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Hage R, Roussel N, Dierick F, Da Natividade J, Jones M, Fourré A. Rethinking neck-related arm pain: hypothetical clinical scenarios to differentiate the underlying IASP-defined pain mechanisms. J Man Manip Ther 2024; 32:378-389. [PMID: 38087995 PMCID: PMC11257017 DOI: 10.1080/10669817.2023.2292909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023] Open
Abstract
Neck-related arm pain is frequently encountered in clinical settings, yet its underlying pain mechanisms remain elusive. While such pain radiating from the neck to the arm is often attributed to injuries or diseases of the nervous system (neuropathic pain), it can also arise from nociceptive (referred) or nociplastic sources. Regrettably, patients exhibiting this specific pain distribution are frequently diagnosed with varying terms, including 'cervicobrachialgia', 'cervicobrachial neuralgia', 'cervicobrachial pain syndrome', and 'cervical radiculopathy'. The ambiguity surrounding these diagnostic labels complicates the clinical reasoning process. It is imperative for clinicians to discern and comprehend the dominant pain mechanism. Three distinct hypothetical clinical scenarios depict patients with almost identical pain distribution but divergent dominant pain mechanisms. Within these scenarios, both subjective and objective examinations are employed to elucidate the dominant pain mechanism associated with neck-related arm pain: nociceptive, neuropathic, and nociplastic. Furthermore, clinicians must remain aware that the dominant pain mechanism can evolve over time.
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Affiliation(s)
- Renaud Hage
- Traitement Formation Thérapie Manuelle (TFTM), Manual Therapy Center, Brussels, Belgium
- CeREF Technique, Haute Ecole Louvain en Hainaut, Mons, Belgium
- Faculté des Sciences de la Motricité, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium
| | - Frédéric Dierick
- Faculté des Sciences de la Motricité, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Luxembourg, Luxembourg
| | - Joël Da Natividade
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Luxembourg, Luxembourg
| | - Mark Jones
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Antoine Fourré
- Traitement Formation Thérapie Manuelle (TFTM), Manual Therapy Center, Brussels, Belgium
- Faculté des Sciences de la Motricité, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
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Bertacchini P. Neurofascialvascular training for carpal tunnel syndrome as an evolution of neurodynamic treatment: A case report. J Bodyw Mov Ther 2024; 39:4-12. [PMID: 38876659 DOI: 10.1016/j.jbmt.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/03/2023] [Accepted: 10/17/2023] [Indexed: 06/16/2024]
Abstract
INTRODUCTION In this case report a new approach called neurofascialvascular training (NFVT) is described. NFVT consists of two mechanisms which improve mechanosensitivity in carpal tunnel syndrome (CTS). The first involves increased blood flow in the nerve microcirculation, while the second stimulates the reciprocal sliding between the thin sheets of connective tissue inside the nerve. The goal of these two actions is to squeeze, mobilize and reduce intraneural edema. The novelty of this approach is the simultaneous involvement of multiple physiological systems to reduce nerve mechanosensitivity. This case report describes the rehabilitation progress achieved by NFVT in a patient with CTS. MAIN SYMPTOMS AND/OR IMPORTANT CLINICAL FINDINGS A 64-year-old woman complaining of nocturnal pain and tingling with severe impairment of sleep quality for two years was diagnosed at CTS. THERAPEUTIC INTERVENTIONS The patient underwent nine 30-min exercise sessions of NFVT. OUTCOMES At each session and at the last follow-up 3 months after the end of treatment the following tests were performed: the upper limb neurodynamic test1 (ULNT1), the Hand Grip Meter and the Phdurkan test. Furthermore ultrasound, numerical rating scale and the Boston Carpal Tunnel Questionnaire (BCTQ) were also adopted. CONCLUSION NFVT can improve symptoms and motor dysfunction in a patient with CTS. TAKE-AWAY LESSON In the presence of mild carpal tunnel syndrome, active neurofascialvascular training that increases peripheral blood flow and targets fascial tissue within the peripheral nervous system can resolve symptoms and produce significant improvement within a few months of starting treatment.
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Affiliation(s)
- Paolo Bertacchini
- Master OMPT, University of Bologna, Bologna, Italy; Private Practice, Parma, Italy.
