Massage & Bodywork

JULY | AUGUST 2016

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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 99 There are several anatomical locations where nerve tissue is highly susceptible to excess tension forces. These locations include: • Tunnels—where a nerve has to pass through a narrow opening. • Branching—where a nerve divides into two or more separate branches. • Fixation—where a nerve is tethered or fixed to an adjacent structure, like where the deep peroneal nerve is tethered to the head of the fibula just below the knee. • Unyielding surface—where a nerve has to pass next to an unyielding surface, such as a bone. One of the most challenging facets of nerve compression and tension disorders is identifying where the primary problem is occurring. There are no high-tech diagnostic tests that have proven reliable and effective in identifying key locations of mechanical nerve stress. As a result, detailed clinical examination in its fullest sense is still the most valuable for assessing these disorders. It is important to incorporate information from history, palpation, and other basic physical examination procedures, such as range-of-motion and resistance testing when examining for nerve involvement. Most upper-extremity nerve dysfunctions are perceived as localized compression disorders like carpal tunnel syndrome. Yet, other nerve disorders that are not specifically named conditions can occur in other locations. For example, scar tissue from an injury can bind a nerve to adjacent structures, limiting its mobility and causing nerve-related symptoms like pain, burning, or tingling. Applying neurodynamics concepts gives you more information about areas of restriction so your treatment can be applied to the most affected region. Neurodynamics principles are also useful in treatment for improving neural mobility. ULNTS The ULNT can prove helpful for locating nerve dysfunction in the upper extremity. 3 These tests are helpful because they can provide information about areas of restriction throughout the entire length of the nerve instead of just a few common compression sites. However, it is important to note that all the procedures that are used to identify nerve entrapment in the upper extremity have some limitations in accuracy. Any specific assessment procedure has a certain degree of reliability and accuracy; this is true for nerve evaluations as well. Some tests are more accurate than others; this is why relying on special tests alone during evaluation is not effective. Special orthopedic tests, such as the Phalen's test for carpal tunnel syndrome (for an example of the Phalen's test, see "Helping Dustin Play," Massage & Bodywork, January/February 2015, page 94), are helpful, but only focus on specific locations of entrapment, such as the carpal tunnel. As mentioned earlier, nerves can be irritated from compression or bind in many locations along the entire length of the nerve. So, any procedure that can help locate areas of neural dysfunction are helpful. Research shows that clinicians can improve assessment accuracy with a comprehensive clinical evaluation that includes a detailed history and series of physical examination methods. Because no single test alone has proven to be highly accurate for recognizing median nerve pathology, combining evaluation procedures produces the most accurate clinical picture of the client's condition. There are four common ULNTs: the first two test the median nerve, the third tests the radial, and the fourth tests the ulnar. The numbering and naming of these tests is not always consistent, but most commonly they are referred to as ULNT #1–4. To avoid confusion in treatment notes, identify the ULNT used by the nerve being stressed during the test. For example, treatment notes might state, "ULNT #1 with median nerve emphasis." This article focuses on ULNT #1 for the median nerve because median nerve disorders are the most common in the upper extremity. Here are some general guidelines for how to perform a ULNT (regardless of which one). The practitioner performs a series of movements that gradually increase tension on the nerve. Symptoms, if present, will usually increase as movements are added. Movements are performed in the order listed with each test. However, it may also be helpful to alter the order in some cases to get more information about the location of decreased neural mobility.

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