Impact of shoulder internal rotation on ulnar nerve excursion and strain in embalmed cadavers. A pilot study

Abstract

The results of this study provide evidence that there is no appreciable difference in excursion or strain when substituting shoulder internal rotation for external rotation during the ULNT3. Patients who exhibit limitation of shoulder external rotation mobility may benefit from this substitution when presenting with signs of ulnar nerve pathodynamics. Further research involving patients will be needed to assess the validity of the experimental maneuver for clinical application.

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

“…21,22 The quality and distribution of sensory responses during the ULNT 3 for both maneuvers were consistent with previous studies. 2,16,[27][28][29][30] The sensations of stretching, burning, tingling, and/or numbness were localized along the ulnar nerve distribution in over 51% of the participants in both groups.…”

“…It was our intention to remain consistent with the previous cadaver study and forego the use of cervical contralateral side-bending. 21 The initial onset of symptoms with the traditional ULNT 3 occurred later in range during the component motion of abduction. This was reported by 70% of the study participants.…”

“…The traditional ULNT 3 was performed following the sequence of movement described by Butler 2,3 : wrist and finger extension, followed by forearm pronation, elbow flexion, shoulder external rotation, shoulder girdle depression, and shoulder abduction. The experimental maneuver was performed following the alternative sequence of movement described by Gugliotti et al 21 : shoulder girdle depression, followed by wrist and finger extension, forearm pronation, slight shoulder abduction, elbow flexion to 90°, shoulder internal rotation, full elbow flexion, and continued shoulder abduction (Appendix B). The starting position was standardized for both maneuvers.…”

“…20 Recent cadaver studies have suggested that the substitution of shoulder internal rotation for external rotation provides a comparable neurodynamic response along the ulnar nerve. 21,22 Gugliotti et al showed a strong correlation (r = 0.98, p = 0.001) of linear excursion and percent strain to exist between the traditional ULNT 3 and an experimental maneuver using internal rotation. Manvell et al also demonstrated that the substitution of shoulder internal rotation provided greater tension (10.00 ± 3.12 N) along the ulnar nerve when compared to traditional ULNT 3 (8.71 ± 3.12 N).…”

“…The selection of the specific sequences used in this study was based on Butler and Gugliotti's description of the tests. 2,3,21 Recent literature provides evidence that the order in which the movements of the neurodynamic test are introduced can influence the responses obtained with the test. 33 Consequently, a different sequence of component motions could have resulted in different findings than those obtained in this study.…”