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Bueno-Gracia E, Malo-Urriés M, Montaner-Cuello A, Borrella-Andrés S, López-de-Celis C. Normal response to tibial neurodynamic test in asymptomatic subjects. J Back Musculoskelet Rehabil 2021; 34:243-249. [PMID: 32831191 DOI: 10.3233/bmr-191814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The straight leg raise test (SLR) is one of the most performed physical tests for mechanosensitivity and impairment of the nervous system. According to the anatomy of the tibial nerve, ankle dorsiflexion and eversion movements could be used to perform the tibial neurodynamic test (TNT). To date, no study has documented the normal responses of the TNT. OBJECTIVE To document normal responses of the TNT in asymptomatic individuals and to investigate influences from sex and leg dominance. METHODS A cross-sectional study with 44 asymptomatic volunteer subjects, a total of 88 lower limbs, was carried out. The range of motion (ROM), quality, and distribution of sensory responses were recorded. The hip flexion ROM was measured when subjects reported an intensity of their symptoms of 2/10 (P1) and 8/10 (P2). RESULTS The mean ROM for hip flexion at P1 was 44.22 ± 13.13∘ and 66.73 ± 14.30∘ at P2. Hip flexion was significantly greater at P2 than P1 (p< 0.001). However, it was not different between sex or limbs (p> 0.05). The descriptor of the quality of sensory responses most often used by participants was stretching (88.6% and 87.5% for P1 and P2, respectively) in the popliteal fossa and posterior calf. CONCLUSIONS This study describes the sensory responses of asymptomatic subjects resulting from the TNT. Our findings indicate that TNT responses are independent of the influence of sex or leg dominance.
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Affiliation(s)
| | | | | | | | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
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Riley SP, Grimes JK, Calandra K, Foster K, Peet M, Walsh MT. Agreement and Reliability of Median Neurodynamic Test 1 and Resting Scapular Position. J Chiropr Med 2021; 19:203-212. [PMID: 33536857 DOI: 10.1016/j.jcm.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022] Open
Abstract
Objective The purposes of this study were to determine whether there are differences between the dominant and nondominant arms for the Median Neurodynamic Test 1 (MNT 1); whether there are differences between men and women on the MNT 1; the reliability of an assessment of resting scapular position; the reliability of the MNT 1; and the frequency and percentage of sensory responses that are present during the MNT 1 in the asymptomatic population. Methods This was a reliability and agreement study. It included asymptomatic students enrolled in the college of health professions and the college of nursing at a university. The Mann-Whitney U was used to determine whether there were any differences between the dominant and nondominant sides and between sexes for elbow extension range of motion and for sensory responses on the numeric pain rating scale when performing the MNT 1. A χ2 analysis was used to determine whether there were any differences between sexes and between dominant and nondominant upper extremities for sensory-response location, sensory-response type, and structural differentiation for raters 1 and 2. The intraclass correlation coefficient (ICC2,3) was used to determine the intertester and intratester reliability for the degrees of elbow extension attained during testing. Results Reliability for degrees of elbow extension and strength of the sensory response was excellent (ICC2,3 ˃ 0.75) and substantial (κ ≥ 0.68), respectively. Resting scapular position and all other components of the MNT 1 demonstrated statistically significant side-to-side differences and κ values ranging from 0.23 to 0.88. Conclusion Elbow extension and magnitude of sensory response are reliable components of the MNT 1 that are not different between the dominant and nondominant sides in the asymptomatic population.
