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Arch Phys Med Rehabil. 2017 Mar;98(3):480-486. doi: 10.1016/j.apmr.2016.06.019. Epub 2016 Jul 20.

Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies.

Author information

1
Institute of Physiotherapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland.
2
Nuffield Department of Clinical Neurosciences, University of Oxford, Headington, UK.
3
Silberling Limited, Oxford, UK.
4
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.

Abstract

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.

KEYWORDS:

Carpal tunnel syndrome; Diagnosis; Nerve compression syndromes; Neurologic examination; Peripheral nerve injuries; Rehabilitation

PMID:
27449322
PMCID:
PMC5324720
DOI:
10.1016/j.apmr.2016.06.019
[Indexed for MEDLINE]
Free PMC Article

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