ULNT1 Neurodynamics Assessment

Median Nerve Assessment – ULNT1

Median nerve (C5-T1)

Starting position:

Patient฀lays฀supine,฀arms฀by฀the฀side,฀and฀shoulder฀close฀to฀the฀edge฀ of the examination table, no pillow if possible, and body straight.
Therapist฀faces฀the฀patient’s฀head฀and฀presses฀near฀hand฀on฀the฀table above the patient’s shoulder in either a knuckles or fist position (avoiding downward or caudad pressure on the superior aspect of the patient’s shoulder).
With฀other฀hand,฀therapist฀holds฀patient’s฀hand฀with฀the฀thumb฀ extended to apply tension to the motor branch of the median nerve.Therapist’s fingers wrap around the patient’s fingers distal to the metacarpophalangeal joints.
Patient’s฀elbow฀is฀flexed฀at฀90฀degrees฀and฀supported฀on฀the฀ therapist’s near (front) thigh.

Movement sequence:

Glenohumeral฀abduction฀up฀to฀90฀to฀110฀degrees,฀if฀available,฀in฀the฀ frontal plane.
Wrist฀and฀inger฀extension฀and฀forearm฀supination.
Glenohumeral฀external฀rotation฀to฀available฀range฀(generally฀stopped at 90 degrees if the patient is very mobile).
Elbow฀extension฀should฀be฀done฀gently฀and฀with฀care฀not฀to฀cause฀ any shoulder motion, especially adduction (which would ease off developing neurodynamic test).

Structural differentiation:

Based฀on฀where฀the฀symptoms฀(if฀any)฀are฀located.
If฀distal฀symptoms฀have฀developed฀(e.g.,฀forearm฀and฀wrist฀pain),฀the neck is moved into contralateral lateral flexion and any change in the distal symptoms would constitute a positive structural differentiation.
If฀proximal฀symptoms฀have฀developed฀(e.g.,฀neck฀and฀shoulder฀pain),฀ the wrist is released from its extended position and any change in the proximal symptoms would constitute a positive structural differentiation.

Palpable areas:

Common entrapments / syndromes: