History
Vascular and mechanical factors can lead to nerve pathology. Pain is the most common symptom. Sensory responses, reported as stretch pain or paresthesia, occur when tissues are in the neural stretch position. Clinical reasoning is used to understand the possible mechanism of injury, such as pathological insult to the nervous tissue or surrounding tissues or symptoms from movement patterns that place tension on the neural tissues and reproduce symptoms.

Tests of Provocation
Neurodynamic test maneuvers are performed to detect tension signs in the neural tissue. The upper limb tension test (ULTT), upper limb neurodynamic test (ULNT), straight leg raise (SLR), and slump test are familiar terms that describe various tests and procedures. The reader is referred to textbooks by Butler for greater details and variations of these tests. Points regarding the tests:

• Because the test positions place stress across multiple joints, every joint in the chain must be tested separately for range, mobility, and symptom provocation prior to nerve tension testing so any restriction that occurs during the test is not the result of joint or periarticular tissue limitations. Coppieters et al. demonstrated that the stretch position altered the available ROM and sensory responses in 35 normal male subjects during neurodynamic testing and reiterated the importance of looking at other influences prior to neural-tension testing.

• Additional tests include nerve palpation, sensation testing, reflex testing, and muscle testing.

• The test positions and maneuvers used to detect nerve tension and mobility are the same as the treatment positions and maneuvers.

• Tension signs are stretch pain or paresthesias that occur when the neurological system is stretched across multiple joints and is relieved when one of the joints in the chain is moved out of the stretch position.

Therefore, the examiner carefully elongates the nerve across each joint in succession until there is symptom provocation (this is described in detail in the techniques section). When symptoms occur, the final position is noted. It is important to recognize that in highly irritable or restrictive conditions full range is not possible. Once symptoms are provoked, the examiner moves one of the joints in the chain out of the stretch position to see if the symptoms are relieved. This may then be repeated with each of the joints in the chain until the examiner understands the mobility pattern of the nerve.

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