Side-to-side range of movement variability in variants of the median and radial neurodynamic test sequences in asymptomatic people

Diagnostic accuracy of the upper limb neurodynamic test 1 using neurodynamic sequencing in diagnosis of carpal tunnel syndrome

BACKGROUND

The upper limb neurodynamic test 1 is used in the diagnosis of median nerve neuropathies such as carpal tunnel syndrome but its diagnostic validity remains limited. Neurodynamic sequencing has been suggested to increase the specificity of the neurodynamic tests, however, to date, information on the diagnostic accuracy of this variation in neurodynamic testing is required.

OBJECTIVES

The aim of this study was to analyze the diagnostic validity of the local sequence of ULNT1 (LS-ULNT1) (i.e. a sequence that begins at the joint where the problem is (wrist) and progressively moves joints further away from it), in the diagnosis of CTS. A secondary aim was to describe the location of sensory responses to this modified neurodynamic test sequence.

DESIGN

A prospective diagnostic accuracy study was designed.

METHOD

Nerve conduction studies were used as the gold standard. The LS-ULNT1 was performed in 58 consecutive patients (17 men, 44 women) with suspected CTS.

RESULTS

Sensitivity of the LS-ULNT1 was 65.7% (CI 48.0-80.9%) and the specificity was 95.7% (CI 78.1-99.9%). The positive and negative likelihood ratios were >5 and < 0.5, respectively, indicating the ability of the test to generate small but sometimes important changes in post-test probability.

CONCLUSIONS

The overall results of this study showed that the LS-ULNT1 could be useful in confirming the diagnosis of CTS. The test demonstrated high specificity and the +LR indicated the ability of the test to generate changes in posttest probability, especially with a positive LS-ULNT1 result.

Neurodynamic Functions and Their Correlations with Postural Parameters in Adolescents with Idiopathic Scoliosis

Knowledge about neurodynamic functions of the nervous system (NS) in patients with idiopathic scoliosis (IS) is limited. This study aimed to assess the mechanosensitivity of the NS structures (MNS) in adolescents with IS. The study included 69 adolescents with IS and 57 healthy peers aged 10–15 years. The Upper Limb Neurodynamic Test 1 (ULNT1), straight leg raise (SLR) test, and slump test (SLUMP) were used to assess MNS. The spinal curvatures in the sagittal plane and selected ranges of motion were measured. The data were analysed using the Mann–Whitney U test and Spearman’s rank correlation. Increased MNS assessed by ULNT1 and SLUMP tests was observed in participants with IS. Values of the neurodynamic tests correlated significantly with the sagittal profile of the spine and the mobility of the spine and lower limbs in both groups. In conclusion, increased MNS occurs in adolescents with IS. Therefore, the examination of adolescents with IS should include an assessment of MNS with the neurodynamic tests. Future studies should investigate this issue to better understand the mechanisms that coexist with IS.

Quantitative body symmetry assessment during neurological examination

BACKGROUND

A lack of movement coordination characterized by the undershoot or overshoot of the intended location with the hand, arm, or leg is often found in individuals with multiple sclerosis (MS). Standardized as Finger-to-Nose (FNT) and The Heel-to-Shin (HST) tests are the most frequently used tests for qualitative examination of upper and lower body coordination. Inertial sensors facilitate in performing quantitative motion analysis and by estimating body symmetry more accurately assess coordination lesion and imbalance.

OBJECTIVES

To assess the body symmetry of upper and lower limbs quantitatively, and to find the best body symmetry indices to discriminate MS from healthy individuals (CO).

METHODS

28 MS patients and 23 CO participated in the study. Spatiotemporal parameters obtained from six Inertial Measurement Units (IMUs) were placed on the upper and lower extremities during FNT and HST tests. All data were analyzed using statistical methods in MATLAB.

RESULTS

Asymmetry indices of temporal parameters showed a significant increase in upper body and lower body asymmetry of MS compared to CO. However, CO have a greater kinematic asymmetry compared to MS.

CONCLUSION

Temporal parameters are the most sensitive to body asymmetry evaluation. However, range of motion is completely inappropriate if it is calculated for one movement cycle.

Agreement and Reliability of Median Neurodynamic Test 1 and Resting Scapular Position

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 (ICC_2,3) 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 (ICC_2,3 ˃ 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.

