Impact of shoulder internal rotation on normal sensory response during ulnar nerve-biased neurodynamic testing of asymptomatic individuals

Abstract

Objective: To determine if substitution of shoulder internal rotation for external rotation during the upper limb neurodynamic test (ULNT₃) evokes comparable ulnar nerve sensory responses in asymptomatic individuals.

Methods: Range of motion, quality, quantity, and distribution of sensory responses in 50 asymptomatic individuals during the traditional ULNT₃ were compared to identical measures during an experimental maneuver using shoulder internal rotation. Quality and quantity of sensory responses were recorded using a 10-cm visual analog scale.

Results: Means of sensory responses for traditional and experimental maneuvers, respectively, were as follows: stretching, 3.84 ± 8.85 and 5.38 ± 2.85 cm; burning, 1.82 ± 2.82 and 2.50 ± 3.10 cm; tingling, 2.13 ± 3.12 and 2.18 ± 2.97 cm; and numbness, 1.04 ± 2.17 and 1.01 ± 2.03 cm. A moderate to strong correlation (ICC = 0.51–0.86) was shown to exist between maneuvers; this relationship was significant (p = .001).

Discussion: Results of this study provide evidence that there was no appreciable difference in sensory responses with regard to burning and tingling when substituting shoulder internal rotation for external rotation during the ULNT₃. The results also suggest that there were only marginal differences in the sensory responses of stretching and numbness during the same substitution.

Conclusion: Patients who have limited glenohumeral external rotation due to pain, instability, and/or articular limitation may benefit from this substitution when presenting with signs of ulnar nerve pathodynamics. Further research will be needed to validate this maneuver in a symptomatic population.

Level of Evidence: Level 2b.

Keywords:

• Neurodynamic test
• Ulnar nerve
• Nerve tension
• ULNT₃
• Sensory response