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Affiliation(s)
- Sean P Riley
- Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut
| | - Jason K Grimes
- Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut
| | - Kylie Calandra
- Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut
| | - Kelsey Foster
- Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut
| | - Melissa Peet
- Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut
| | - Matthew T Walsh
- Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut
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Jiménez Del Barrio S, Ceballos-Laita L, Bueno-Gracia E, Rodríguez-Marco S, Haddad-Garay M, Estébanez-de-Miguel E. Effects of Diacutaneous Fibrolysis on Mechanosensitivity, Disability, and Nerve Conduction Studies in Mild to Moderate Carpal Tunnel Syndrome: Secondary Analysis of a Randomized Controlled Trial. Phys Ther 2021; 101:6054187. [PMID: 33373445 DOI: 10.1093/ptj/pzaa222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 11/23/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE People diagnosed with carpal tunnel syndrome (CTS) have fibrosis between the soft, connective, and neural tissues that could worsen the compression of the median nerve. The diacutaneous fibrolysis (DF) technique may release tissue adhesions and increase the mobility of connective tissues. The purpose of this study was to compare the outcomes of DF in people with mild to moderate CTS on mechanosensitivity, disability, and nerve conduction studies. METHODS This was a secondary analysis of a double-blinded, randomized, placebo-controlled trial. Patients were recruited between April and September 2016 from the Department of Neurophysiology at the Hospital Miguel Servet, Zaragoza, Spain. Thirty-nine people (52 wrists) diagnosed with mild to moderate CTS were included. Participants were randomly assigned to either the DF group (n = 26) or the sham group (n = 26). Both groups received 5 therapy sessions, 2 sessions per week. Mechanosensitivity with the Upper Limb Neurodynamic Test 1, symptom severity and functional status with the Boston Carpal Tunnel Questionnaire, and median nerve sensory conduction velocity with nerve conduction studies were the outcomes measured. Assessments were recorded at baseline and after the intervention. RESULTS The DF group showed significant improvements in the following: mechanosensitivity, with 28.46 degrees of elbow extension range of motion (95% CI = 19.2-37.7); an increase of 1.0 point (95% CI = 0.7-1.4) for the Boston Carpal Tunnel Questionnaire symptom severity and functional status score; and sensory conduction velocity of median nerve, which improved to 5.8 m/s (95% CI = 2.5-9.2). CONCLUSION Participants with mild to moderate CTS experienced improvements in symptom severity, functional status, mechanosensitivity, and nerve conduction studies after 5 sessions of DF. IMPACT This study provides evidence of an approach based on soft and connective tissues around the median nerve in patients with CTS.
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Normal response to sural neurodynamic test in asymptomatic participants. A cross-sectional study. Musculoskelet Sci Pract 2020; 50:102258. [PMID: 32966955 DOI: 10.1016/j.msksp.2020.102258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Neurodynamic tests (NDTs) consist of a combination of movements aimed to stress different parts of the nervous system and are considered to be able to detect increased nerve mechanosensitivity. Currently, there are no studies in healthy subjects that define the normal response to sural neurodynamic test (NDTSUR). OBJECTIVES The main aim of this study was to document normal responses of the NDTSUR in asymptomatic participants. The secondary aim was to investigate potential gender and leg dominance influences. DESIGN A cross-sectional study was designed. METHODS NDTSUR was performed on 44 asymptomatic participants with a total of 88 lower limbs. The range of motion at the point of first appearance of symptoms (S1) and the point of pain tolerance (S2), quality and distribution of sensory responses were recorded. RESULTS Hip flexion was significantly greater (p < 0.001) at S2 (63.6 ± 13.1°) than S1 (42.5 ± 12°) and the mean difference was 21.8° (95% CI: 21.8; 22.8) (p < 0.001). However, hip flexion was not different between gender nor dominance (p > 0.05). The descriptor of the quality of the sensory responses more often used by participants was stretching (87% and 76% for S1 and S2, respectively) in the posterior knee and lateral leg. CONCLUSIONS This study describes the sensory responses of asymptomatic participants resulting from the NDTSUR. The findings indicate that NDTSUR responses are independent of the influence of gender or leg dominance.
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Bueno-Gracia E, Pérez-Bellmunt A, Estébanez-de-Miguel E, López-de-Celis C, Caudevilla-Polo S, Shacklock M, González-Rueda V. Effect of cervical contralateral lateral flexion on displacement and strain in the median nerve and flexor digitorum superficialis at the wrist during the ULNT1 - Cadaveric study. Musculoskelet Sci Pract 2020; 50:102244. [PMID: 32906084 DOI: 10.1016/j.msksp.2020.102244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A key issue in neurodynamic testing is whether a manoeuvre designed to produce differential biomechanical behaviour (structural differentiation) of nerve compared to adjacent muscle is mechanically accurate. The aim of this study was to investigate the capacity of cervical contralateral lateral flexion to produce differential biomechanical behaviour of the median nerve at the wrist (mechanical specificity) in relation to the adjacent muscle (flexor digitorum superficialis) at different ranges of upper limb neurodynamic test 1 in cadavers. MATERIAL AND METHODS A cross-sectional study was carried out. In fresh frozen cadavers, with microstrain devices and Vernier calipers, strain and excursion in the median nerve and flexor digitorum superficialis muscle were measured during cervical contralateral lateral flexion at 0°, 30°, 60° and 90° of elbow flexion of the upper limb neurodynamic test 1. RESULTS The cervical movement resulted in proximal excursion and significant changes in strain in the median nerve at 0°, 30° and 60° of elbow flexion during the upper limb neurodynamic test 1 (p < 0.05). In contrast, the structural differentiation manoeuvre did not affect the strain nor the excursion in the muscle at any position of the elbow (p > 0.05). CONCLUSION Adding CCLF to each ULNT1 median elbow angle increased strain and created proximal excursion of the median nerve at the wrist. Neck movement produced no changes in strain nor excursion of the flexor digitorum superficialis. This study adds to evidence that, in certain circumstances, neck movement may be used in differentiation of nerve and muscle disorders in the wrist.
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Affiliation(s)
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
| | | | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
| | | | | | - Vanesa González-Rueda
- Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
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Reliability of the beighton score and impact of generalized joint mobility and resting scapular position on Median Neurodynamic Test 1. J Bodyw Mov Ther 2020; 24:131-137. [PMID: 33218501 DOI: 10.1016/j.jbmt.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/20/2019] [Accepted: 07/19/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION There is a lack of understanding of the impact of generalized joint mobility, joint hypermobility, and resting scapular position on neurodynamic testing of the median nerve. The objectives of the study were to determine: 1) the reliability of the Beighton score (BS) with and without the cutoff score for general joint hypermobility (GJH); 2) if there are differences in the Median Neurodynamic Test 1 (MNT 1) based on the Beighton cutoff score for GJH; 3) if there are differences in the MNT 1 based on an assessment of resting scapular position; 4) if there are relationships between the BS with and without the cutoff score for GJH, resting scapular position, and MNT 1. METHODS Testing was performed by two testers at two-time intervals at least 1 week apart. The population of interest was healthy asymptomatic adults. The outcome measures included the BS, resting scapular position, and MNT 1. RESULTS Intraclass correlation coefficients (ICC2,1) were 0.52 for intertester reliability at visit 1 and 0.86 at visit 2, with intratester reliability of 0.88 for Tester 1 and 0.71 for Tester 2 for the BS. Intertester prevalence-adjusted bias-adjusted kappa (PABAK) values for the Beighton GJH cutoff scores were 0.80-0.84 and 0.80 to 0.92 for intratester reliability. There were no statistically significant differences or relationships for any of the other variables of interest. CONCLUSION Joint mobility and resting scapular position are not confounding variables when performing MNT 1 in an asymptomatic population.
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Bueno-Gracia E, Malo-Urriés M, Borrella-Andrés S, Montaner-Cuello A, Estébanez-de-Miguel E, Fanlo-Mazas P, López-de-Celis C. Neurodynamic test of the peroneal nerve: Study of the normal response in asymptomatic subjects. Musculoskelet Sci Pract 2019; 43:117-121. [PMID: 31272895 DOI: 10.1016/j.msksp.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/06/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Neurodynamic tests (NDTs) have shown to be useful in evaluating neural tissue involvement. Peroneal nerve reaches high importance in ankle injuries. However, up to date, no study has documented the normal responses for this nerve. OBJECTIVES The objective of this study was to document normal responses of the peroneal neurodynamic test (NDTPER) in asymptomatic subjects. Differences in sensory response depending on sex and leg dominance were also examined. DESIGN A cross-sectional study was designed. METHOD Forty-four asymptomatic subjects with a total of 88 lower limbs were tested. The range of motion (ROM) at the point of first appearance of symptoms (S1) and the point of symptoms tolerance (S2), quality and distribution of sensory responses were recorded. RESULTS Hip flexion was significantly higher at S2 than S1 (mean difference, 27.22°; 95% CI: 25.29°, 29.14°; p < 0.001). However, it was not different between sex, nor dominance (p > 0.05). The descriptor of the quality of sensory responses more often used by subjects was stretching (90.9%) in the external foot (74.6%). CONCLUSIONS This study provides the normal hip flexion angle and quality and distribution of sensory responses to the NDTPER in asymptomatic subjects. Responses were independent of the influence of sex or leg dominance.
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Affiliation(s)
| | | | | | | | | | | | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain; Fundació Institut Universitary per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
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Díez Valdés S, Vega JA, Martínez-Pubil JA. Upper Limb Neurodynamic Test 1 in patients with Acquired Brain Injury: a cross-sectional study. Brain Inj 2019; 33:1039-1044. [PMID: 31026183 DOI: 10.1080/02699052.2019.1606441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Neurodynamic intervention is used in the treatment of patients with Acquired Brain Injury as a method to inhibit the spasticity or reduce the sensory impairment. Purpose of the study: Assess and compare bilateral median nerve mechanosensitivity and its relationship with physical and functional status in patients with hemiparesis or upper limb paresis after ABI. Materials and Methods: Volunteer Patients from the Brain Injury Rehabilitation Unit of the Hospital Universitario Central de Asturias were evaluated for six months. Taking into account inclusion and exclusion criteria, from the 98 original patients having treatment in the Unit included, only 32 were admitted to the final study. The assessment protocol incorporated as main outcomes: bilateral mechanosensitivity of the median nerve (sensory responses, structural differentiation and maximum range of movement in Upper Limb Neurodynamic Test 1) and as secondary outcomes: hypertonia, sensory impairment, upper limb motor function and Activities of Daily Living performance. Results: Significant differences were found when comparing the bilateral maximum range of movement in Upper Limb Neurodynamic Test 1. No relationship was found between the results of the neurodynamic test of the affected upper limb and the secondary outcomes. Conclusions: Mechanosensitivity disturbance observed in the affected upper limb may benefit from neurodynamic treatment.
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Affiliation(s)
- Silvia Díez Valdés
- a Departamento de Morfología y Biología Celular, Grupo SINPOS , Universidad de Oviedo , Oviedo , Spain
| | - José A Vega
- a Departamento de Morfología y Biología Celular, Grupo SINPOS , Universidad de Oviedo , Oviedo , Spain.,b Facultad de Medicina y Ciencias de la Salud , Universidad Autónoma de Chile , Temuco , Chile
| | - José A Martínez-Pubil
- c Departamento de Cirugía y Especialidades Médico-Quirúrgicas , Universidad de Oviedo , Oviedo , Spain
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Brandini da Silva FC, José da Silva J, Sarri AJ, Paiva CE, Aloisio da Costa Vieira R. Comprehensive Validation Study of Quality-of-Life Questionnaire Using Objective Clinical Measures: Breast Cancer Treatment Outcome Scale (BCTOS), Brazilian Portuguese Version. Clin Breast Cancer 2018; 19:e85-e100. [PMID: 30473244 DOI: 10.1016/j.clbc.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION When evaluating a quality-of-life questionnaire (QLQ), many validation studies do not correlate quality-of-life scores with objective measurements of complications associated with treatment. PATIENTS AND METHODS We performed a cross-sectional observational study with 300 patients submitted to breast-conserving therapy. The patients answered the European Organization for Research and Treatment of Cancer (EORTC) QLQs C-30 and BR23, as well as the Brazilian Portuguese version of the Breast Cancer Treatment Outcome Scale (BCTOS) questionnaire. Retest, internal consistency, factorial analysis, convergent/divergent analysis, and Rasch evaluation were performed. All patients underwent physical evaluations to assess lymphedema, handgrip strength, shoulder range of motion, breast cosmesis, and breast pain, and these groups were compared on the basis of BCTOS scores. Receiver operating characteristic curve determined the predictive value of BCTOS scores associated with clinical practice. RESULTS The internal consistencies of the BCTOS domains ranged from 0.785 to 0.895. Factor analysis grouped according to the original questionnaire. Convergent validation showed differences in the sexual functioning and sexual enjoyment domains of the EORTC BR23. Analysis of known groups found that in most domains, the scores were higher in patients with lymphedema, strength deficit, shoulder range-of-motion alteration, poor breast cosmesis, breast pain, and axillary lymphadenectomy. Using a cutoff of 1.26, lymphedema was associated with the edema domain; using a cutoff of 1.33, Late Effects Normal Tissue Task Force/Subjective, Objective, Management, Analytic pain was associated with the pain domain; and using a cutoff of 2.37, the cosmetic domain was associated with subjective cosmesis. CONCLUSION The association of objective measurements in a validation study of quality of life qualified the study and allowed us to develop better parameters for comparisons of results of breast-conserving therapy between populations.
