Negative neurodynamic tests do not exclude neural dysfunction in patients with entrapment neuropathies

Baselgia, Larissa T., Bennett, David L., Silbiger, Robert M. and Schmid, Annina B. (2017) Negative neurodynamic tests do not exclude neural dysfunction in patients with entrapment neuropathies. Archives of Physical Medicine and Rehabilitation, 98 3: 480-486. doi:10.1016/j.apmr.2016.06.019


Author Baselgia, Larissa T.
Bennett, David L.
Silbiger, Robert M.
Schmid, Annina B.
Title Negative neurodynamic tests do not exclude neural dysfunction in patients with entrapment neuropathies
Journal name Archives of Physical Medicine and Rehabilitation   Check publisher's open access policy
ISSN 1532-821X
0003-9993
Publication date 2017-03-01
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.apmr.2016.06.019
Open Access Status DOI
Volume 98
Issue 3
Start page 480
End page 486
Total pages 7
Place of publication Maryland Heights, MO, United States
Publisher W.B. Saunders
Collection year 2018
Language eng
Formatted 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.
Keyword Carpal tunnel syndrome
Diagnosis
Nerve compression syndromes
Neurologic examination
Peripheral nerve injuries
Rehabilitation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
 
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