Neural Provocation Upper Quadrant

• Upper limbs neural provocation tests:

  • tests the mobility of the nervous system, surrounding vascular tissue and connective tissue
  • establish a baseline of symptoms prior to test and throughout
  • ensure to clarify symptoms prior to test and throughout the test to determine if it leads to reproduction of pts symptoms
  • add cervical spine lateral flexion to load or unload the tension
• Upper limbs neural provocation tests:

  • monitor for:
  • symptoms reproduction
  • differences in ROM between sides
  • associated resistance to movement and muscle spasms to movement and muscle spasms
  • tests are positive if:
  • pts symptoms are reproduced and you can structurally differentiate by moving a joint at least 2 joints away from area of pain
  • there is a different response to the unaffected side
• Median nerve provocation:

  • pts position:
  • supine and close to side of bed thats being tests
  • therapist action:
  • stand to side of the bed, facing pts
  • stabilise shoulder girdle with your elbow and forearm with your arm thats closest to the pts
  • with your other hand, abduct the pts shoulder to 90 degrees
  • extend wrist
  • supinate forearm
  • externally rotate shoulder
  • extend elbow
  • add cervical spine lateral flexion to load/unload
• Radial nerve provocation:

  • pts position:
  • supine, close to side of the bed youre testing and slightly diagonal so their scapula is off the edge
  • therapist action:
  • stand by pts head facing towards their feet in a step stance position
  • depress the shoulder girdle with your thigh closes to the pts
  • hold pts elbow with your medial hand and hand/wrist with your lateral hand
  • move elbow into extension
  • add shoulder internal rotation and forearm pronation
  • place wrist and fingers into finger flexion
  • slowly abduct shoulder
  • add cervical spine lateral flexion to load/unload
• Ulnar nerve provocation:

  • pts position:
  • supine, close to the side of the bed youre testing
  • therapist action:
  • stand to side of the bed facing towards pts
  • place hand closest to pts under the shoulder girdle to stabilise it
  • stabilise pts elbow onto therapists thigh
  • with your other hand move the pts wrist and finger into extension
  • pronate the forearm, elbow in flexion
  • externally rotate the shoulder
  • hand stabilising the shoulder girdle applies depression force
  • abduct the shoulder
  • add cervical spine lateral flexion to load/unload