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Affiliation(s)
- Fabíola Cristina Brandini da Silva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil; Department of Physiotherapy, Barretos Cancer Hospital, Barretos, Brazil
| | - Jonathas José da Silva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil; Department of Physiotherapy, Barretos Cancer Hospital, Barretos, Brazil
| | - Almir José Sarri
- Department of Physiotherapy, Barretos Cancer Hospital, Barretos, Brazil
| | - Carlos Eduardo Paiva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil; Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - René Aloisio da Costa Vieira
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil; Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil.
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Gugliotti M, Cohen D, Hernandez A, Hinrichs K, Osmundsen N. Impact of shoulder internal rotation on normal sensory response during ulnar nerve-biased neurodynamic testing of asymptomatic individuals. J Man Manip Ther 2017; 25:39-46. [PMID: 28855791 DOI: 10.1080/10669817.2016.1173317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To determine if substitution of shoulder internal rotation for external rotation during the upper limb neurodynamic test (ULNT3) evokes comparable ulnar nerve sensory responses in asymptomatic individuals. METHODS Range of motion, quality, quantity, and distribution of sensory responses in 50 asymptomatic individuals during the traditional ULNT3 were compared to identical measures during an experimental maneuver using shoulder internal rotation. Quality and quantity of sensory responses were recorded using a 10-cm visual analog scale. RESULTS Means of sensory responses for traditional and experimental maneuvers, respectively, were as follows: stretching, 3.84 ± 8.85 and 5.38 ± 2.85 cm; burning, 1.82 ± 2.82 and 2.50 ± 3.10 cm; tingling, 2.13 ± 3.12 and 2.18 ± 2.97 cm; and numbness, 1.04 ± 2.17 and 1.01 ± 2.03 cm. A moderate to strong correlation (ICC = 0.51-0.86) was shown to exist between maneuvers; this relationship was significant (p = .001). DISCUSSION Results of this study provide evidence that there was no appreciable difference in sensory responses with regard to burning and tingling when substituting shoulder internal rotation for external rotation during the ULNT3. The results also suggest that there were only marginal differences in the sensory responses of stretching and numbness during the same substitution. CONCLUSION Patients who have limited glenohumeral external rotation due to pain, instability, and/or articular limitation may benefit from this substitution when presenting with signs of ulnar nerve pathodynamics. Further research will be needed to validate this maneuver in a symptomatic population. LEVEL OF EVIDENCE Level 2b.
