title: The influence of scapular depression on upper limb neurodynamic test responses.
abstract: OBJECTIVE
  Upper limb neurodynamic testing (ULNT) can be used clinically to assist in identifying neural tissue involvement in patients with upper quarter pain and dysfunction. Consideration for scapular positioning is a crucial component of ULNT standardization, as variations in positioning may dramatically impact sensory and motor responses. This study aimed to determine if there was a meaningful difference in test outcomes when the ULNT was performed in alternative scapular positions.
  
  
  METHODS
  This cross-sectional study included 40 asymptomatic individuals. Repeated ULNT testing was performed on the dominant limb with the scapula blocked in neutral (ULNTb) and in scapular depression (ULNTd). Sensory responses, muscle activity, and range of motion outcomes were compared between the two test variations.
  
  
  RESULTS
  Pre-positioning in scapular depression (ULNTd) led to reduced elbow extension range of motion, provoked greater upper trapezius muscle activity and an earlier onset and broader area of sensory responses compared to ULNTb.
  
  
  CONCLUSIONS
  During ULNTb, the limbs were taken further into range and elicited reduced muscle activation and more localized sensory response providing a less vigorous version of the test. This study demonstrates that scapular positioning has a meaningful impact on ULNT test outcomes in healthy, asymptomatic individuals. The ULNTd can be considered a more vigorous version that may be appropriate when the cervical motions commonly utilized for structural differentiation are limited or contraindicated.
authors: Graduate Program in Physical Therapy, University of California and San Francisco State University, CA, USA.
authors: Allison
authors: A
authors: Legakis
authors: Benjamin S
authors: BS
authors: Boyd
keywords: Mechanosensitivity; Neurodynamics; Range of motion
references: Anesthesiology. 2002 Jul;97(1):75-81
references: 12131106
references: Man Ther. 2001 Aug;6(3):154-62
references: 11527455
references: J Natl Med Assoc. 2010 Jan;102(1):18-27
references: 20158132
references: Spine (Phila Pa 1976). 2003 Jan 1;28(1):52-62
references: 12544957
references: Clin Biomech (Bristol, Avon). 1995 Jul;10(5):235-239
references: 11415559
references: Int J Epidemiol. 1995 Apr;24(2):381-8
references: 7635600
references: Man Ther. 1997 Aug;2(3):144-149
references: 11440527
references: Man Ther. 1997 Aug;2(3):157-164
references: 11440529
references: Man Ther. 2001 May;6(2):88-96
references: 11414778
references: Clin Biomech (Bristol, Avon). 1995 Jul;10(5):240-244
references: 11415560
references: J Orthop Sports Phys Ther. 2009 Nov;39(11):780-90
references: 19881004
references: Aust J Physiother. 1991;37(3):143-52
references: 25026478
references: Man Ther. 2002 May;7(2):89-94
references: 12151245
references: Pain. 2005 Jun;115(3):248-253
references: 15911151
references: Phys Ther. 1987 Jan;67(1):43-8
references: 3797476
references: Clin Biomech (Bristol, Avon). 2000 Jan;15(1):9-14
references: 10590339
references: Spine (Phila Pa 1976). 1994 Jan 1;19(1):26-33
references: 8153800
references: J Man Manip Ther. 2008;16(3):136-41
references: 19119402
references: Head Neck Oncol. 2009 Jul 14;1:26
references: 19594943
references: J Electromyogr Kinesiol. 2000 Oct;10(5):361-74
references: 11018445
references: Physiother Res Int. 2002;7(3):146-56
references: 12426912
references: Man Ther. 2011 Apr;16(2):125-30
references: 20810302
references: Br J Rheumatol. 1989 Dec;28(6):528-33
references: 2641994
references: Aust J Physiother. 1994;40(2):99-103
references: 25025320
references: Man Ther. 1999 Feb;4(1):33-8
references: 10463019
references: Am J Clin Nutr. 1982 Nov;36(5):936-42
references: 7137077
references: J Hand Surg Am. 2002 Nov;27(6):1032-40
references: 12457354