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Ciuffreda G, Bueno-Gracia E, Albarova-Corral I, Montaner-Cuello A, Pérez-Rey J, Pardos-Aguilella P, Malo-Urriés M, Estébanez-de-Miguel E. In Vivo Effects of Joint Movement on Nerve Mechanical Properties Assessed with Shear-Wave Elastography: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:343. [PMID: 38337859 PMCID: PMC10855485 DOI: 10.3390/diagnostics14030343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave elastography (SWE). Greater tensile loads can lead to greater stiffness, which can be quantified using SWE. Therefore, this study aimed to conduct a systematic review and meta-analysis to perform an overview of the effect of joint movements on nerve mechanical properties in healthy nerves. The initial search (July 2023) yielded 501 records from six databases (PubMed, Embase, Scopus, Web of Science, Cochrane, and Science Direct). A total of 16 studies were included and assessed with a modified version of the Downs and Black checklist. Our results suggest an overall tendency for stiffness increase according to a pattern of neural tensioning. The main findings from the meta-analysis showed a significant increase in nerve stiffness for the median nerve with wrist extension (SMD [95%CI]: 3.16 [1.20, 5.12]), the ulnar nerve with elbow flexion (SMD [95%CI]: 2.91 [1.88, 3.95]), the sciatic nerve with ankle dorsiflexion (SMD [95%CI]: 1.13 [0.79, 1.47]), and the tibial nerve with both hip flexion (SMD [95%CI]: 2.14 [1.76, 2.51]) and ankle dorsiflexion (SMD [95%CI]: 1.52 [1.02, 2.02]). The effect of joint movement on nerve stiffness also depends on the nerve segment, the amount of movement of the joint mobilized, and the position of other joints comprised in the entirety of the nerve length. However, due to the limited number of studies, many aspects of nerve behavior together with the effect of using different ultrasound equipment or transducers for nerve stiffness evaluation still need to be fully investigated.
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Affiliation(s)
- Gianluca Ciuffreda
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
| | - Elena Bueno-Gracia
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Isabel Albarova-Corral
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Alberto Montaner-Cuello
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Jorge Pérez-Rey
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Pilar Pardos-Aguilella
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Miguel Malo-Urriés
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Elena Estébanez-de-Miguel
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
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Verhagen AP, Brown H, Hancock M, Anderson D. Test procedures and positive diagnostic criteria of the upper limb tension tests differ: a systematic review of the DiTA database. Braz J Phys Ther 2023; 27:100558. [PMID: 37967500 PMCID: PMC10679807 DOI: 10.1016/j.bjpt.2023.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The validity of the ULTT is unclear, due to heterogeneity of test procedures and variability in the definition of a positive test OBJECTIVE: To evaluate test procedures and positive diagnostic criteria for the upper limb tension test (ULTT) in diagnostic test accuracy studies. METHODS A systematic review of diagnostic accuracy studies was performed. We conducted a search of the DiTA (Diagnostic Test Accuracy) database and selected primary studies evaluating the diagnostic accuracy of the ULTT. We assessed risk of bias, performed data extraction on study characteristics, test procedures, and positive diagnostic criteria, and performed a descriptive analysis. RESULTS We included nine studies (681 participants), four diagnosing people with cervical radiculopathy (CR), four diagnosing people with carpal tunnel syndrome (CTS), and one included both CR and CTS. The risk of bias varied between 2 and 6 out of 6 positive items. Eight studies reported on the ULTT1 (median nerve). Overall, all studies clearly described their test procedures and positive diagnostic criteria although the order of movements and the diagnostic criteria between studies varied. We suggest a more standardised test procedure for the ULTT1 to consist of: 1) stabilising the shoulder in abduction, 2) extending the wrist/fingers, 3) supinating the forearm, 4) externally rotating the shoulder, 5) extending the elbow, and finally 6) performed structural differentiation by side bending (lateral flexion) of the neck. This proposed test procedure should reproduce the symptoms and enables the clinician to evaluate whether symptoms increase/decrease when stressing or relaxing the nerves. CONCLUSION Based on our findings we proposed a more standardised test procedure for the ULTT1 with accompanying positive diagnostic criteria to facilitate homogeneity in future diagnostic accuracy studies of the ULTT.
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Affiliation(s)
- Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia.
| | - Hayley Brown
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - David Anderson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Spine Institute Research Group, Sydney Spine Institute, Burwood, Sydney, Australia
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Shen P, Chi-Chung Tsang R, Liang Y, Chen X. Diagnostic accuracy of the upper limb neurodynamic test with median bias (ULNT1) for cervical radiculopathy: a systematic review and meta-analysis. Physiotherapy 2023; 120:17-25. [PMID: 37356367 DOI: 10.1016/j.physio.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 05/06/2023] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The upper limb neurodynamic test for median nerve (ULNT1) is commonly applied for assessment of cervical radiculopathy (CR). However, the diagnostic accuracy of ULNT1 in diagnosing CR remains unclear. OBJECTIVE This study aimed to examine the diagnostic accuracy of the ULNT1 for the CR. DATA SOURCES Four databases were searched for relevant studies published up to April 30, 2023. STUDY SELECTION Cross-sectional or cohort studies that assessed the diagnostic accuracy of ULNT1 for CR were included. DATA SYNTHESIS The methodological quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. A bivariate random-effects regression model was used for the data synthesis. The overall quality of evidence was evaluated using the GRADE approach. RESULTS A total of 592 references were identified, and five studies with 465 patients met the inclusion criteria. The overall quality of the body of evidence was very low across studies. Heterogeneity of studies was high. The pooled sensitivity and specificity of the ULNT1 were 0.69 (95% CI 0.50-0.83) and 0.54 (95% CI 0.36-0.71), respectively. The summary receiver operating characteristic curve area was 0.65 (95% CI 0.61-0.69). CONCLUSION There is low certainty of evidence that the ULNT1 has only fair accuracy in diagnosing CR. The ULNT1 was recommended as an add-on test after the existing diagnostic pathway to enhance diagnostic accuracy further. High-quality studies which follow the Standards for Reporting of Diagnostic Accuracy and the QUADAS-2; a revised tool for the quality assessment of diagnostic accuracy, are needed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42021255686 CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Peng Shen
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China
| | | | - Ying Liang
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China
| | - Xiwen Chen
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China.
