Relationship Between Interpretation and Accuracy of the Upper Limb Neurodynamic Test 1 in Carpal Tunnel Syndrome

Vanti, Carla; Bonfiglioli, Roberta; Calabrese, Monica; Marinelli, Francesco; Violante, Francesco Saverio; Pillastrini, Paolo

doi:10.1016/j.jmpt.2011.09.008

Cited by 18 publications

(9 citation statements)

References 40 publications

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“…As observed by Vanti et al. , 21 for the median neurodynamic test, mean elbow ROM was 155 ° for P1 and 164 ° for P2. As such, the use of P 2 as an end-point measure might explain the greater mean elbow ROM reported by Covill and Petersen.…”

Section: Discussionsupporting

confidence: 74%

“…The end points were R1 and P1, as these have been shown to have excellent inter- and intra-rater reliability. 21,23,24 Participants were instructed to say “now” upon the onset of any sensation change during the neurodynamic test and the movement paused for measurement purposes. The examiner said “R” when the onset of resistance was felt and again the movement was paused for measurement.…”

Section: Methodsmentioning

confidence: 99%

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Side-to-side elbow range of movement variability in an ulnar neurodynamic test sequence variant in asymptomatic people

Tong

Liu

Hall

2018

Hong Kong Physiother. J.

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Background: Range of motion (ROM) asymmetry between sides is one indicator of a positive neurodynamic test, but this has been less well studied for the ulnar nerve. Objective: The purpose of this study was to investigate side-to-side variation in elbow ROM during an ulnar neurodynamic test sequence, including contralateral cervical side°exion, in 40 asymptomatic subjects. Methods: A traditional goniometer was used to measure elbow°exion ROM at two end points, onset of resistance (R1) and symptom onset (P 1). Two repeated measures of R1 and P 1 were taken on each side. Results: Reliability for R1 and P 1 was found to be good (ICC ! 0:83, SEM 5:37) with no signi¯cant di®erence in mean ROM between sides. A signi¯cant relationship between sides was seen (r values ! 0:48) and R 2 values > 0:23; this indicates at least 23% of the variance observed in one limb was accounted for by range in the opposite limb. This relationship was slightly stronger for R1 than P 1. Lower bound scores indicate that intra-individual ROM di®erence > 23 for R1 and 22 for P 1 would exceed normal ROM asymmetry. Conclusion: These¯ndings provide clinicians with background information of ROM asymmetry during the ulnar neurodynamic test.

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Section: Discussionsupporting

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Side-to-side elbow range of movement variability in an ulnar neurodynamic test sequence variant in asymptomatic people

Tong

Liu

Hall

2018

Hong Kong Physiother. J.

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“…For instance, approximately 58% of patients with lumbosacral radiculopathy have a negative straight leg raise, 8 and for CTS, the percentage of positive ULNTs varies from 18% to 72%. 5 , 6 , 7 This variation in prevalence values among the different studies is most likely explained by the different performances of ULNTs and the varying criteria for a positive test. For instance, some studies used structural differentiation as an essential criterion to rate a neurodynamic test as positive, 5 whereas structural differentiation was not required for a positive test outcome in other studies.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 6 , 7 This variation in prevalence values among the different studies is most likely explained by the different performances of ULNTs and the varying criteria for a positive test. For instance, some studies used structural differentiation as an essential criterion to rate a neurodynamic test as positive, 5 whereas structural differentiation was not required for a positive test outcome in other studies. 7 We strictly adhered to the recommended criteria for a standardized performance and interpretation of ULNTs, 20 which includes structural differentiation as an essential test criterion.…”

Section: Discussionmentioning

confidence: 99%

“…1 Commonly used tests include the straight leg raise or slump test for patients with radiating back or leg pain 2 or upper limb neurodynamic tests (ULNTs) for patients with radiating neck or arm pain. 3 , 4 The clinometric properties of these tests are however weak, 5 , 6 , 7 , 8 which is reflected in a subgroup of patients with normative neurodynamic tests despite a clear injury to their peripheral nervous system. For instance, some patients with lumbar radiculopathy have an inconspicuous straight leg raise, 9 and a substantial proportion of patients with carpal tunnel syndrome (CTS) have negative ULNTs despite confirmed nerve involvement.…”

mentioning

confidence: 99%

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Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies

Baselgia

Bennett

Silbiger³

et al. 2017

Archives of Physical Medicine and Rehabilitation

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ObjectiveTo examine differences in somatosensory phenotypes of patients with positive and negative neurodynamic tests and compare these with healthy participants.DesignCase-control study.SettingUniversity department.ParticipantsPatients with electrodiagnostically confirmed carpal tunnel syndrome (CTS) (n=53) and people without CTS (n=26) participated in this study (N=79). Patients with CTS were subgrouped according to the results of the upper limb neurodynamic tests biasing the median nerve into patients with positive or negative neurodynamic tests.InterventionsNot applicable.Main Outcome MeasureAll participants underwent quantitative sensory testing in the median innervated territory of their hand.ResultsOnly 46% of patients with CTS had positive neurodynamic tests. No differences were identified between groups for pain thresholds (P>.247). However, patients with CTS had increased mechanical (P<.0001) and thermal detection thresholds (P<.0001) compared with people without CTS. Patients with negative neurodynamic tests had a more pronounced vibration detection deficit (mean, 7.43±0.59) than people without CTS (mean, 7.89±0.22; P=.001). Interestingly, warm detection was the only domain differentiating positive (mean, 4.03°C±2.18°C) and negative neurodynamic test groups (6.09°C±3.70°C, P=.032), with patients with negative neurodynamic tests demonstrating increased loss of function.ConclusionsPatients with negative neurodynamic tests seem to have a more severe dysfunction of the unmyelinated fiber population. Our findings suggest that neurodynamic tests should not be used in isolation to judge neural involvement. Rather, they should be interpreted in the context of loss of function tests of the small fiber domain.

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Displacement of the nervous system through articular movement by ultrasound. Bibliographic review

Munné

Pedret

2018

Apunts. Medicina de l'Esport

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Relationship Between Interpretation and Accuracy of the Upper Limb Neurodynamic Test 1 in Carpal Tunnel Syndrome

Cited by 18 publications

References 40 publications

Side-to-side elbow range of movement variability in an ulnar neurodynamic test sequence variant in asymptomatic people

Side-to-side elbow range of movement variability in an ulnar neurodynamic test sequence variant in asymptomatic people

Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies

Displacement of the nervous system through articular movement by ultrasound. Bibliographic review

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