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Upper Limb Neurodynamic Test 2-Median Nerve Bias: An Investigation of Examiner Reliability, End-Range Shoulder Abduction, and Symptom Response in Asymptomatic Subjects

1 May 2001


Background and purpose: The Upper Limb Tension Test (ULTT) has been established as a physical therapy examination tool to assist in assessment of the cervical nerve roots and peripheral nerves as possible components contributing to upper limb symptoms in patients. Research has focused on the use of the ULTT in assessment of asymptomatic individuals, and on the ULTT2-Radial Nerve Bias, which stresses the radial nerve. There has been very little research regarding the responses to the ULTT2-Median Nerve Bias in asymptomatic individuals. As with other areas of physical therapy, scientific research in this subjects has lagged behind clinical practice. The ULTTI-Median Nerve Bias has only recently been identified through research to be a sensitive and specific test (Kleinrensink et al. 2000). The purpose of this study was to examine intrarater and interrater reliability as well as symptom response during the application of the ULTT2-Median Nerve Bias.

Methods: The ULNT2-Median Nerve Bias was administered by examiner one according to the methods described by Butler. Prior to the release of the end-position, a sensitizing maneuver was completed. After the sensitizing maneuver was completed, examiner two completed three consecutive measurements of end-range abduction. The test was then repeated on the opposite side. At the end of the test, each subject was asked to diagram and describe his/her symptom response felt at the end of each test. Each subject was tested with examiner one applying the test, then tested the next day at approximately the same time with examiner two applying the test. Testing on the second day was performed within an hour of the time the subject was tested on day one to reduce the risk of diurnal variations in the tissues of interest. In addition, the order of examiners applying the test was varied.

Results: Data was analyzed using an ANOVA with repeated measures and then interclass corelation coefficients were calculated from the means generated by the ANOVA. Intrarater reliability was found to be acceptable. A significant difference in end-range abduction was found between arms when measured by both examiner one and examiner two. Interrater reliability was found to be poor, thus each examiners results were calculated separately. The most common location of symptoms reported by subjects was the lateral part of the hand. The most common description was a pulling sensation.

Discussion and Conclusion: The methods used in previous studies to establish intra- and interrater reliability during neurodynamic testing have been inadequate. Using curently accepted methods, we were able to establish intrarater reliability for the procedure in question. There is a decreased range of motion available in the dominant arm of asymptomatic individuals when assessed using the ULNT2-Median Nerve Bias. Research on the reliability of a more clinically applicable method of measurement of end-range motion available during neurodynamic testing may be appropriate.


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