Diagnostic accuracy of upper limb neurodynamic tests in the diagnosis of cervical radiculopathy

Grondin, Francis; Cook, Chad; Hall, Toby; Maillard, Olivier; Perdrix, Yannick; Freppel, S.

doi:10.1016/j.msksp.2021.102427

Cited by 16 publications

(25 citation statements)

References 25 publications

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“…Using a single upper limb neurodynamic test for the median, radial, and ulnar nerves in isolation did not alter the chance of ruling out cervical radiculopathy. Only the combination of three positive tests was useful 15 …”

Section: Discussionmentioning

confidence: 99%

“…In a recent prospective diagnostic accuracy study, Spurling's test and reduced reflexes had a high specificity for defining cervical radiculopathy, whereas the presence of paresthesia showed a high sensitivity, 13 although the interpretation of Spurling's test has also been recently questioned 14 . Indeed, there is no gold standard for testing cervical radiculopathy 15 . Furthermore, even in the lumbar spine, pain distribution and sensory disturbances can be difficult to interpret and were deemed unreliable when distinguishing between subsequent surgery‐verified L5 and S1 root involvement 16 …”

Section: Introductionmentioning

confidence: 99%

“…14 Indeed, there is no gold standard for testing cervical radiculopathy. 15 Furthermore, even in the lumbar spine, pain distribution and sensory disturbances can be difficult to interpret and were deemed unreliable when distinguishing between subsequent surgery-verified L5 and S1 root involvement. 16 In daily practice, spine doctors often agree that a clinical examination, suggesting a symptomatic herniation at one cervical level, but an MRI revealing a herniation at an adjacent level can still serve as an adequate explanation for the patient's complaints.…”

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confidence: 99%

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Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study

Redebrandt

Brandt

Hawran

et al. 2022

Health Science Reports

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Objectives: Cervical nerve root compression can lead to radiculopathy in the arm. Some studies have reported low accuracy in determining the responsible nerve root in both cervical and lumbar regions. This prospective, observational, pragmatic study aimed to determine the accuracy of the clinical evaluation relative to magnetic resonance imaging (MRI) findings in patients with arm radiculopathy.Methods: Patients with neck pain and neck-related arm pain referred to a spine unit underwent a standard clinical neurological examination and cervical spine MRI. The clinical examination required a judgment of the most likely cervical root involved, including the side. The Interobserver reproducibility was tested. Using MRI, the most likely nerve root involved according to radiology was assessed.Results: Eighty-three patients met the inclusion criteria. The Interobserver reproducibility between clinical evaluators was 58%, with a modest κ coefficient (0.33, 95% confidence interval [CI]: 0.18-0.47) classified only as "fair agreement."Only 31% (95% CI: 22-42) of the 83 patients exhibited full agreement regarding the suspected cervical root as assessed via the clinical evaluation and MRI. In another 28% (95% CI: 18-39), the clinical evaluation identified an adjacent level to that identified on MRI.Conclusions: In cervical radiculopathy, the clinical-neurological examination diagnosed the same in 31% or an adjacent cervical root in 28% of the patients in relation to the most affected cervical root on MRI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study

Redebrandt

Brandt

Hawran

et al. 2022

Health Science Reports

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“…Physical examination tests that have demonstrated increased specificity relative to others are Spurling, cervical distraction, and shoulder abduction tests, with Spurling researched and used to the greatest degree 4,91–93. The optional fifth criterion was selected as in accordance with the NASS recommendations, diagnosing CR in conservative management settings through history and physical examination findings is sufficient 2–5. As a result, similar to lumbar radiculopathy, the main criteria we recommended for RCTs assessing conservative interventions are based on history and clinical examination findings 110.…”