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Villagrán I, Rammsy F, Del Valle J, Gregorio de Las Heras S, Pozo L, García P, Torres G, Varas J, Mandrusiak A, Corvetto M, Fuentes-Cimma J. Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students. BMC MEDICAL EDUCATION 2023; 23:267. [PMID: 37081551 PMCID: PMC10116106 DOI: 10.1186/s12909-023-04229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. METHODS Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. RESULTS Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. CONCLUSION The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.
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Affiliation(s)
- Ignacio Villagrán
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Francisca Rammsy
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Javiera Del Valle
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Sofía Gregorio de Las Heras
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Liliana Pozo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Patricio García
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Gustavo Torres
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Julián Varas
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Marcia Corvetto
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Fuentes-Cimma
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
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Bernhardsson S, Larsson A, Bergenheim A, Ho-Henriksson CM, Ekhammar A, Lange E, Larsson MEH, Nordeman L, Samsson KS, Bornhöft L. Digital physiotherapy assessment vs conventional face-to-face physiotherapy assessment of patients with musculoskeletal disorders: A systematic review. PLoS One 2023; 18:e0283013. [PMID: 36943857 PMCID: PMC10030027 DOI: 10.1371/journal.pone.0283013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND This systematic review aimed to assess the certainty of evidence for digital versus conventional, face-to-face physiotherapy assessment of musculoskeletal disorders, concerning validity, reliability, feasibility, patient satisfaction, physiotherapist satisfaction, adverse events, clinical management, and cost-effectiveness. METHODS Eligibility criteria: Original studies comparing digital physiotherapy assessment with face-to-face physiotherapy assessment of musculoskeletal disorders. Systematic database searches were performed in May 2021, and updated in May 2022, in Medline, Cochrane Library, Cinahl, AMED, and PEDro. Risk of bias and applicability of the included studies were appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Quality Appraisal of Reliability Studies tool. Included studies were synthesised narratively. Certainty of evidence was evaluated for each assessment component using GRADE. RESULTS Ten repeated-measures studies were included, involving 193 participants aged 23-62 years. Reported validity of digital physiotherapy assessment ranged from moderate/acceptable to almost perfect/excellent for clinical tests, range of motion, patient-reported outcome measures (PROMs), pain, neck posture, and management decisions. Reported validity for assessing spinal posture varied and was for clinical observations unacceptably low. Reported validity and reliability for digital diagnosis ranged from moderate to almost perfect for exact+similar agreement, but was considerably lower when constrained to exact agreement. Reported reliability was excellent for digital assessment of clinical tests, range of motion, pain, neck posture, and PROMs. Certainty of evidence varied from very low to high, with PROMs and pain assessment obtaining the highest certainty. Patients were satisfied with their digital assessment, but did not perceive it as good as face-to-face assessment. DISCUSSION Evidence ranging from very low to high certainty suggests that validity and reliability of digital physiotherapy assessments are acceptable to excellent for several assessment components. Digital physiotherapy assessment may be a viable alternative to face-to-face assessment for patients who are likely to benefit from the accessibility and convenience of remote access. TRIAL REGISTRATION The review was registered in the PROSPERO database, CRD42021277624.
