The gliding apparatus of peripheral nerve and its clinical significance

Millesi, H.; Zöch, G.; Rath, T.

doi:10.1016/s0753-9053(05)80485-5

Cited by 121 publications

(93 citation statements)

References 5 publications

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“…For PNP, probable means that (1) the patient's symptoms fit a nerve-related distribution, (2) the history of symptoms is consistent with a nerve-related problem, and either (3a) a clinical neurological examination shows positive or negative sensory signs that match the innervation territory of the suspected nerve problem, or (3b) diagnostic tests, such as imaging or electrophysiological studies, confirm an injury or disease that explains the distribution of PNP. dian (ULNT MEDIAN ), 13,18,21,56,57,61,66,67,119,124,127 radial (ULNT RADIAL ), 122 and ulnar (ULN-T ULNAR ) 2,3,13,21,47,66,72,83,98,123 nerve tests increase strain in the corresponding nerve. Each test preferentially loads its corresponding nerve at the elbow and wrist, 13,56 suggesting that mechanosensitivity of a particular nerve near these joints may be most readily assessed by the corresponding ULNT.…”

Section: Diagnosing Peripheral Neuropathic Painmentioning

confidence: 99%

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

Nee¹,

Jull²,

Vicenzino³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

125

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Synopsis The validity of upper-limb neurodynamic tests (ULNTs) for detecting peripheral neuropathic pain (PNP) was assessed by reviewing the evidence on plausibility, the definition of a positive test, reliability, and concurrent validity. Evidence was identified by a structured search for peer-reviewed articles published in English before May 2011. The quality of concurrent validity studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool, where appropriate. Biomechanical and experimental pain data support the plausibility of ULNTs. Evidence suggests that a positive ULNT should at least partially reproduce the patient's symptoms and that structural differentiation should change these symptoms. Data indicate that this definition of a positive ULNT is reliable when used clinically. Limited evidence suggests that the median nerve test, but not the radial nerve test, helps determine whether a patient has cervical radiculopathy. The median nerve test does not help diagnose carpal tunnel syndrome. These findings should be interpreted cautiously, because diagnostic accuracy might have been distorted by the investigators' definitions of a positive ULNT. Furthermore, patients with PNP who presented with increased nerve mechanosensitivity rather than conduction loss might have been incorrectly classified by electrophysiological reference standards as not having PNP. The only evidence for concurrent validity of the ulnar nerve test was a case study on cubital tunnel syndrome. We recommend that researchers develop more comprehensive reference standards for PNP to accurately assess the concurrent validity of ULNTs and continue investigating the predictive validity of ULNTs for prognosis or treatment response. J Orthop Sports Phys Ther 2012;42(5):413–424, Epub 8 March 2012. doi:10.2519/jospt.2012.3988

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Section: Diagnosing Peripheral Neuropathic Painmentioning

confidence: 99%

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

Nee¹,

Jull²,

Vicenzino³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

125

View full text Add to dashboard Cite

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“…It has been demonstrated that the median nerve will move up to 9.6 mm with wrist flexion and slightly less with extension. 88 Chronic compression is thought to cause fibrosis, which will inhibit nerve gliding. Injury/scarring of the mesoneurium will cause the nerve to adhere to surrounding tissue.…”

Section: A Pathophysiologic Basis For Clinical Examinationmentioning

confidence: 99%

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

MacDermid¹,

Doherty²

2004

J Orthop Sports Phys Ther

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Carpal Tunnel Syndrome (CTS) is a pressure-induced neuropathy that causes sensorimotor disturbances of the median nerve, which impair functional ability. A clear history that elicits relevant personal and work exposures and the nature of symptoms can lead to a high probability of a correct diagnosis. Hand diagrams and diagnostic questionnaires are available to provide structure to this process. A variety of provocative tests have been described and have variable accuracy. The Phalen's wrist flexion and the carpal compression tests have the highest overall accuracy, while Tinel's nerve percussion test is more specific to axonal damage that may occur as a result of moderate to severe CTS. Sensory evaluation of light touch, vibration, or current perception thresholds can detect early sensory changes, whereas 2-point discrimination changes and thenar atrophy indicate loss of nerve fibers occurring with more severe disease. Electrodiagnosis can encompass a variety of tests and is commonly used to assess the presence/severity of neuropathic changes and to preclude alternative diagnoses that overlap with CTS in presentation. The pathophysiologic changes occurring with different stages of nerve compression must be considered when interpreting diagnostic test results and predicting response to physical therapy management.

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“…With increased nerve irritation at the entrapment points, edema and subsequent fibrous can occur. This increased connective tissue may decrease normal neural excursion [Millesi et al, 1990]. The progression of chronic nerve compression is intensified as the amount of force and duration of the compression increases [Mackinnon et al, 1984[Mackinnon et al, , 1985.…”

Section: Hypothesismentioning

confidence: 99%

Multilevel nerve compression and muscle imbalance in work‐related neuromuscular disorders*

Novak

Mackinnon

2002

American J Industrial Med

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The gliding apparatus of peripheral nerve and its clinical significance

Cited by 121 publications

References 5 publications

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

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

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

Multilevel nerve compression and muscle imbalance in work‐related neuromuscular disorders*

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