Upper Limb Tension (neurodynamic) Test 1 – Median Nerve, Anterior Interosseous Nerve, and C5,6,7 Nerve Root Bias

Purpose of Upper Limb Tension Test 1: To determine if the tension along the median/anterior interosseous/C5,6,7 nerve roots contributes to neurologic symptoms associated with cervical radiculopathy.

Patient position: Supine lying.

Examiner position: Standing beside the examination table, facing the patient, at the side of the limb to be tested.

Procedure: Perform the joint positioning sequence in the following order:

1. Shoulder girdle/Scapular depression (with the examiner’s one hand around the patient’s wrist and the other hand wrapping/cupping/stabilizing the patient’s shoulder girdle from the front),
2. Shoulder abduction up to 110 degrees (using the examiner’s thigh closer to the patient),
3. Wrist extension,
4. Fingers and thumb extension,
5. Forearm supination,
6. Shoulder external rotation,
7. Elbow extension,
8. Sensitizing position: Contralateral or Ipsilateral cervical spine lateral flexion.

Outcome: This test is positive if (a) the limb/joint positioning sequence reproduces symptoms associated with radiculopathy, (b) the sensitizing position reproduces symptoms, and (c) there is a repeatable and measurable asymmetry between both sides along with the reproduction of symptoms.

Reference:

1. Kleinrensink GJ, Stoeckart R, Mulder PG, Hoek G, Broek T, Vleeming A, et al. Upper limb tension tests as tools in the diagnosis of nerve and plexus lesions. Anatomical and biomechanical aspects. Clinical biomechanics (Bristol, Avon). 2000;15(1):9-14.
2. Kleinrensink GJ, Stoeckart R, Vleeming A, Snijders CJ, Mulder PGH. Mechanical tension in the median nerve. The effects of joint positions. Clinical Biomechanics. 1995;10(5):240-4.