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Affiliation(s)
- Susanne Bernhardsson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anette Larsson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Department of General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Herrljunga Rehabilitation Clinic, Primary Care Rehabilitation, Region Västra Götaland, Herrljunga, Sweden
| | - Anna Bergenheim
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chan-Mei Ho-Henriksson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Lidköping Rehabilitation Clinic, Primary Care Rehabilitation, Region Västra Götaland, Lidköping, Sweden
| | - Annika Ekhammar
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Eriksberg Rehabilitation Clinic, Primary Care Rehabilitation, Region Västra Götaland, Gothenburg, Sweden
| | - Elvira Lange
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Lena Nordeman
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin S Samsson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Capio Ortho Center Gothenburg, Gothenburg, Sweden
| | - Lena Bornhöft
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Torslanda Rehabilitation Clinic, Primary Care Rehabilitation, Region Västra Götaland, Gothenburg, Sweden
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Kitade I, Kawabata A, Yonemura Y, Takahashi A. Imaging and Clinical Findings after Auto-mobilization in a Cervical Disk Herniation Patient with Prolonged Neck Pain: A 7-year Follow-up Case Report. Prog Rehabil Med 2022; 7:20220062. [PMID: 36561294 PMCID: PMC9741952 DOI: 10.2490/prm.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background Auto-mobilization (AM) is a treatment method that patients can use by themselves for pain relief. We report the case of a patient diagnosed with cervical disk herniation (CDH), with frequent recurrences of upper limb numbness and neck pain. The patient experienced a favorable outcome after cervical spine AM, as evidenced by the immediate and long-term relief of his symptoms as well as changes observed through imaging. Case A 33-year-old-man diagnosed with CDH presented with frequent recurrences of upper limb numbness and neck pain. Radiographic and T2-weighted magnetic resonance imaging scans revealed cervical spine kyphosis and a left paracentral to intraforaminal lesion with disk herniation of protrusion type at C4-5. He was started on AM to elicit physiological lordosis of the cervical spine. This treatment was painless and did not cause withdrawal on discontinuation. AM improved the mobility of his cervical lower facet joints, reduced dysesthesia, and eliminated pain. Improvement in neck pain and cervical kyphosis and reduction of disk herniation were observed 2 years after initiating the intervention. Discussion Appropriate physical therapy evaluation and cervical AM for this patient resulted in symptomatic relief and indirect disk herniation regression. By adding imaging findings to clinical findings, the effect of AM could be visualized, and the reliability of the therapeutic effect was further enhanced.
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Affiliation(s)
- Ippei Kitade
- Division of Rehabilitation Medicine, University of Fukui
Hospital, Eiheiji, Japan
| | - Akihiro Kawabata
- Division of Rehabilitation Medicine, Echizen Municipal Ota
Hospital, Echizen, Japan
| | - Yoshimasa Yonemura
- Division of Rehabilitation Medicine, Echizen Municipal Ota
Hospital, Echizen, Japan
| | - Ai Takahashi
- Division of Rehabilitation Medicine, University of Fukui
Hospital, Eiheiji, Japan, Department of Orthopaedic Surgery, University of Fukui,
Eiheiji, Japan
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Accuracy of the Most Common Provocation Tests for Diagnosing Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:522-531. [PMID: 35722757 DOI: 10.2519/jospt.2022.10828] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the screening performances of the most important provocation tests for diagnosing carpal tunnel syndrome (CTS). DESIGN Diagnostic test accuracy systematic review with meta-analysis. LITERATURE SEARCH We systematically searched the MEDLINE, Scopus, Web of Science, and Cochrane databases from inception to November 2020. STUDY SELECTION CRITERIA Observational studies comparing the accuracies of the Durkan test (DT), the hand elevation test (HET), the Phalen test (PT), the Tinel test (TT), and the upper-limb neurodynamic test specific to the median nerve (ULNT1) with electrodiagnosis for screening for CTS. DATA SYNTHESIS Random-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of these tests. Hierarchical summary receiver operating characteristic curve analyses were used to summarize the overall test performance. RESULTS Thirty-seven studies were included in the meta-analysis, with a total sample of 2662 wrists for DT, 864 wrists for HET, 6361 wrists for PT, 6094 wrists for TT, and 571 wrists for ULNT1. The pooled dORs for screening for CTS were 15.84 (95% CI: 3.78, 66.38) for DT, 128.63 (95% CI: 40.64, 407.12) for HET, 7.23 (95% CI: 4.06, 12.86) for PT, 5.31 (95% CI: 3.49, 8.09) for TT, and 1.78 (95% CI: 0.61, 5.19) for ULNT1. CONCLUSION HET has the best clinical performance for detecting CTS and should be considered the first screening test of choice during the physical examination. The most common tests (DT, PT, and TT) have good accuracies for screening for CTS. J Orthop Sports Phys Ther 2022;52(8):522-531. Epub: 19 June 2022. doi:10.2519/jospt.2022.10828.
