Diagnostic accuracy of the upper limb neurodynamic test 1 using neurodynamic sequencing in diagnosis of carpal tunnel syndrome

Bueno-Gracia, Elena (Universidad de Zaragoza) ; Fanlo-Mazas, Pablo (Universidad de Zaragoza) ; Malo-Urriés, Miguel (Universidad de Zaragoza) ; Rodriguez-Mena, Diego (Universidad de Zaragoza) ; Montaner-Cuello, Alberto (Universidad de Zaragoza) ; Ciuffreda, Gianluca (Universidad de Zaragoza) ; Shacklock, Michael ; Estébanez-de-Miguel, Elena (Universidad de Zaragoza)

Resumen: Background
The upper limb neurodynamic test 1 is used in the diagnosis of median nerve neuropathies such as carpal tunnel syndrome but its diagnostic validity remains limited. Neurodynamic sequencing has been suggested to increase the specificity of the neurodynamic tests, however, to date, information on the diagnostic accuracy of this variation in neurodynamic testing is required.

Objectives
The aim of this study was to analyze the diagnostic validity of the local sequence of ULNT1 (LS-ULNT1) (i.e. a sequence that begins at the joint where the problem is (wrist) and progressively moves joints further away from it), in the diagnosis of CTS. A secondary aim was to describe the location of sensory responses to this modified neurodynamic test sequence.

Design
A prospective diagnostic accuracy study was designed.

Method
Nerve conduction studies were used as the gold standard. The LS-ULNT1 was performed in 58 consecutive patients (17 men, 44 women) with suspected CTS.

Results
Sensitivity of the LS-ULNT1 was 65.7% (CI 48.0–80.9%) and the specificity was 95.7% (CI 78.1–99.9%). The positive and negative likelihood ratios were >5 and < 0.5, respectively, indicating the ability of the test to generate small but sometimes important changes in post-test probability.

Conclusions
The overall results of this study showed that the LS-ULNT1 could be useful in confirming the diagnosis of CTS. The test demonstrated high specificity and the +LR indicated the ability of the test to generate changes in posttest probability, especially with a positive LS-ULNT1 result.

Idioma: Inglés

DOI: 10.1016/j.msksp.2023.102897

Año: 2023

Publicado en: MUSCULOSKELETAL SCIENCE AND PRACTICE 69 (2023), 102897 [7 pp.]
ISSN: 2468-8630

Factor impacto JCR: 2.2 (2023)

Categ. JCR: REHABILITATION rank: 29 / 170 = 0.171 (2023) - Q1 - T1

Factor impacto CITESCORE: 4.1 - Physical Therapy, Sports Therapy and Rehabilitation (Q2)

Factor impacto SCIMAGO: 0.755 - Physical Therapy, Sports Therapy and Rehabilitation (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
Área (Departamento): Área Fisioterapia (Dpto. Fisiatría y Enfermería)