Section: Discussionmentioning

confidence: 99%

Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review

Plener

Silva-Oolup

et al. 2022

Spine

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Study Design. Systematic review. Objective. The aim of this study was to evaluate the inclusion and exclusion criteria for participants in randomized control trials (RCTs) assessing conservative management for cervical radiculopathy (CR), to determine if any consensus exists within the literature. Summary of Background Data. A 2012 systematic review identified a lack of uniformity for the eligibility criteria of participants in RCTs evaluating conservative interventions for CR. Since then, a large number of RCTs have been published, signaling the need for an updated evaluation of this topic. Materials and Methods. We electronically searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022, to identify RCTs assessing conservative management of CR. Information extracted was analyzed to determine the level of homogeneity and/or heterogeneity of the inclusion and exclusion criteria across studies. Results. Seventy-six RCTs met our inclusion criteria with 68 distinct trials identified. The inclusion of arm pain with or without another symptom (i.e. numbness, paresthesia, or weakness) was required in 69.12% of trials, 50% of trials required participants to exhibit neck symptoms, and 73.53% of studies required some form of clinical examination findings, but inconsistencies existed for the number and type of tests used. Furthermore, 41.18% of trials included imaging, with 33.82% of trials requiring magnetic resonance imaging findings. The most common exclusion criteria included were the presence of red flags and cervical myelopathy in 66.18% and 58.82% of trials, respectively. Conclusions. Overall, there is still a lack of uniformity for the inclusion/exclusion criteria of trials assessing the conservative management of CR, with some improvements noted compared with the 2012 review. Based on the current literature assessing the diagnostic utility of clinical symptoms and confirmatory tests, we proposed inclusion criteria for trials assessing conservative interventions. Future research should aim to develop standardized classification criteria to improve consistency among studies.

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“…The upper limb neurodynamic test 1 (ULNT1) consists of a series of movements constructed to stress various parts of the nervous system and is regarded to be capable of detecting increased nerve mechanosensitivity [ 1 , 2 ]. Clinicians use range of motion (ROM) and sensory responses to evaluate neurodynamic tests and compare sides and/or relate results to normal values in order to diagnose upper extremity peripheral neuropathic pain [ 3 , 4 ]. Furthermore, musculoskeletal physiotherapists evaluate ULNT1 (median nerve) to discover changes in mechanosensitivity in the neural system, hence measuring function gain for patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Quantifying the Elasticity Properties of the Median Nerve during the Upper Limb Neurodynamic Test 1

Lin

Chen

Deng

et al. 2022

Applied Bionics and Biomechanics

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Background. The upper limb neurodynamic test 1 (ULNT1) consists of a series of movements that are thought to detect an increase in neuromechanical sensitivity. In vivo, no trail was made to quantify the association between the nerve elasticity and different limb postures during ULNT1. Objectives. (1) To investigate the relationship between nerve elasticity and limb postures during ULNT1 and (2) to investigate the intra- and interoperator reliabilities of shear wave elastography (SWE) in quantifying the elasticity of median nerve. Methods. Twenty healthy subjects (mean age: 19.9 ± 1.4 years old) participated in this study. The median nerve was imaged during elbow extension in the following postures: (1) with neutral posture, (2) with wrist extension (WE), (3) with contralateral cervical flexion (CCF), and (4) with both WE and CCF. The intra- and interoperator reliabilities measured by two operators at NP and CCF+WE and intraclass correlation coefficients (ICCs) were calculated. Results. The intraoperator ( ICC = 0.72 – 0.75 ) and interoperator ( ICC = 0.89 – 0.94 ) reliabilities for measuring the elasticity of the median nerve ranged from good to excellent. The mean shear modulus of the median nerve increased by 53.68% from NP to WE+CCF. Conclusion. SWE is a reliable tool to quantify the elasticity of the median nerve. There was acute modulation in the elasticity of the median nerve during the ULNT1 when healthy participants reported substantial discomfort. Further studies need to focus on the elasticity properties of the median nerve in patients with peripheral neuropathic pain.

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Diagnostic accuracy of upper limb neurodynamic tests in the diagnosis of cervical radiculopathy

Cited by 16 publications

References 25 publications

Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study

Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study

Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review

Quantifying the Elasticity Properties of the Median Nerve during the Upper Limb Neurodynamic Test 1

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