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Fundaun J, Kolski M, Baskozos G, Dilley A, Sterling M, Schmid AB. Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis. Pain 2022; 163:e789-e811. [PMID: 35050963 PMCID: PMC7612893 DOI: 10.1097/j.pain.0000000000002509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is no clear understanding of the mechanisms causing persistent pain in patients with whiplash-associated disorder (WAD). The aim of this systematic review was to assess the evidence for nerve pathology and neuropathic pain in patients with WAD. EMBASE, PubMed, CINAHL (EBSCO), and MEDLINE were searched from inception to September 1, 2020. Study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scales. Fifty-four studies reporting on 390,644 patients and 918 controls were included. Clinical questionnaires suggested symptoms of predominant neuropathic characteristic in 34% of patients (range 25%-75%). The mean prevalence of nerve pathology detected with neurological examination was 13% (0%-100%) and 32% (10%-100%) with electrodiagnostic testing. Patients independent of WAD severity (Quebec Task Force grades I-IV) demonstrated significantly impaired sensory detection thresholds of the index finger compared with controls, including mechanical (SMD 0.65 [0.30; 1.00] P < 0.005), current (SMD 0.82 [0.25; 1.39] P = 0.0165), cold (SMD -0.43 [-0.73; -0.13] P = 0.0204), and warm detection (SMD 0.84 [0.25; 1.42] P = 0.0200). Patients with WAD had significantly heightened nerve mechanosensitivity compared with controls on median nerve pressure pain thresholds (SMD -1.10 [-1.50; -0.70], P < 0.0001) and neurodynamic tests (SMD 1.68 [0.92; 2.44], P = 0.0004). Similar sensory dysfunction and nerve mechanosensitivity was seen in WAD grade II, which contradicts its traditional definition of absent nerve involvement. Our findings strongly suggest a subset of patients with WAD demonstrate signs of peripheral nerve pathology and neuropathic pain. Although there was heterogeneity among some studies, typical WAD classifications may need to be reconsidered and include detailed clinical assessments for nerve integrity.
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Affiliation(s)
- Joel Fundaun
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Melissa Kolski
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Musculoskeletal Outpatient Department, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Andrew Dilley
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
| | - Annina B Schmid
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
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Latif J, Aveledo R, Lam PH, Murrell GAC. Postoperative Pain and Paresthesia in Labral Repairs of the Shoulder: Location Does Matter. Orthop J Sports Med 2022; 10:23259671221105080. [PMID: 35747364 PMCID: PMC9210089 DOI: 10.1177/23259671221105080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Favorable outcomes have been reported regarding postoperative shoulder pain and function after repair of anteroinferior (Bankart) glenohumeral labral tears. However, the outcomes of patients after repair of isolated superior labral anterior-posterior (SLAP) tears are a contentious topic. The authors have also anecdotally noted that patients evaluated with labral tears complained of numbness and tingling in their ipsilateral hand. Purpose: To determine if there is a difference in the temporal outcomes of shoulder pain and hand paresthesia in patients with SLAP tears versus Bankart tears after arthroscopic repair. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 66 consecutive patients who underwent arthroscopic labral repair at a single institution between August 2018 and February 2021. The prevalence and magnitude of shoulder pain as well as numbness and tingling of the hand were assessed using questions from the L’Insalata Shoulder Questionnaire and the Boston Carpal Tunnel Questionnaire preoperatively and at 1 week, 6 weeks, 12 weeks, and 6 months after surgery. Results: Preoperatively, patients with SLAP lesions reported a higher prevalence of shoulder pain during sleep compared with those with Bankart tears (P < .05). Postoperatively, patients who underwent SLAP repair reported a larger proportion and more severe magnitude of shoulder pain during rest, overhead activities, and sleep compared with those who underwent Bankart repair (P < .05). Only patients who underwent Bankart repair reported improvements in the prevalence and magnitude of their shoulder pain during rest, overhead activities, and sleep by 6 months postoperatively compared with preoperative levels (P < .05). Preoperatively, 30% of patients with Bankart repairs and 40% of patients with SLAP repairs reported hand tingling, while 35% and 50%, respectively, reported hand numbness. The prevalence and magnitude of hand tingling and numbness were not significantly different between groups at any time point. Conclusion: Study results indicated that patients who underwent SLAP repair experienced worse shoulder pain outcomes compared with those who underwent Bankart repair using the same anchor and surgical technique. Only patients who underwent Bankart repair reported improvements in their hand numbness after surgery. Therefore, labral tear location does matter with respect to shoulder pain and hand numbness.
