Upper limb neurodynamic test 1 in patients with clinical diagnosis of carpal tunnel syndrome: A diagnostic accuracy study

Trillos, María Constanza; Soto, Felipe; Briceño-Ayala, Leonardo

doi:10.1016/j.jht.2017.05.004

Cited by 10 publications

(5 citation statements)

References 34 publications

(35 reference statements)

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“…Only a 10° difference in mobility of elbow extension between the two sides or reproduction of the patient's symptoms is sufficient to consider the test to be positive for Wainner's criteria. Thus, it appears that our study showed a good NLR compared to other studies [ 16 ,18,27] Table 3 . We should emphasize that 92 participants (98%) in the present study had chronic CTS with symptoms lasting more than three months.…”

Section: Discussionsupporting

confidence: 65%

“…These authors insisted that the test should at least partially reproduce the patient’s symptoms and that they change with the SD maneuver. The same study concluded that the ROM difference of 10 degrees or more between the two sides in the elbow extension or completion of all movement sequences is not a valid criterion for defining a positive ULNT as in Wainner’s criteria used for several previous studies [ 16 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 96%

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The validity of the upper limb neurodynamic test 2 A in women with a clinical diagnosis of carpal tunnel syndrome: a prospective diagnostic accuracy study

Beddaa¹,

Kably²,

Mouhi³

et al. 2022

Pan Afr Med J

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Introduction the validity of the upper limb neurodynamic tests and especially the upper limb neurodynamic test 1 for diagnosing carpal tunnel syndrome has been the subject of several previous studies. However, the upper limb neurodynamic test 2A, which is also a test designated to assess the mechanosensitivity of the median nerve, has not been sufficiently studied, particularly for the diagnosis of carpal tunnel syndrome. Methods we used the upper limb neurodynamic test 2A as the index test and nerve conduction studies as the reference standard. We considered the upper limb neurodynamic test 2A positive according to Nee et al. criteria. Sensitivity, specificity, positive likelihood, and negative likelihood were calculated. In addition, a receiver operating characteristics analysis was carried out. Results ninety-four women (188 hands) suspected of carpal tunnel syndrome with a mean age of 48.87 years and SD of 12.09 participated in the study. The sensitivity of the upper limb neurodynamic test 2A was estimated at 73.4%, the specificity at 47%, the positive likelihood ratio was 1.38, the negative likelihood ratio was 0.57, and the Kappa agreement was 20.3%, and the area under the curve 60.1%. Conclusion the upper limb neurodynamic test 2A does not seem to have value in the diagnosis of carpal tunnel syndrome when compared to nerve conduction studies. It could be alternatively used to detect an increased mechanosensitivity of the median nerve when the upper limb neurodynamic test 1 cannot be performed in case of a range of motion limitation of the shoulder abduction.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 96%

The validity of the upper limb neurodynamic test 2 A in women with a clinical diagnosis of carpal tunnel syndrome: a prospective diagnostic accuracy study

Beddaa¹,

Kably²,

Mouhi³

et al. 2022

Pan Afr Med J

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“…The Upper Limb Tension Test 1 (ULNT1) uses a combination of movements of the upper limb to expose the median nerve to 18% of strain, with 4% of the strain at the distal part of the nerve [ 10 ]. The Upper Limb Tension Test 1 is considered a valid test for carpal tunnel syndrome [ 11 , 12 , 13 , 14 ]. However, it has been observed that these tests do not behave in the same way based on the clinical and psychosocial presentations of the patient.…”

Section: Introductionmentioning

confidence: 99%

Understanding the Mechanosensitivity of the Median Nerve in Pre-Surgical Carpal Tunnel Syndrome Patients: A Correlational Study

Hernández-Secorún,

Abenia-Benedí,

Lucha-López

et al. 2024

Brain Sciences

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(1) Background: Neurodynamic tests are recommended for the diagnosis of entrapment neuropathies such as carpal tunnel syndrome (CTS). However, their association with clinical variables in severe patients or patients with associated comorbidities is poorly documented. This study aims to analyze the association between the mechanosensitivity of the median nerve and symptoms, function and psycho-social variables in moderate and severe carpal tunnel syndrome patients with comorbidities; (2) Methods: Correlational study. In total, 42 pre-surgical patients (24 females; 59.1 ± 12.7 years) included in the Spanish Public Healthcare System with an electrodiagnostic of CTS were selected. Sociodemographic variables and clinical features (symptoms, function, sensitivity and quality of life evaluated with the 36-item Short Form Survey (SF-36) and the Medical Outcomes Study Sleep Scale (MOS-sleep) were recorded. Upper Limb Neurodynamic Test 1 was used to evaluate neural mechanosensitivity; (3) Results: The 81% had a severe CTS and 78.6% had some comorbidity. The average time from the first medical visit to the surgeon’s visit was 365.5 days. Median nerve mechanosensitivity correlated weakly with the SF-36 subscale, General Health, (Spearman’s rho = 0.367) and MOS sleep scale, Awaken Short of Breath or with headache dimension (Spearman’s rho = −0.353) and moderately with SF-36 subscale, Social Functioning (Spearman’s rho = 0.553); (4) Conclusions: No associations were observed for median nerve mechanosensitivity, except for quality of life and sleep. Both social determinants and clinical variables should be considered when examining and treating these patients.

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“…The upper limb neurodynamic test 1 (ULNT1) consists of a series of movements constructed to stress various parts of the nervous system and is regarded to be capable of detecting increased nerve mechanosensitivity [ 1 , 2 ]. Clinicians use range of motion (ROM) and sensory responses to evaluate neurodynamic tests and compare sides and/or relate results to normal values in order to diagnose upper extremity peripheral neuropathic pain [ 3 , 4 ]. Furthermore, musculoskeletal physiotherapists evaluate ULNT1 (median nerve) to discover changes in mechanosensitivity in the neural system, hence measuring function gain for patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Quantifying the Elasticity Properties of the Median Nerve during the Upper Limb Neurodynamic Test 1

Lin

Chen

Deng

et al. 2022

Applied Bionics and Biomechanics

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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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Upper limb neurodynamic test 1 in patients with clinical diagnosis of carpal tunnel syndrome: A diagnostic accuracy study

Cited by 10 publications

References 34 publications

The validity of the upper limb neurodynamic test 2 A in women with a clinical diagnosis of carpal tunnel syndrome: a prospective diagnostic accuracy study

The validity of the upper limb neurodynamic test 2 A in women with a clinical diagnosis of carpal tunnel syndrome: a prospective diagnostic accuracy study

Understanding the Mechanosensitivity of the Median Nerve in Pre-Surgical Carpal Tunnel Syndrome Patients: A Correlational Study

Quantifying the Elasticity Properties of the Median Nerve during the Upper Limb Neurodynamic Test 1

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