Side-to-side elbow range of movement variability in an ulnar neurodynamic test sequence variant in asymptomatic people.
Michelle Meng Yim Tong, Vincent Cheng-Hsin Liu, Toby Hall
PMID 30930585WHAT IT FOUND
For the ulnar neurodynamic test, side-to-side elbow range differences must exceed 23 degrees at resistance or 22 degrees at symptom onset to be considered clinically relevant.
Smaller differences fall within normal variation and measurement error. Range comparison is less useful than symptom reproduction.
Key findings
01Side-to-side elbow range differences must exceed 23 degrees for the resistance endpoint and 22 degrees for the symptom onset endpoint to be considered clinically relevant.
02Elbow range of motion in one limb accounts for only a small proportion of the range in the opposite limb, meaning side-to-side comparison is a weak criterion for identifying a positive test.
03The mean difference between left and right sides was very small, at most 1.5 degrees, with no significant difference between sides.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only asymptomatic young adults (mean age 30.14 years), so these thresholds may not apply to older populations or those with existing musculoskeletal conditions. Participants were excluded if they had any history of trauma or limitation in upper quadrant range of motion, meaning the results do not account for common clinical comorbidities. The use of a traditional goniometer was described as cumbersome and potentially difficult to place accurately during the complex test sequence, which may have contributed to the observed variability. The study did not test the median or radial neurodynamic tests, so these thresholds are specific only to the ulnar nerve sequence.
Declared interests
The authors declared no conflicts of interest. The research did not receive specific grant funding from public, commercial, or not-for-profit sectors.
The easy way to misread this
Do not assume that any side-to-side asymmetry in elbow range of motion during ulnar neurodynamic testing is clinically significant. Differences smaller than 23 degrees at resistance or 22 degrees at symptom onset fall within normal variation and measurement error in asymptomatic people.