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Affiliation(s)
- Joseph Latif
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
| | - Ricardo Aveledo
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
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Lathlean T, Ramachandran AK, Sim S, Whittle IR. Clinical utility and reproducibility of surface electromyography in individuals with chronic low back pain: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e058652. [PMID: 35577472 PMCID: PMC9114948 DOI: 10.1136/bmjopen-2021-058652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is one of the most common disorders presenting in primary healthcare. Kinematic studies of low lumbar pelvic mobility allied with surface electromyography (sEMG) may assist in the assessment and management of CLBP. However, the applicability in the use of sEMG in the clinical setting remains uncertain. In this protocol, we aim to review the clinical utility and reproducibility of the sEMG component of these kinematic studies in patients with CLBP. METHODS AND ANALYSIS This protocol was informed by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) and results will be reported in line with the PRISMA. Searches will be conducted on PubMed, Scopus, Web of Science, Embase, CINAHL and Google Scholar databases, along with a comprehensive review of grey literature. Two reviewers will conduct the searches and independently screen them, according to title and abstract. Two independent reviewers will then assess the full-text versions of those selected articles and assess the risk of bias using the defined protocol inclusion criteria. The risk of bias within the studies included will be assessed via the Quality Assessment of Diagnostic Accuracy Studies tool, V.2 and the Grading of Recommendations Assessment, Development and Evaluation guidelines will be used to assess certainty of evidence for recommendations based on the risk of bias findings. Meta-analysis will be conducted where appropriate on groups of studies with low heterogeneity. In instances of higher heterogeneity, meta-synthesis will instead be completed, comparing results in terms of increased or decreased clinical utility and/or reproducibility of sEMG. ETHICS AND DISSEMINATION Ethics approval was not required for this research. It is anticipated that the results will influence the use, interpretation and further development of sEMG in management and assessment of these patients. PROSPERO REGISTRATION NUMBER CRD42021273936.
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Affiliation(s)
- Timothy Lathlean
- Faculty of Health and Medical Sciences (FHMS), The University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia
- Precision Health Future Science Platform, CSIRO at South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Stephanie Sim
- Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Ian R Whittle
- International Spine Centre, Adelaide, South Australia, Australia
- The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
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Pain, paraesthesia and the rotator cuff: the prevalence and magnitude of shoulder pain and hand numbness and tingling before and after rotator cuff repair. JSES Int 2022; 6:615-622. [PMID: 35813148 PMCID: PMC9264141 DOI: 10.1016/j.jseint.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Shoulder pain and loss of function are classically associated with rotator cuff tears, while paresthesia of the hand is not. We noted anecdotally that paresthesia of the arm was common in patients presenting with rotator cuff tears. The purpose of this study was to determine the prevalence and magnitude of hand paresthesia, its relationship to pain, and how surgery affected these symptoms. Methods This prospective cross-sectional study assessed the prevalence and magnitude of shoulder pain and hand numbness and tingling (as assessed by 2 questions from the modified Boston Carpal Tunnel Questionnaire) preoperatively and at 1 week, 6 weeks, 12 weeks, and 6 months postoperatively among 213 consecutive patients who presented for and underwent arthroscopic rotator cuff repair. Results The preoperative levels of prevalence and severity of shoulder pain during rest, overhead activities, and sleep improved by 52%, 22%, and 34%, respectively, compared with those by 6 months postoperatively (P < .05). Seventy-five patients (33%) reported hand paresthesia before surgery. There was a 50% and 60% reduction in the severity of hand tingling and numbness, respectively, by 1 week after surgery (P < .05). The preoperative level of hand numbness (Wald statistic; W = 20) and whether the patient’s shoulder problem was caused by a specific injury (W = 6) were predictive of the presence of hand numbness at 6 months after surgery (P < .05). Conclusion This study showed that many patients who undergo rotator cuff repairs present with hand paresthesia that is associated with their shoulder pain. The prevalence and severity of shoulder pain and hand numbness and tingling improved postoperatively.
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Quantifying the Elasticity Properties of the Median Nerve during the Upper Limb Neurodynamic Test 1. Appl Bionics Biomech 2022; 2022:3300835. [PMID: 35355794 PMCID: PMC8958106 DOI: 10.1155/2022/3300835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/29/2022] [Accepted: 03/04/2022] [Indexed: 12/04/2022] Open
Abstract
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. Musculoskelet Sci Pract 2021; 55:102427. [PMID: 34298491 DOI: 10.1016/j.msksp.2021.102427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Upper limb neurodynamic tests (ULNT) are used to diagnose neuropathic conditions such as cervical radiculopathy (CR). Within the literature, a positive ULNT is defined in markedly variable ways, which is likely why the diagnostic accuracy of these tests lacks consistency across studies. OBJECTIVES To determine the diagnostic accuracy of single and combined upper limb neurodynamic tests ((ULNT)1,2a, 2b and 3) for cervical radiculopathy using test findings that are similar to those used in practice. DESIGN Diagnostic accuracy study (prospective) design following the updated STARD 2015 reporting guideline. METHOD From 109 consecutively enrolled individuals with suspected CR. Of the 85 participants included, 27 (31.7%) were diagnosed with CR (mean age, 43.9years; Neck Disability Index 38,16%). ULNTs test were performed by a blind examiner to a CR reference standard of clinical diagnosis and magnetic resonance imaging verification provided by a neurosurgeon. RESULTS In general, the single tests were better at ruling in CR versus ruling out. Of the single ULNT, the ULNT3 demonstrated the strongest post-test probability change with a positive finding (73.28%). Three of four test combinations demonstrated the highest clinical utility for changing the post-test probability with a positive finding at 83.29% and with LR+ = 12.89 (95%CI: 3.10-53.62). Having none of the test's positive was able to rule out CR with LR- = 0.08 (95%CI: 0.01-0.56). CONCLUSION ULNTs fail to significantly alter post-test probability when used singularly for diagnosis of CR. However, combinations of ULNT (3 out of 4 positive) can rule in CR, and rule out CR when all ULNT are negative.
