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

Publication date: Available online 20 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Larissa Baselgia, David LH. Bennett, Robert M. Silbiger, Annina B. Schmid
ObjectiveTo examine differences in somatosensory phenotypes of patients with positive and negative neurodynamic tests and compare these to healthy controls.Designcase-control studySettingUniversity departmentParticipantsFifty-three patients with electrodiagnostically confirmed carpal tunnel syndrome (CTS) and 26 healthy controls participated in this study. Patients with CTS were sub-grouped according to the results of the upper limb neurodynamic tests (ULNT) biasing the median nerve into patients with positive (ULNT^pos) or negative (ULNT^neg) neurodynamic tests.InterventionsNAMain outcome measureAll participants underwent quantitative sensory testing in the median innervated territory of their hand.ResultsOnly 46% of patients with CTS had positive neurodynamic tests. No differences were identified between groups for pain thresholds (p>0.247). However, CTS patients had increased mechanical (p<0.0001) and thermal detection thresholds (p<0.0001) compared to healthy controls. ULNT^neg patients had a more pronounced vibration detection deficit (mean (SD): 7.43 (0.59)) compared to healthy controls (7.89 (0.22), p=0.001). Interestingly, warm detection was the only domain differentiating ULNT^pos (mean degrees Celsius (SD): 4.03 (2.18)) and ULNT^neg groups (6.09 (3.70), p=0.032), with ULNT^neg patients demonstrating increased loss of function.ConclusionPatients with normal neurodynamic tests seem to have a more severe dysfunction of the unmyelinated fibre 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 fibre domain.



from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2a0qhui
via IFTTT