Median nerve ULNT1: position and sequence
ULNT1 loads the median nerve by combining scapular depression, shoulder abduction and external rotation, wrist and finger extension and elbow extension. Contralateral cervical side-bending is added at the end as structural differentiation.
- Position
- Supine
- Starting position
- Lie face up with the head and neck neutral, the shoulder girdle relaxed and the tested arm beside the body. Elbow bent about 90°, forearm and wrist neutral.
- End position
- Scapula depressed, shoulder abducted to about 100° and externally rotated, forearm supinated, wrist and fingers extended and elbow almost straight. Contralateral cervical side-bending is added last as structural differentiation.
Sequence
- Scapular depression
Take the shoulder towards the feet and keep it depressed throughout the sequence. This is the component that sets the proximal load.
- Shoulder abduction to 100°
Take the arm away from the body to about 100°, without shrugging the shoulder towards the ear. The arm rests at shoulder height.
- Wrist and finger extension
Take the back of the hand towards the forearm and open the fingers. The palm faces the feet.
- Forearm supination
Turn the forearm until the palm faces up, without moving the shoulder.
- External rotation of the shoulder
Turn the arm outwards: the forearm moves away from the trunk and the hand drops towards the couch.
- Elbow extension
Straighten the elbow gradually until the arm is straight. This is the component that usually reproduces symptoms: stop where they appear.
- Contralateral cervical side bending
Tilt the head towards the side opposite the tested arm. This is the remote structural differentiation manoeuvre.