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Carta G, Seregni A, Casamassima A, Galli M, Geuna S, Pagliaro P, Zago M. Validation and Reliability of a Novel Vagus Nerve Neurodynamic Test and Its Effects on Heart Rate in Healthy Subjects: Little Differences Between Sexes. Front Neurosci 2021; 15:698470. [PMID: 34552462 PMCID: PMC8450330 DOI: 10.3389/fnins.2021.698470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background The vagus nerve (VN), also called the pneumogastric nerve, connects the brainstem to organs contained in the chest and abdomen. Physiologically, VN stimulation can rapidly affect cardiac activity and heart rate (HR). VN neuropathy can increase the risk of arrhythmias and sudden death. Therefore, a selective test of VN function may be very useful. Since peripheral neurodynamic tests (NDT) are reliable for the assessment of neuropathies in somatic nerves, we aimed to validate a novel NDT to assess VN activity, namely, the VN-NTD. Methods In this cross-sectional double-blind, sex-balanced study, 30 participants (15 females) completed a checklist of autonomic dysfunction symptoms. During the VN-NDT administration, HR and symptoms (i.e., mechanical allodynia) were monitored in parallel to a real-time ultrasonography imaging (USI) and motion capture analysis of the neck. The VN-NDT impact on HR and its accuracy for autonomic symptoms reported in the last 7 days were tested. Results The VN-NDT induced a significant HR reduction of about 12 and 8 bpm in males and females [t(1, 119) = 2.425; p < 0.017; ηp2 = 0.047, 95% confidence interval (CI): 0.93–9.18], respectively. No adverse events were observed during VN-NDT. A substantial interexaminer agreement between the evaluators in symptoms induction by VN-NDT was detected [F(1, 119) = 0.540; p = 0.464; ηp2 = 0.005, low effect]. Notably, mechanical allodynia accuracy for gastrointestinal dysfunctions was excellent (p < 0.05; 95% CI: 0.52–0.73; p < 0.001; 95% CI: 0.81–0.96). Conclusions The novel VN-NDT is a valid and accurate test capable of detecting VN activation with high sensitivity. Data provided are suitable for both sexes as a hallmark of HR variation due to VN normal response. The proposed VN-NDT may be reliable as daily routine neurological examination tests for the evaluation of neuropathic signs related to neuroinflammation of the VN. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT04192877.
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Affiliation(s)
- Giacomo Carta
- Human Anatomy, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy.,Department of Rehabilitation, Sesto Hospital, ASST Nord Milano, Milan, Italy
| | - Agnese Seregni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Andrea Casamassima
- General Surgery Department, S. Maria delle Stelle Hospital, ASST Melegnano e Martesana Melzo, Milan, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Stefano Geuna
- Human Anatomy, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy
| | - Pasquale Pagliaro
- Human Physiology, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - Matteo Zago
- Department of Mechanics, Politecnico di Milano, Lecco, Italy
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Intractable lateral epicondilytis: A differential diagnosis algorithm for a correct clinical interpretation. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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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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Sartorio F, Dal Negro F, Bravini E, Ferriero G, Corna S, Invernizzi M, Vercelli S. Relationship between nerve conduction studies and the Functional Dexterity Test in workers with carpal tunnel syndrome. BMC Musculoskelet Disord 2020; 21:679. [PMID: 33054739 PMCID: PMC7558696 DOI: 10.1186/s12891-020-03651-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background Dexterity impairments caused by carpal tunnel syndrome (CTS) make working and daily activities challenging. We aimed to investigate: i) the relationship between dexterity and nerve conduction studies (NCS) in workers with classic symptoms presentation; ii) the ability of the Functional Dexterity Test (FDT) to discriminate different levels of CTS severity as classified by NCS; iii) the diagnostic accuracy of a clinical battery composed of the FDT, Phalen’s test and Tinel’s sign. Methods In a convenience sample of individuals diagnosed with CTS, we correlated FDT net scores with the NCS-based classification by means of Spearman’s (rho) test. Discriminative ability of the FDT was assessed by ANOVA, and a ROC curve determined cutoff thresholds. Sensitivity, specificity, and likelihood ratios (LRs) were used to investigate the diagnostic accuracy of the clinical battery. Results Data from 180 hands were collected. The FDT was significantly correlated (rho = 0.25, p < 0.001) with NCS. The FDT was able to discriminate subjects with severe/extreme NCS findings, and two thresholds (0.29–0.36) were identified. Adding the FDT to the provocative tests improved the overall diagnostic accuracy (specificity: 0.97, CI95% 0.83–0.99; LR+: 14.49, CI95% 2.09–100.53). Conclusions Sensorimotor impairments related to CTS can affect hand dexterity. The FDT discriminated patients with severe NCS involvement. Positive results on the clinical battery (Phalen, Tinel, and FDT) could help to confirm the CTS diagnosis, showing a very high specificity and LR+. On the contrary, the low sensitivity is not able to rule out CTS in individuals with negative results.
