–265
  47. Reid J. Ascending nerve roots. J Neurosurg. 1960;23:148–155
  48. Adams C, Logue V. Studies in cervical spondylotic myelopathy: movement of the cervical roots, dura and cord and their relation to the course of the extrathecal roots. Brain. 1971;94:557–568
  49. Selvaratnam P, Glasgow E, Matyas T. Strain effects on the nerve roots of brachial plexus. J Anat. 1988;161:260–264
  50. Wright T, Glowczewskie F, Wheeler D, Miller G, Cowin D. Excursion and strain of the median nerve. J Bone Joint Surg [Am]. 1996;78(12):1897–1903
  51. Werner C, Rosen I, Thorngren K. Clinical and neurophysiologic characteristics of the pronator syndrome. Clin Orthop. 1985;197:231–237
  52. Sunderland S. Nerves and Nerve Injury. 2nd ed. Edinburgh, UK: Churchill Livingstone; 1978;
  53. Yaxley GA, Jull GA. A modified upper limb tension test: an investigation of responses in normal subjects. Aust J Physiother. 1991;37:143–151
  54. Grant R, Forrester C, Hides J. Screen based keyboard operation: the adverse effects on the neural system. Aust J Physiother. 1995;41(2):99–107
  55. Drye CD. The upper limb tension test 3: An investigation of the intrarater and interrater reliability and the subjective response to the test. Master's Thesis, MGH Institute of Health Professions; 1993: No. 1351903.
  56. Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 2nd ed. Philadelphia, PA: FA Davis Company; 1985;
  57. In:  Williams PL,  Warwick R editor. Gray's Anatomy. 36th ed. Philadelphia: WB Saunders Company; 1980;
  58. Portney LG, Watkins MP. Foundations of Clinical Research: Application to Practice. Stamford, CT: Appleton & Lange; 2000;
  59. Friberg R, Reeder M, Talley D, Perry T, Ramerez C, Gable C. Symptom distribution for upper limb tension tests 1, 2A, 2B, 3. [abstract PO18] J Orthop Sports Phys Ther. 2000;30(1):A-6
  60. Howard PD. The effect of a radial nerve biased neurodynamic test on shoulder abduction in asymptomatic adults [abstract PL81]. J Orthop Sports Phys Ther. 1999;29(1):A-27
  61. Arking R. The Biology of Aging Observations & Principles. 3rd ed. Oxford, UK: University Press; 2006;171–174
  62. Goodman CC, Boissonnault WG, Fuller KS. Pathology Implications for the Physical Therapist. 2nd ed. Philadelphia, PA: Saunders; 2003;1140–1142

 All the authors contributed equally to this work.

 A portion of the study was conducted as a research requirement while Mr. Przechera was a master of physical therapy student in the Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical School. Ms. Julian and Ms. Coderre were students in the Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical School, at the time when a portion of the study was conducted, as part of the DPT requirement. All students were supervised by Ms. Petersen. This study was approved by the Northwestern University Institutional Review Board. A portion of the study was funded by a grant by the Orthopaedic Section, APTA, Inc. This article was adapted from a presentation at the Combined Sections Meeting, American Physical Therapy Association, Tampa, FL in February 2003.

 Competing interests: The authors declare that they have no competing interests.

PII: S0894-1130(09)00049-0

doi: 10.1016/j.jht.2009.05.001

Journal of Hand Therapy
Volume 22, Issue 4 , Pages 344-354 , October 2009

Article Tools

* Image Usage & Resolution