Reliability of the beighton score and impact of generalized joint mobility and resting scapular position on Median Neurodynamic Test 1

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 (ICC_2,1) 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.

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

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 flexion, in 40 asymptomatic subjects.

Methods:

A traditional goniometer was used to measure elbow flexion ROM at two end points, onset of resistance (R1) and symptom onset (P1). Two repeated measures of R1 and P1 were taken on each side.

Results:

Reliability for R1 and P1 was found to be good (ICC ≥0.83, SEM ≤5.37) with no significant difference in mean ROM between sides. A significant relationship between sides was seen (r values ≥0.48) and R2 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 P1. Lower bound scores indicate that intra-individual ROM difference >23° for R1 and 22^° for P1 would exceed normal ROM asymmetry.

Conclusion:

These findings provide clinicians with background information of ROM asymmetry during the ulnar neurodynamic test.

Immediate Effects of Thoracic Spine Thrust Manipulation on Neurodynamic Mobility

OBJECTIVE

The purpose of this study was to investigate the immediate effects of thoracic spine thrust manipulation (TSM) on the upper limb provocation test (ULPT) and seated slump test (SST) in individuals with identified neurodynamic mobility impairments. A secondary aim was to determine if correlation existed between the perception of effect and improvements in neurodynamic mobility following a thrust manipulation compared with mobilization.

METHODS

A pretest-posttest experimental design randomized 48 adults into 2 groups: TSM or mobilization. Participants with identified neurodynamic mobility impairment as assessed with the ULPT or SST received a pre-assigned intervention (TSM, n = 64 limbs; mobilization, n = 66 limbs). Perception of effect was assessed to determine its influence on outcome. Repeated-measures analysis of variance was used to examine the effects of intervention, and Fisher's exact test and independent t tests were used to determine the influence of perception.

RESULTS

Both the ULPT (P < .001) and SST (P < .001) revealed improvements at posttest regardless of intervention. The ULPT effect sizes for TSM (d = 0.70) and mobilization (d = 0.69) groups were medium. For the SST, the effect size for the TSM group (d = 0.53) was medium, whereas that for the mobilization group (d = 0.26) was small. Participants in the mobilization group with positive perception had significantly greater (P < .05) mean neurodynamic mobility changes than those with a negative perception.

CONCLUSIONS

Neurodynamic mobility impairment improved regardless of intervention. The magnitude of change was greater in the ULPT than SST. Although both interventions appeared to yield similar outcomes, individuals who received mobilization and expressed a positive perception of effect exhibited significantly greater changes in neurodynamic mobility than those without a positive perception.

Intrarater Agreement of Elbow Extension Range of Motion in the Upper Limb Neurodynamic Test 1 Using a Smartphone Application

OBJECTIVE

To estimate the intrarater agreement of the Compass application of a smartphone in the assessment of elbow extension range of motion (EE-ROM) at pain onset and maximum tolerable point during the Upper Limb Neurodynamic Test 1 (ULNT1).

DESIGN

Within-day intrarater agreement study.

SETTING

Private and university clinical settings.

PARTICIPANTS

Volunteers (N=41; 21 men; age, 31.34±13.27y; height, 1.67±0.07m; body mass, 70.53±12.37kg) recruited from the community, with no symptoms or musculoskeletal abnormalities in their upper body quadrant and no regional or systemic nerve dysfunction.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Ninety-five percent limits of agreement (LOA), standard error of the measurement, and minimal detectable change at the 95% confidence level (MDC₉₅) of EE-ROM at pain onset and maximum tolerable point during the ULNT1.

RESULTS

Standard error of the measurement and MDC₉₅ were relatively high on both sides when considering the onset of pain (standard error of the measurement, 6.6°-6.8°; MDC₉₅, 18.4°-18.8°). Better results were found for the maximum tolerable point (standard error of the measurement, 4.2°-4.8°; MDC₉₅, 11.7°-13.2°). The 95% LOA showed a similar trend.

CONCLUSIONS

Smartphone measurements showed relatively wide agreement parameters of elbow extension during the ULNT1. These results are, nevertheless, comparable with previous studies using goniometric assessment when considering maximal pain tolerance. Further research is needed before the possible widespread use of the smartphone in neurodynamic assessment.