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

Abstract

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

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

“…Currently, to our knowledge, no study has documented the normal responses of the ulnar upperlimb neurodynamic test (ULNT3). 28 In a case report described by Shacklock, 36 an association between improvement of the ULNT3 response and a decrease in symptoms was found in a patient with surgically confirmed ulnar neuropathy.…”

“…6,13,26 Finally, recent evidence asserts that a positive upper-limb neurodynamic test should at least partially reproduce the patient's symptoms, and structural differentiation should change these symptoms. 28 This latter definition of a positive upper-limb neurodynamic test has been shown to be reliable when used clinically. 28 …”

“…28 This latter definition of a positive upper-limb neurodynamic test has been shown to be reliable when used clinically. 28 …”

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