Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system

Abstract

Background: Clinical tests to assess peripheral nerve disorders can be classified into two categories: tests for afferent/efferent nerve function such as nerve conduction (bedside neurological examination) and tests for increased mechanosensitivity (e.g. upper limb neurodynamic tests (ULNTs) and nerve palpation). Reliability reports of nerve palpation and the interpretation of neurodynamic tests are scarce. This study therefore investigated the intertester reliability of nerve palpation and ULNTs. ULNTs were interpreted based on symptom reproduction and structural differentiation. To put the reliability of these tests in perspective, a comparison with the reliability of clinical tests for nerve function was made.

The Validity of Upper-Limb Neurodynamic Tests for Detecting Peripheral Neuropathic Pain

“…9,82,108,110 Only Schmid et al 82 required that a positive test reproduce the patient's symptoms and that structural differentiation change these symptoms. Each ULNT was applied to 31 patients with unilateral arm and/or neck pain that had been present for at least 4 weeks.…”

“…According to cut-offs proposed by Landis and Koch, 59 interexaminer reliability was moderate (κ = 0.41-0.60) for ULNT1 MEDIAN , ULNT2 MEDIAN , and ULNT RADIAL , and fair (κ = 0.21-0.40) for ULNT ULNAR (TABLE 1). 82 Kappa values can be reduced by a high or low proportion of positive tests (prevalence) or inflated by a high level of disagreement between examiners on the proportion of positive tests (bias). 88 Prevalence and bias indices 88 (calculated from original data obtained from the authors) were low (TABLE 1), indicating that these issues did not affect the kappa values reported by Schmid et al 82 Additional studies are needed to improve the precision of these reliability estimates, because 95% confidence intervals for each ULNT's kappa value ranged from less than 0.20 to greater than 0.70 (TABLE 1).…”

Ulnar Nerve Neurodynamic Test: Study of the Normal Sensory Response in Asymptomatic Individuals

“…7,8,16,19,22,35 Neurodynamic tests are considered to be able to detect increased nerve mechanosensitivity. 12,15,16,19,22,33 This heightened sensitivity in response to mechanical stimuli has been attributed to local inflammatory processes within the nerve 1,4,10,11,14,22 that are specifically related to its connective tissue. 32 When determining whether the result of a neurodynamic test is suggestive of increased nerve mechanosensitivity and therefore relevant to current patient complaints, it is important to consider several factors.…”

An Exploratory Study to Determine the Relationship between Cervical Dysfunction and Perimenstrual Migraines

“…According to Schmit and colleagues (2009), these tests show moderate reliability (k ¼ 0.45). 50 Cervical segment testing Segmental dysfunction is implicated in the initiation and perpetuation of myofascial pain. 17 Decreased joint ROM can lead to shortening and tightening of the muscle, which causes trigger point formation.…”