Upper limb neurodynamic test 2-median nerve bias: An investigation of reliability of single examiner measurement of shoulder abduction using a compass inclinometer

Background and Purpose: The Upper Limb Neurodynamic Test (ULNT) is recognized as a physical 11 therapy tool to assist in assessment of possible neural tissue contributions to upper limb symptoms in patients. Previous research has been conducted on Upper Limb Neurodynamic Test # 2 (ULNT2) median nerve bias to investigate examiner reliability of end-range shoulder abduction measurement and normal responses in asymptomatic subjects. However, this previous research utilized a testing protocol that required two examiners and time-intensive subject positioning. Since this protocol is not conveniently applied in the clinical environment, the purpose of this study was to investigate examiner reliability of a clinically oriented application of the ULNT2 median nerve bias using a single examiner protocol on asymptomatic subjects. Furthermore, the authors sought to contribute to the normative data for sensations provoked by ULNT2 median nerve bias in asymptomatic subjects. Results: Intrarater reliability was calculated using a Model 3 ICC (3, 1) and was0.63 for examiner I and 0.55 for examiner II. Interrater reliability was calculatedusing a Model 2 ICC (2,1), and was 0.64 for trial 1 and 0.80 for trial 2. Thestandard error of measurement between trials for examiner I was 7.35 degreesand 6.41 degrees for examiner II. The standard error of measurement betweenexaminers for trial 1 was 6.87 degrees and 4.85 degrees for trial 2. Discussion and Conclusion: Intrarater and interrater reliability for a single examiner test protocol for ULNT2 median nerve bias were determined to be below values acceptable for clinical application. Consistency of sensations located in the lateral aspect of the forearm and radial three digits of the hand were at a level that offered some support to the proposal that comparing for symmetry between sides may be one criterion for identifying a positive response to this neurodynamic test, but this needs to be validated in a symptomatic population