Neurodynamic Testing Procedure PDF

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Neurodynamic Testing Procedures They are used to test the neurodynamics or the sensitivity of the nerves, standardising the whole body. They must be done slowly. Interpreting neurodynamic tests: Positive result: Reproduction of patient symptoms and / or limitation of movement during any component of the test, which can be altered by the application or removal of an appropriate sensitising manoeuvre. Comparison can be made with the other side, however this should be done with caution, where the continuous nature of neural tissue can makes this less conclusive than when testing other structures, even where there is an apparently asymptomatic side. Negative result: No reproduction of relevant symptoms and no increased resistance or limitation to movement. Upper Limb Neurodynamic Tests (ULNT) ULNT1 - Median Nerve Test components: 1. Contralateral cervical flexion 2. Shoulder girdle depression 3. Shoulder abduction 4. Wrist and finger extension 5. Forearm supination 6. Shoulder lateral rotation 7. Elbow extension 8. Appropriate sensitising manoeuvre - head moved to the

Procedure: Patient: The patient is supine on a plinth, pillow under head only, not shoulders. Head side flexed away from therapist. Elbow rested on therapists’ thigh. Clinician: Standing alongside the patient on the side to be tested, facing the patient. Place fist on the plinth right by their nearest shoulder and extend the wrist to depress the patient’s shoulder. ULNT 2b - Radial Nerve This test can be used when the patient is experiencing shooting pain in their arm during activities such as putting their coat on or reaching.

Procedure: Patient: The patient is positioned in supine on a plinth - lying diagonally. Clinician: Standing Test components: alongside 1. Cont r al at er al c er v i c al fl ex i on- the patient c hi nup on the 2. Shoul dergi r dl edepr es s i on side to be 3. Wr i s tandfi ngerandt humbfl ex - tested, i on facing 4. El bowex t ens i on down the 5. Whol ear m medi al r ot at i on plinth. De6. Abduc t i on press the 7. Appr opr i at es ens i t i s i ng shoulder with you hip. Step forward with opposite leg. manoeuv r e

ULNT 3 - Ulnar Nerve Test components: 1. Contralateral cervical flexion 2. Wrist extension 3. Forearm pronation 4. Elbow flexion 5. Shoulder lateral rotation 6. Shoulder girdle depression 7. Shoulder abduction 8. Appropriate sensitising manoeuvre Procedure: Patient: The patient is positioned in supine on a plinth. Hand starting pointing upwards.

Clinician: Standing alongside the patient on the side to be tested, facing the patient. Resting their hand on the patient’s hand to keep their fingers extended. The lower limb / spinal neurodynamic tests Straight Leg Raise - Sciatic Nerve + Branches Procedure: Patient: The patient is positioned supine on a plinth, with a single pillow (or note the number of pillows if more required), to allow for reproducibility of position for future testing. Clinician: Positioning can vary according to clinician height/strength and comfort of handling. Standing on the side of the patient to be Test components: 1. Hip Flexion 2. Maintain knee extension 1. Additional components: 3. Medial rotation / adduction (Sciatic nerve) 4. Dorsiflexion and eversion (Tibial nerve) 5. Plantarflexion and inversion (Common peroneal nerve). 6. Appropriate sensitising manoeuvre tested, facing the patient.

The procedure of the test involves the clinician passively moving the hip, with the knee extended, +/- additional movements of the hip, ankle and foot to bias specific nerves, followed by a ‘sensitising manoeuvre’ - to increase the specificity to the area of symptoms. These additional components may be added at the beginning of the test, before hip flexion, or after as long as the sequence is noted.

Sensitising manoeuvre = ankle dorsiflexion or cervical flexion, depending on symptom location. The Slump Test - Sciatic Nerve and the Spinal Cord t is experiencTest components: 1. Hands behind back 2. Slump sitting - tuck tummy in and chin to their chest. 3. Clinician stabilises position with forearm and hand on back 4. Active unilateral knee extension 1. Additional variations: 5. Active ankle dorsiflexion with knee extension 6. Bilateral LL components 7. Appropriate sensitising Manoeuvre

Procedure: Patient: The patient is positioned in sitting on the side of the plinth with their hands held lightly behind their back Clinician: Sat alongside patient. The clinician places their forearm and hand on the patients head and thoracic spine to stabilise this position. The clinician asks the patient to perform unilateral or bilateral knee and ankle movements and notes symptom response, followed by an appropriate sensitising manoeuvre = lifting their head up. Prone Knee Bend - Femoral Nerve Procedure: Patient: The patient is positioned in prone on a plinth. Clinician: Standing on the side of the patient to be tested. The clinician grasps the Test components: lower leg 1. Prone lying around the 2. Passive knee flexion ankle joint and passively flexes the knee and notes any reported change in symptoms and any loss of range.

Femoral Slump test - Femoral Nerve (More Common and reliable) Test components: 1. Trunk flexion, knees to chest 2. Patient holds bottom leg 3. Active cervical flexion 4. Passive knee flexion 5. Passive hip extension 6. Appropriate sensitising Manoeuvre Lifting the head back up. Procedure: Patient: The patient is positioned in side lying on a plinth, with the side to be tested uppermost, facing away from the therapist. Clinician: Standing behind the patient. The procedure of the test involves the patient hugging both knees to their chest, with the trunk and cervical spine in flexion, and holding on to the bottom leg. The clinician then supports and passively moves the top leg, noting any symptom onset and then applies an appropriate sensitising manoeuvre....