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SCIENCE OF NERVES Tethered Median Nerve Stress Test An evaluation test that is now being used with increasing frequency is the tethered median nerve stress test. Some degree of neural tension is already a component of this test. The wrist is held in extension and supination. While in this position, the index finger is pulled into hyperextension as far as motion allows. The finger movement can be performed by the practitioner or by the client. If neurological symptoms are felt within about one minute, the test is considered positive. Additional neural tension can be added to the proximal upper extremity to make this procedure more sensitive. Positions to add include lateral neck flexion to the opposite side, shoulder abduction, elbow extension, and forearm supination (Image 8). Note that not all of these motions need to be added. In some cases, symptoms will be exacerbated with the addition of just one position. This may also be helpful for identifying other potential regions of median nerve entrapment. For example, if symptoms are particularly aggravated when elbow extension is added, there is an increased likelihood that some nerve binding or restriction around the elbow or forearm is involved. CONCLUSION Clients are increasingly using massage therapists to address a wide variety of soft-tissue disorders like carpal tunnel syndrome. Because we do not rely on high-tech diagnostic procedures, and in many cases, they are not accurate, the physical examination methods we use are increasingly valuable. While some practitioners may be familiar with these standard evaluation procedures, using effective clinical reasoning to modify them in ways that make them more sensitive increases their value and makes your assessment even more accurate. With a better understanding of the primary location of nerve pathology, we can most accurately direct treatment for more effective results. Notes 1. A. Kozak et al., "Association Between Work-Related Biomechanical Risk Factors and the Occurrence of Carpal Tunnel Syndrome: An Overview of Systematic Reviews and a Meta-Analysis of Current Research," BMC Musculoskeletal Disorders 16 (2015): 231. doi:10.1186/s12891-015-0685-0. 2. V. Neuhaus et al., "Evaluation and Treatment of Failed Carpal Tunnel Release," Orthopedic Clinics of North America 43, no. 4 (2012): 439–47. doi:10.1016/j.ocl.2012.07.013. 3. M. Shacklock, Clinical Neurodynamics (Elsevier, 2005). Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. Hand elevation test. Modified hand elevation test. 6 7 Modified pressure provocative test. 5 Modified tethered median nerve stress test. 8 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 . 89