This document discusses neural tissue mobilization of the upper limb. It defines neurodynamics as the clinical application of nervous system mechanics and physiology as they relate to musculoskeletal function. Neurodynamic tests are described to assess the median, ulnar, and radial nerves. The tests involve moving the associated joints in specific positions and directions to apply tension or sliding movement to the nerves while monitoring for symptoms. Structural differentiation is used to identify the level of nerve involvement. Contraindications for neural tissue mobilization include certain nervous system disorders or areas of instability. The goal is to assess nerve mobility and produce tension or gliding of the nerves for non-irritable neurogenic or neuropathic conditions.

1. NEURAL TISSUE MOBILIZATION
(ASSESSMENT-UPPER LIMB)
- NITHIN NAIR (MPT-1)

2. WHAT IS NEURODYNAMICS
Eg : Excessive pronation at ankle (mechanical); Diabetic neuropathy (physiological)

3. CLINICAL NEURODYNAMIC DEFINITION
• Clinical application of mechanics and physiology of nervous system as
they relate to each other and are integrated with musculoskeletal function

4. INTEGRATIVE FUNCTION – NERVOUS SYSTEM &
MUSCULOSKELETAL SYSTEM
Mechanical Interface: Tissues most anatomically adjacent to the nervous system that
can move the nervous system. Eg: Supinator muscle (Radial nerve)

5. TERMINOLOGIES
• Convergence: Nerve move toward the part where tension is applied.
• Sliders: movement of nerve without stretching (stretch at one joint
and relax at other joint) – goal is to produce gliding movement in
relation to surrounding tissues
• Tensioners: It produces an increase in tension in neural structures. -
goal is to produce tension in the certain part of peripheral nerve.

6. INDICATIONS
• Use in non-irritable conditions (neuropathic/neurogenic)
• For pathomecanical causes:
- Fibrosis
- Connective tissue adhesions
- Restriction of normal tissue mobility

7. CONTRAINDICATIONS
• Malignancies of the nervous system or vertebral column
• Acute inflammatory infections
• Areas of instability
• Spinal Cord Injuries
• Suspected disc lesions
• Cauda equina lesions
• Dizziness related to vertebral artery insufficiencies
• Any central nervous system disorders (e.g. spina bifida, MS)
• Worsening neurological signs

8. MEDIAN NEURODYNAMIC TEST
SHOULDER DEPRESSION
PISTOL GRIP

9. MEDIAN NEURODYNAMIC TEST
ELBOW FLEXED 90°
SHOULDER ABDUCTION 90 -110°
EXTERNAL ROTATION (FULL AVAILABLE RANGE)

10. MEDIAN NEURODYNAMIC TEST
FOREARM SUPINATION
WRIST & FINGER EXTENSION
ELBOW EXTENSION

11. MEDIAN NEURODYNAMIC TEST
KEEP DOING TILL P1 (START OF PAIN). ASK FOR THE AREA OF SYMPTOMS
DO STRUCTURAL DIFFERENTIATION – SWITCH ON / SWITCH OFF
PROXIMAL SYMPTOMS (ABOVE ELBOW) – USE THE WRIST
DISTAL SYMPTOMS (AT OR BELOW ELBOW) – USE THE NECK

12. ULNAR NEURODYNAMIC TEST
ARM EXTENDED WITH PALM FACING DOWN
SHOULDER DEPRESSION
WRIST AND FINGER EXTENSION
FOREARM PRONATION
ELBOW FLEXED – TRY TO TOUCH SHOULDER

13. ULNAR NEURODYNAMIC TEST
GLENOHUMERAL EXTERNAL ROTATION
USE THIGH (Therapist) TO SUPPORT ARM
GLENOHUMERAL ABDUCTION 55 - 60°
SD: DISTAL SYMPTOMS – RELEASE SCAPULAR DEPRESSION
PROXIMAL SYMPTOMS – RELEASE WRIST FLEXION

14. RADIAL NEURODYNAMIC TEST
SHOULDER DEPRESSION
ELBOW EXTENSION

15. RADIAL NEURODYNAMIC TEST
INTERNAL ROTATION
PRONATION
WRIST AND FINGER FLEXION

16. RADIAL NEURODYNAMIC TEST
SHOULDER ABDUCTION
SD: DISTAL SYMPTOMS – RELEASE SCAPULAR DEPRESSION
PROXIMAL SYMPTOMS – RELEASE WRIST FLEXION