The Sporting Nerve Part 1 | The Sporting Nerve Part 2 | Piriformis | Contralateral Tests
Sciatica: Is Extension the Right Choice? | Trouble Shooting with Scapular Stabilisation
Wrist Technique during Median Neurodynamic Testing | Tarlov's Cysts
Asymmetry and Diagnosis: Are We Neurodynamic Mirror Images?
Trouble Shooting with Scapular Stabilisation
Scapular depression is one of the most important movements of the upper limb neurodynamic tests. The movement exerts significant elongation effects on the brachial plexus (Adams and Logue 1971) and regularly produces significant changes in symptoms during the median neurodynamic test 1 and ulnar neurodynamic test.
One of the most common problems with technique of the upper limb neurodynamic tests (median 1 and ulnar) is control of the scapula. This is one movement which, if not well controlled, can profoundly influence the result of the test. The key is stability - no depression, no elevation. The following are some possible trouble spots with technique:
- poor blocking of elevation - the test will fail to express itself accurately in the final movement because of inconsistency. This can allow increased movement and a lack of sensitivity, therefore may be predispose the test to a false negative result
- excessive depression - this will produce a more restricted range of motion and may provoke more than necessary
- inconsistency between test applications - this will produce variations in the responses which may then lead to inaccurate diagnosis and assessment of progress.
Solutions in Technique
Figure 1 AFigure 1 A. Poor blocking of elevation. The hand is not in the best position to control cephalad/caudad movement of the scapular and, if pressed on strongly, is often uncomfortable for the patient. The therapist uses their latissimus dorsi and pectorals to control the scapula, not very efficient and making it difficult for the therapist to relax. In patients with strong elevation contractions, this produces a 'wrestling' effect between the therapist and patient. The therapist's wrist must remain as straight as possible so as to produce maximum control
(see Figure 1 C.).
Figure 1 BFigure 1 B. Flexed wrist. This can produce less control of the scapular and places unnecessary force on the therapist's wrist joint.
Figure 1 CFigure 1 C. Straight wrist position - this allows the therapist to apply direct pressure on the plinth, using friction of the knuckles on the plinth to prevent caudad and cephalad sliding. This is a very efficient and stable posture for both therapist and patient. No caudad pressure is exerted on the scapula. The therapist's hand simply remains stable, gently placed against the skin over the patient's acromion. The therapist positions themself over the patient so it is easy to apply pressure down their straight arm and wrist to the plinth. This technique ensures accuracy with efficiency.
REMEMBER: Technique is important!
Adams C, Logue V 1971 Studies in cervical spondylotic myelopathy, 1 Movement of the cervical roots, dura and cord, and their relation to the course of the extrathecal roots. Brain 94: 557-568/em>
Shacklock M 2005 Clinical Neurodynamics. Elsevier, Oxford.