An Experimental Pain Model to Investigate the Specificity of the Neurodynamic Test for the Median Nerve in the Differential Diagnosis of Hand Symptoms  Michel W. Coppieters, PT, PhD, Ali M. Alshami, MPhty, Paul W. Hodges, PhD, PT, MedDr  Archives of Physical Medicine and Rehabilitation  Volume 87, Issue 10, Pages 1412-1417 (October 2006) DOI: 10.1016/j.apmr.2006.06.012 Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 The neurodynamic test for the median nerve. The test is used to evaluate the impact of compression and tension in the median nerve at the carpal tunnel by combined movements of the wrist, elbow, and shoulder girdle. While elevation of the shoulder girdle is prevented, the nerve bed of the median nerve is elongated by shoulder abduction, wrist extension, forearm supination, lateral rotation of the shoulder, and elbow extension. Cervical contralateral side bending can be added to further increase the length of the nerve bed. From Butler DS. The sensitive nervous system. Unley: Noigroup Publications; 2000. p 317.20 © 2000. Reprinted with permission of Noigroup Publications. Archives of Physical Medicine and Rehabilitation 2006 87, 1412-1417DOI: (10.1016/j.apmr.2006.06.012) Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 2 Pain perception during continuous infusion of hypertonic saline in the thenar muscles. Following a rapid increase during the first minute, a relatively constant pain intensity could be induced. Archives of Physical Medicine and Rehabilitation 2006 87, 1412-1417DOI: (10.1016/j.apmr.2006.06.012) Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 3 (A) The different test positions that correspond with different stages of the neurodynamic test for the median nerve. The positions are described in detail in appendix 1. (B) The intensity of the induced hand pain () and the size of the painful area () did not differ significantly for the 8 different positions with a variable amount of nerve bed elongation. The y axis represents both pain intensity (VAS) and size of the painful area (diameter of the presented circles ranging from 0.5 to 7.5cm). The error bars denote 95% confidence intervals. The right panel shows the most frequently reported locations of hand pain during the experiment. A darker gray tint represents a larger number of subjects reporting pain in the involved area. Archives of Physical Medicine and Rehabilitation 2006 87, 1412-1417DOI: (10.1016/j.apmr.2006.06.012) Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions