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What position selectively places the most tension on the radial nerve?

In an effort to improve examination maneuvers that discriminate between causes of upper extremity neuropathy, researchers recently conducted a study to determine the upper extremity position that produces high radial nerve tension while simultaneously generating low tension (comparatively) in median and ulnar nerves.1 Selective tensioning of peripheral nerves has the potential to refine differential examination for conditions causing upper extremity neuropathic symptoms by mechanically stressing a single nerve in relative isolation.

Using a strain gauge attached to the median, ulnar, and radial nerves of 10 embalmed cadavers, a series of tests measured tension on each major nerve with the upper extremity in a variety of positions. The position producing high radial nerve and relatively low ulnar and median nerve tension was: scapular depression, elbow extension (00), maximum humeral internal rotation, full forearm pronation, 650 wrist flexion, 400 humeral abduction, 250 humeral extension, full wrist ulnar deviation, and thumb flexion.

Understanding the position only from the text description above may be difficult. Unfortunately, copyright privileges prevent including pictures from the article in this blog. Though this research suggests the nerve tensioning maneuver will help confirm pain arising from the radial nerve, research has yet to confirm that it does in living people. Nevertheless, study results indicate that this position can be clinically useful, especially for a practitioner with good differential diagnostic skills who appropriately weighs exam findings based on the strength of evidence supporting each diagnostic test.

Reference List
1. Manvell JJ, Manvell N, Snodgrass SJ, Reid SA. Improving the radial nerve neurodynamic test: An observation of tension of the radial, median and ulnar nerves during upper limb positioning. Man Ther. 2015.

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