PURPOSE/HYPOTHESIS: Determine if proximal or distal nerve tensioning is more effective in treatment of upper limb neurodynamic dysfunction.

NUMBER OF SUBJECTS: Forty subjects with a positive upper-limb neural tension test for the median or ulnar nerve (9 male, 31 female).

MATERIALS/METHODS: Subjects randomly assigned to either proximal tensioning (n = 14), distal tensioning (n = 13), or control (n = 13) groups. Dependent measures: Neck Disability Index (NDI), range of motion (ROM), grip and pinch strength. Treatment groups received training and a Home Exercise Program of 2 minutes tensioning daily for 2 weeks. The control group was advised to resume normal activities. Neurodynamic restrictions were assessed with a goniometer with elbow flexion for median nerve and shoulder abduction for ulnar nerve at provocation of symptoms. Sequential instructions and demonstration for assessment of grip and pinch strength, using the Jamar Hand and Pinch Dynamometer were given prior to testing. While sitting, the standard grip strength position was used which required humeral adduction with elbow flexion of 90°, and neutral forearm and wrist position. While sitting, the pincer pinch strength position was used which required humeral adduction with elbow flexion of 90°, and neutral forearm and wrist position with index finger and thumb remaining out of hyperextension. Subjects squeezed the dynamometer at setting 2 for 3 seconds alternating between the right and left hands. The scores of 3 successive trials were recorded with the mean score used for analysis.

RESULTS: No significant differences were found between groups preintervention for pinch, ROM, and NDI scores. There is statistically significant difference in mean pinch (P<.05) in both intervention groups compared to control, with proximal treatment group showing greater mean pinch than distal, and distal greater than control. There is no significant change with NDI score. Total median ROM improved significantly (P<.05) in intervention groups when compared to the control, with no difference between proximal and distal treatment groups. Total Ulnar ROM improved significantly (P<.05) in proximal and distal treatment groups compared to the control, with distal tensioning group having a statistically significant improvement compared to proximal tensioning group.

CONCLUSIONS: Pinch strength improved significantly in both proximal and distal groups compared to the control, with no difference between treatment groups. Median ROM improved significantly with both proximal and distal groups compared to control, with no difference between treatment groups. Ulnar ROM improved significantly with both proximal and distal groups compared to control, but distal intervention group was statistically significant when compared to proximal intervention group.

CLINICAL RELEVANCE: Selecting a strategy for tensioning (proximal or distal) for the median nerve does not make a difference while tensioning of the ulnar nerve is most effectively accomplished distally.