Alexander Bushell CHIR20006 S0287741

Identify a central concern

Patients regularly present with pain which radiates down the arm. The clinician needs to
differentiate pathologies from the cervical, shoulder, central nervous system (CNS), and
peripheral nervous system (PNS). After a thorough history is taken including pain
distribution, the practitioner may choose to conduct an upper limb neuro tension (ULNT) test.
The purpose of the ULNT test is to reproduce familial symptoms by increasing provocation to
the median, ulnar and radial nerves through specific arm positions.
This is something which as a cohort we were exposed to at the end of third year and whilst I
can perform the tests, through self-evaluation I would not rate myself in the professional
bracket that is used on the OSCE rubrics.
Research a strategy to address the central concern

I sought out some research literature on the ULNT. Butler et al (1) reports that there is high
inter- and intra- practitioner reliability using the brachial plexus tension test (BPTT) which is
provokes the same tissues as the ULNT but is different in the position sequencing and has a
specific grading scale for each region along a neural pathway being tested. The ULNT
however, is what is used within the Central Queensland University (CQU) chiropractic junior
and senior clinics and therefore is what I will use until graduated. I will then investigate the
BPTT further and seek out professional education courses in this area.
Implement change strategy to address the central concern
From the start of term 2, 2021 I decided to perform ULNT on at least one person per week.
The outcome was to become more proficient in four key areas client positioning, tissue
provocation, interpretation, and report of findings to the ‘patient’. A numerical score was
assigned through self-assessment and with ‘patient’ oral feedback. Grading Scale: 1 Needs
work, 2 Average, 3 Professional, 4 Excellent.
Reassess if change strategy has been successful
Over the course of five weeks there is a marked improvement across all four key areas
which can be seen in the following chart.

ULNMT Grading Scale Over One Month

R.O.F

Provocation

Interpretation

Positioning

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

Series 1 Series 2 Series 3 Series 4 Series 5

1
Alexander Bushell CHIR20006 S0287741

Grading Scale: 1 Needs work, 2 Average, 3 Professional, 4 Excellent

References:

1. Mark W. Butler CK, Mary Lou Galantino, M. Alysia Mastrangelo. Reliability and accuracy of
the brachial plexus neurodynamic test. Journal of Hand Therapy. 2019;32:483-8.