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Bueno-Gracia E, Fanlo-Mazas P, Malo-Urriés M, Rodriguez-Mena D, Montaner-Cuello A, Ciuffreda G, Shacklock M, Estébanez-de-Miguel E. Diagnostic accuracy of the upper limb neurodynamic test 1 using neurodynamic sequencing in diagnosis of carpal tunnel syndrome. Musculoskelet Sci Pract 2024; 69:102897. [PMID: 38118353 DOI: 10.1016/j.msksp.2023.102897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/22/2023]
Abstract
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.
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Affiliation(s)
- Elena Bueno-Gracia
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza. C/ Domingo Miral s/n 50009, Zaragoza, Spain.
| | - Pablo Fanlo-Mazas
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza. C/ Domingo Miral s/n 50009, Zaragoza, Spain.
| | - Miguel Malo-Urriés
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza. C/ Domingo Miral s/n 50009, Zaragoza, Spain.
| | - Diego Rodriguez-Mena
- Neurophysiology Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza. C/ San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Alberto Montaner-Cuello
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza. C/ Domingo Miral s/n 50009, Zaragoza, Spain
| | - Gianluca Ciuffreda
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza. C/ Domingo Miral s/n 50009, Zaragoza, Spain
| | | | - Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza. C/ Domingo Miral s/n 50009, Zaragoza, Spain.
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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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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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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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Taterra D, Henry BM, Zarzecki MP, Sanna B, Pękala PA, Cirocchi R, Walocha JA, Tubbs RS, Tomaszewski KA. Prevalence and anatomy of the axillary arch and its implications in surgical practice: A meta-analysis. Surgeon 2018; 17:43-51. [PMID: 29801707 DOI: 10.1016/j.surge.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The following research aimed to investigate the prevalence and anatomical features of the axillary arch (AA) - a muscular, tendinous or musculotendinous slip arising from the latissimus dorsi and that terminates in various structures around the shoulder girdle. The AA may complicate axillary lymph node biopsy or breast reconstruction surgery and may cause thoracic outlet syndrome. METHODS Major electronic databases were thoroughly searched for studies on the AA and its variations. Data regarding the prevalence, morphology, laterality, origin, insertion and innervation of the AA was extracted and included in this meta-analysis. The AQUA tool was used in order to assess potential risk of bias within the included studies. RESULTS The AA was reported in 29 studies (10,222 axillas), and its pooled prevalence estimate in this meta-analysis was found to be 5.3% of the axillas: unilaterally (61.6%) and bilaterally (38.4%). It was predominantly muscular (55.1% of the patients with the AA), originated from the latissimus dorsi muscle or tendon (87.3% of the patients with the AA), inserted into the pectoralis major muscle or fascia (35.2% of the patients with the AA), and was most commonly innervated by the thoracodorsal nerve (39.9% of the patients with the AA). CONCLUSION The AA is a relatively common variant, hence it should not be neglected. Oncologists and surgeons should consider this variant while diagnosing an unknown palpable mass in the axilla, as the arch might mimic a neoplasm or enlarged lymph nodes.
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Affiliation(s)
- Dominik Taterra
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Michał P Zarzecki
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Faculty of Medicine and Surgery, University of Cagliari, Monserrato, Italy
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Roberto Cirocchi
- Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Italy
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Hartstein AJ, Lievre AJ, Grimes JK, Hale SA. Immediate Effects of Thoracic Spine Thrust Manipulation on Neurodynamic Mobility. J Manipulative Physiol Ther 2018; 41:332-341. [PMID: 29669688 DOI: 10.1016/j.jmpt.2017.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Aaron J Hartstein
- Division of Physical Therapy, Shenandoah University, Winchester, Virginia.
| | - Arthur J Lievre
- Division of Physical Therapy, Shenandoah University, Winchester, Virginia
| | - Jason K Grimes
- College of Health Professions, Sacred Heart University, Fairfield, Connecticut
| | - Sheri A Hale
- Division of Physical Therapy, Shenandoah University, Winchester, Virginia
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Cruz J, Morais N. Intrarater Agreement of Elbow Extension Range of Motion in the Upper Limb Neurodynamic Test 1 Using a Smartphone Application. Arch Phys Med Rehabil 2016; 97:1880-1886. [PMID: 27207436 DOI: 10.1016/j.apmr.2016.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/15/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Joana Cruz
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal; Department of Health Technologies, School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal
| | - Nuno Morais
- Department of Health Technologies, School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal.
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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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Adriaenssens N, De Ridder M, Lievens P, Van Parijs H, Vanhoeij M, Miedema G, Voordeckers M, Versmessen H, Storme G, Lamote J, Pauwels S, Vinh-Hung V. Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy. World J Surg Oncol 2012; 10:86. [PMID: 22591589 PMCID: PMC3488523 DOI: 10.1186/1477-7819-10-86] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 05/16/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Scapula alata (SA) is a known complication of breast surgery associated with palsy of the serratus anterior, but it is seldom mentioned. We evaluated the risk factors associated with SA and the relationship of SA with ipsilateral shoulder/arm morbidity in a series of patients enrolled in a trial of post-surgery radiotherapy (RT). METHODS The trial randomized women with completely resected stage I-II breast cancer to short-course image-guided RT, versus conventional RT. SA, arm volume and shoulder-arm mobility were measured prior to RT and at one to three months post-RT. Shoulder/arm morbidities were computed as a post-RT percentage change relative to pre-RT measurements. RESULTS Of 119 evaluable patients, 13 (= 10.9%) had pre-RT SA. Age younger than 50 years old, a body mass index less than 25 kg/m2, and axillary lymph node dissection were significant risk factors, with odds ratios of 4.8 (P = 0.009), 6.1 (P = 0.016), and 6.1 (P = 0.005), respectively. Randomization group was not significant. At one to three months' post-RT, mean arm volume increased by 4.1% (P = 0.036) and abduction decreased by 8.6% (P = 0.046) among SA patients, but not among non-SA patients. SA resolved in eight, persisted in five, and appeared in one patient. CONCLUSION The relationship of SA with lower body mass index suggests that SA might have been underestimated in overweight patients. Despite apparent resolution of SA in most patients, pre-RT SA portended an increased risk of shoulder/arm morbidity. We argue that SA warrants further investigation. Incidentally, the observation of SA occurring after RT in one patient represents the second case of post-RT SA reported in the literature.
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Affiliation(s)
- Nele Adriaenssens
- Breast Clinic, Oncologic Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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