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Affiliation(s)
- Mark Gugliotti
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Danielle Cohen
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Angela Hernandez
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Kristen Hinrichs
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Nicole Osmundsen
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
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Wolny T, Saulicz E, Linek P, Myśliwiec A, Saulicz M. Effect of manual therapy and neurodynamic techniques vs ultrasound and laser on 2PD in patients with CTS: A randomized controlled trial. J Hand Ther 2017; 29:235-45. [PMID: 27094495 DOI: 10.1016/j.jht.2016.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 03/13/2016] [Accepted: 03/17/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Randomized controlled trial. INTRODUCTION Two-point discrimination (2PD) test can be used to assess both clinical condition and the effects of therapy in carpal tunnel syndrome (CTS) patients. PURPOSE OF THE STUDY To determine whether there are specific differences in 2PD between symptomatic and asymptomatic hands in CTS patients and to evaluate the impact of 2 therapy regimes on 2PD in patients with CTS. METHODS Therapy for the neurodynamic mobilization group was based on manual therapy and neurodynamic techniques. Therapy for the electrophysical modalities group was based on red and infrared laser and ultrasound therapy using a contact method applied in the transverse ligament area. Therapeutic cycle consisted of 20 therapy sessions delivered at twice-weekly intervals. RESULTS After therapy, 2PD in the symptomatic limbs in the neurodynamic mobilization and electrophysical modalities groups significantly improved (p < .001). However, there was no statistically significant difference between the treatment groups. CONCLUSIONS Both therapy programs used in this study were beneficial for improving 2PD. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Tomasz Wolny
- Department of Kinesiotherapy and Special Physiotherapy Methods, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Physiotherapy, The Academy of Business, Dąbrowa Górnicza, Poland
| | - Edward Saulicz
- Department of Kinesiotherapy and Special Physiotherapy Methods, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Physiotherapy, The Academy of Business, Dąbrowa Górnicza, Poland
| | - Paweł Linek
- Department of Kinesiotherapy and Special Physiotherapy Methods, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
| | - Andrzej Myśliwiec
- Department of Kinesiotherapy and Special Physiotherapy Methods, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Mariola Saulicz
- Department of Physiotherapy, The Academy of Business, Dąbrowa Górnicza, Poland; Department of Physiotherapy in Diseases of Internal Organs, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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Side-to-side range of movement variability in variants of the median and radial neurodynamic test sequences in asymptomatic people. ACTA ACUST UNITED AC 2014; 19:338-42. [DOI: 10.1016/j.math.2014.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/03/2014] [Accepted: 03/05/2014] [Indexed: 11/19/2022]
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Ulnar nerve neurodynamic test: study of the normal sensory response in asymptomatic individuals. J Orthop Sports Phys Ther 2014; 44:450-6. [PMID: 24816501 DOI: 10.2519/jospt.2014.5207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To describe and analyze normal sensory responses to the ulnar upper-limb neurodynamic test (ULNT3) and to investigate the influence of sex and arm dominance. BACKGROUND Neurodynamic tests are commonly used in the clinical evaluation of patients with musculoskeletal pain disorders. While the normal responses of other upper-limb neurodynamic tests have been previously investigated, there are no studies that have reported the normal responses for the ULNT3. METHODS A total of 68 asymptomatic individuals between 18 and 50 years of age volunteered to participate in the study. Of these, 57 (29 women, 28 men) were eligible for the study. The variables measured were pain intensity using a numeric rating scale, shoulder abduction angle, and quality and distribution of symptoms at the point of pain tolerance of the ULNT3. RESULTS There were statistically significant differences in pain intensity and shoulder abduction angle between the sexes, with women having higher perceived pain and lower shoulder angle than men (P<.05). There was a significant difference of 6.6° (95% confidence interval: 1.1°, 12.1°) in shoulder abduction angle during the ULNT3 (P<.05) between the dominant arm and nondominant arm. The symptoms most often described during application of the ULNT3 were stretching (90%), followed by pain, and the most frequent location of symptoms was the anteromedial half of the forearm. CONCLUSION The results of this study provide the normal shoulder abduction angle and quality and distribution of symptoms for the ULNT3. These data can be used by clinicians as a reference when using the ULNT3 in their clinical reasoning and decision making.