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Affiliation(s)
- Francesco Sartorio
- Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno (NO), Italy
| | - Francesca Dal Negro
- Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno (NO), Italy
| | | | - Giorgio Ferriero
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate (VA), Via Maugeri 4, I-27100, Pavia, Italy.
| | - Stefano Corna
- Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno (NO), Italy
| | - Marco Invernizzi
- Physical and Rehabilitation Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Stefano Vercelli
- Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno (NO), Italy
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Diagnostic accuracy of patient interview items and clinical tests for cervical radiculopathy. Physiotherapy 2020; 111:74-82. [PMID: 33309074 DOI: 10.1016/j.physio.2020.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of patient interview items and clinical tests to diagnose cervical radiculopathy. DESIGN A prospective diagnostic accuracy study. PARTICIPANTS Consecutive patients (N=134) with a suspicion of cervical radiculopathy were included. A medical specialist made the diagnosis of cervical radiculopathy based on the patient's clinical presentation and corresponding Magnetic Resonance Imaging findings. Participants completed a list of patient interview items and the clinical tests were performed by a physiotherapist. MAIN OUTCOME MEASURES Diagnostic accuracy was determined in terms of sensitivity, specificity, and positive (+LR) and negative likelihood ratios (-LR). Sensitivity and specificity values ≥0.80 were considered high. We considered +LR≥5 and -LR≤0.20 moderate, and +LR≥10 and -LR≤0.10 high. RESULTS The history items 'arm pain worse than neck pain', 'provocation of symptoms when ironing', 'reduction of symptoms by walking with your hand in your pocket', the Spurling test and the presence of reduced reflexes showed high specificity and are therefore useful to increase the probability of cervical radiculopathy when positive. The presence of 'paraesthesia' and 'paraesthesia and/or numbness' showed high sensitivity, indicating that the absence of these patient interview items decreases the probability of cervical radiculopathy. Although most of these items had potentially relevant likelihood ratios, none showed moderate or high likelihood ratios. CONCLUSIONS Several patient interview items, the Spurling test and reduced reflexes are useful to assist in the diagnosis of cervical radiculopathy. Because there is no gold standard for cervical radiculopathy, caution is required to not over-interpret diagnostic accuracy values.
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Normalization of Spinal Cord Displacement With the Straight Leg Raise and Resolution of Sciatica in Patients With Lumbar Intervertebral Disc Herniation: A 1.5-year Follow-up Study. Spine (Phila Pa 1976) 2019; 44:1064-1077. [PMID: 30985566 DOI: 10.1097/brs.0000000000003047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A controlled radiologic follow-up study. OBJECTIVE The aim of this study was to ascertain whether changes in cord excursion with straight leg raise test (SLR) at 1.5-year follow-up time accompany changes in clinical symptoms. SUMMARY OF BACKGROUND DATA Lumbar intervertebral disc herniation (LIDH) is known to be a key cause of sciatica. Previously, we found that a significant limitation of neural displacement (66.6%) was evident with the SLR on the symptomatic side of patients with subacute single level posterolateral LIDH. METHODS Fourteen patients with significant sciatic symptoms due to a subacute single-level posterolateral LIDH were reassessed clinically and radiologically at 1.5 years follow-up with a 1.5T MRI scanner. Displacement of the conus medullaris during the unilateral and bilateral SLR was quantified reliably with a randomized procedure and compared between SLRs and to data from baseline. Multivariate regression models and backward variable selection method were employed to identify variables more strongly associated with a decrease in low back pain (LBP) and radicular symptoms. RESULTS Compared with previously presented baseline values, the data showed a significant increase in neural sliding in all the quantified maneuvers (P ≤ 0.01), and particularly of 2.52 mm (P ≤ 0.001) with the symptomatic SLR.Increase in neural sliding correlated significantly with decrease of both radicular symptoms (Pearson = -0.719, P ≤ 0.001) and LBP (Pearson = -0.693, P ≤ 0.001). Multivariate regression models and backward variable selection method confirmed the improvement of neural sliding effects (P ≤ 0.004) as the main variable being associated with improvement of self-reported clinical symptoms. CONCLUSION To our knowledge, these are the first noninvasive data to objectively support the association between increase in magnitude of neural adaptive movement and resolution of both radicular and LBP symptoms in in vivo and structurally intact human subjects. LEVEL OF EVIDENCE 2.
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