Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies.
- Baselgia LT Institute of Physiotherapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland.
- Bennett DL Nuffield Department of Clinical Neurosciences, University of Oxford, Headington, UK.
- Silbiger RM Silberling Limited, Oxford, UK.
- Schmid AB Nuffield Department of Clinical Neurosciences, University of Oxford, Headington, UK; School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia. Electronic address: annina.schmid@neuro-research.ch.
- 2016-07-25
Published in:
- Archives of physical medicine and rehabilitation. - 2017
Carpal tunnel syndrome
Diagnosis
Nerve compression syndromes
Neurologic examination
Peripheral nerve injuries
Rehabilitation
Adult
Aged
Carpal Tunnel Syndrome
Case-Control Studies
Cross-Sectional Studies
Female
Humans
Male
Median Nerve
Middle Aged
Nerve Compression Syndromes
Neurologic Examination
Physical Therapy Modalities
English
OBJECTIVE
To examine differences in somatosensory phenotypes of patients with positive and negative neurodynamic tests and compare these with healthy participants.
DESIGN
Case-control study.
SETTING
University department.
PARTICIPANTS
Patients with electrodiagnostically confirmed carpal tunnel syndrome (CTS) (n=53) and people without CTS (n=26) participated in this study (N=79). Patients with CTS were subgrouped according to the results of the upper limb neurodynamic tests biasing the median nerve into patients with positive or negative neurodynamic tests.
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURE
All participants underwent quantitative sensory testing in the median innervated territory of their hand.
RESULTS
Only 46% of patients with CTS had positive neurodynamic tests. No differences were identified between groups for pain thresholds (P>.247). However, patients with CTS had increased mechanical (P<.0001) and thermal detection thresholds (P<.0001) compared with people without CTS. Patients with negative neurodynamic tests had a more pronounced vibration detection deficit (mean, 7.43±0.59) than people without CTS (mean, 7.89±0.22; P=.001). Interestingly, warm detection was the only domain differentiating positive (mean, 4.03°C±2.18°C) and negative neurodynamic test groups (6.09°C±3.70°C, P=.032), with patients with negative neurodynamic tests demonstrating increased loss of function.
CONCLUSIONS
Patients with negative neurodynamic tests seem to have a more severe dysfunction of the unmyelinated fiber population. Our findings suggest that neurodynamic tests should not be used in isolation to judge neural involvement. Rather, they should be interpreted in the context of loss of function tests of the small fiber domain.
To examine differences in somatosensory phenotypes of patients with positive and negative neurodynamic tests and compare these with healthy participants.
DESIGN
Case-control study.
SETTING
University department.
PARTICIPANTS
Patients with electrodiagnostically confirmed carpal tunnel syndrome (CTS) (n=53) and people without CTS (n=26) participated in this study (N=79). Patients with CTS were subgrouped according to the results of the upper limb neurodynamic tests biasing the median nerve into patients with positive or negative neurodynamic tests.
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURE
All participants underwent quantitative sensory testing in the median innervated territory of their hand.
RESULTS
Only 46% of patients with CTS had positive neurodynamic tests. No differences were identified between groups for pain thresholds (P>.247). However, patients with CTS had increased mechanical (P<.0001) and thermal detection thresholds (P<.0001) compared with people without CTS. Patients with negative neurodynamic tests had a more pronounced vibration detection deficit (mean, 7.43±0.59) than people without CTS (mean, 7.89±0.22; P=.001). Interestingly, warm detection was the only domain differentiating positive (mean, 4.03°C±2.18°C) and negative neurodynamic test groups (6.09°C±3.70°C, P=.032), with patients with negative neurodynamic tests demonstrating increased loss of function.
CONCLUSIONS
Patients with negative neurodynamic tests seem to have a more severe dysfunction of the unmyelinated fiber population. Our findings suggest that neurodynamic tests should not be used in isolation to judge neural involvement. Rather, they should be interpreted in the context of loss of function tests of the small fiber domain.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.apmr.2016.06.019
- PMID 27449322
- Persistent URL
- https://sonar.ch/global/documents/292302
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