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Boyd BS, Villa PS. Normal inter-limb differences during the straight leg raise neurodynamic test: a cross sectional study. BMC Musculoskelet Disord 2012; 13:245. [PMID: 23227972 PMCID: PMC3541198 DOI: 10.1186/1471-2474-13-245] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/05/2012] [Indexed: 11/10/2022] Open
Abstract
Background The straight leg raise (SLR) neurodynamic test is commonly used to examine the sensitivity of the lower quarter nervous system to movement. Range of motion during the SLR varies considerably, due to factors such as age, sex and activity level. Knowing intra-individual, inter-limb differences may provide a normative measure that is not influenced by such demographic characteristics. This study aimed to determine normal asymmetries between limbs in healthy, asymptomatic individuals during SLR testing and the relationship of various demographic characteristics. Methods The limb elevation angle was measured using an inclinometer during SLR neurodynamic testing that involved pre-positioning the ankle in plantar flexion (PF/SLR) and neutral dorsiflexion (DF/SLR). Phase 1 of the study included 20 participants where the ankle was positioned using an ankle brace replicating research testing conditions. Phase 2 included 20 additional participants where the ankle was manually positioned to replicate clinical testing conditions. Results The group average range of motion during PF/SLR was 57.1 degrees (SD: 16.8 degrees) on the left and 56.7 degrees (SD: 17.2 degrees) on the right while during DF/SLR the group average was 48.5 degrees (SD: 16.1 degrees) on the left and 48.9 degrees (SD: 16.4 degrees) on the right. The range of motion during SLR was moderately correlated to weight (−0.40 to −0.52), body mass index (−0.41 to −0.52), sex (0.40 to 0.42) and self-reported activity level (0.50 to 0.57). Intra-individual differences between limbs for range of motion during PF/SLR averaged 5.0 degrees (SD: 3.5 degrees) (95% CI: 3.8 degrees, 6.1 degrees) and during DF/SLR averaged 4.1 degrees (SD: 3.2 degrees) (95% CI: 3.1 degrees, 5.1 degrees) but were not correlated with any demographic characteristic. There were no significant differences between Phase 1 and Phase 2. Conclusions Overall range of motion during SLR was related to sex, weight, BMI and activity level, which is likely reflected in the high variability documented. We can be 95% confident that inter-limb differences during SLR neurodynamic testing fall below 11 degrees in 90% of the general population of healthy individuals. In addition, inter-limb differences were not affected by demographic factors and thus may be a more valuable comparison for test interpretation.
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Affiliation(s)
- Benjamin S Boyd
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA 94609, USA.
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Adriaenssens N, Vinh-Hung V, Miedema G, Versmessen H, Lamote J, Vanhoeij M, Lievens P, van Parijs H, Storme G, Voordeckers M, De Ridder M. Early contralateral shoulder-arm morbidity in breast cancer patients enrolled in a randomized trial of post-surgery radiation therapy. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2012; 6:79-93. [PMID: 22904635 PMCID: PMC3418149 DOI: 10.4137/bcbcr.s9362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Shoulder/arm morbidity is a common complication of breast cancer surgery and radiotherapy (RT), but little is known about acute contralateral morbidity. METHODS Patients were 118 women enrolled in a RT trial. Arm volume and shoulder mobility were assessed before and 1-3 months after RT. Correlations and linear regression were used to analyze changes affecting ipsilateral and contralateral arms, and changes affecting relative interlimb differences (RID). RESULTS Changes affecting one limb correlated with changes affecting the other limb. Arm volume between the two limbs correlated (R = 0.57). Risk factors were weight increase and axillary dissection. Contralateral and ipsilateral loss of abduction strongly correlated (R = 0.78). Changes of combined RID exceeding 10% affected the ipsilateral limb in 25% of patients, and the contralateral limb in 18%. Aromatase inhibitor therapy was significantly associated with contralateral loss of abduction. CONCLUSIONS High incidence of early contralateral arm morbidity warrants further investigations.
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Affiliation(s)
- Nele Adriaenssens
- Breast Clinic, Oncological Surgery, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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Manualtherapie bei chronischem Spannungskopfschmerz. MANUELLE MEDIZIN 2012. [DOI: 10.1007/s00337-012-0904-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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