000147844 001__ 147844 000147844 005__ 20250923084439.0 000147844 0247_ $$2doi$$a10.3390/jcm13237122 000147844 0248_ $$2sideral$$a141274 000147844 037__ $$aART-2024-141274 000147844 041__ $$aeng 000147844 100__ $$aCiuffreda, Gianluca$$uUniversidad de Zaragoza 000147844 245__ $$aAccuracy of the standard and distal-to-proximal sequence of the upper limb neurodynamic test 1 for the diagnosis of carpal tunnel syndrome: the role of side-to-side comparisons 000147844 260__ $$c2024 000147844 5060_ $$aAccess copy available to the general public$$fUnrestricted 000147844 5203_ $$aBackground/Objective: This study aimed to evaluate the diagnostic accuracy of two upper limb neurodynamic test 1 (ULNT1) sequences for detecting carpal tunnel syndrome (CTS) in patients with unilateral symptoms. The standard sequence (ULNT1-STD) and a distal-to-proximal sequence (ULNT1-DIST) were investigated. A local-initiated sequence may facilitate symptoms reproduction in CTS, and comparing the affected side with the unaffected side could improve the detection of altered median nerve mechanosensitivity when symptoms are not directly reproduced. Methods: A total of 134 consecutive patients with clinically suspected unilateral CTS were recruited. Nerve conduction studies were used as a reference test. Results: When considering only symptom reproduction as the criterion for a positive test, ULNT1-STD showed a sensitivity of 0.398 and a specificity of 0.780 (positive likelihood ratio [+LR]: 1.81; negative likelihood ratio [−LR]: 0.77); whereas ULNT1-DIST demonstrated a sensitivity of 0.548 with a specificity of 0.732 (+LR: 2.04; −LR: 0.62). When a positive test was defined by symptom reproduction or inter-limb asymmetry (in range of motion or sensory response), ULNT1-STD showed an improved sensitivity of 0.613 but a reduced specificity of 0.537 (+LR: 1.32; −LR: 0.72). In comparison, ULNT1-DIST increased its sensitivity to 0.871 with a specificity of 0.683 (+LR: 2.75; −LR: 0.19). Conclusions: ULNT1-DIST offers better diagnostic accuracy for CTS compared to the ULNT1-STD sequence, especially when interlimb asymmetries in range of motion or sensory response are considered. However, side-to-side comparisons have reduced utility in cases with bilateral symptoms, limiting their application in clinical practice. 000147844 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/ 000147844 590__ $$a2.9$$b2024 000147844 592__ $$a0.919$$b2024 000147844 591__ $$aMEDICINE, GENERAL & INTERNAL$$b65 / 332 = 0.196$$c2024$$dQ1$$eT1 000147844 593__ $$aMedicine (miscellaneous)$$c2024$$dQ1 000147844 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000147844 700__ $$0(orcid)0000-0002-0026-9224$$aBueno Gracia, Elena$$uUniversidad de Zaragoza 000147844 700__ $$aArgüello Espinosa, María Irache 000147844 700__ $$aShacklock, Michael 000147844 700__ $$aNavarrete Navarro, Sonia 000147844 700__ $$aVicente Garza, Inés 000147844 700__ $$aRodríguez Mena, Diego 000147844 700__ $$0(orcid)0000-0002-5161-7479$$aEstébanez de Miguel, Elena$$uUniversidad de Zaragoza 000147844 7102_ $$11003$$2027$$aUniversidad de Zaragoza$$bDpto. Anatom.Histolog.Humanas$$cArea Anatom.Embriol.Humana 000147844 7102_ $$11006$$2413$$aUniversidad de Zaragoza$$bDpto. Fisiatría y Enfermería$$cÁrea Fisioterapia 000147844 773__ $$g13, 23 (2024), 7122 [17 pp.]$$pJ. clin.med.$$tJournal of Clinical Medicine$$x2077-0383 000147844 8564_ $$s1821140$$uhttps://zaguan.unizar.es/record/147844/files/texto_completo.pdf$$yVersión publicada 000147844 8564_ $$s2693450$$uhttps://zaguan.unizar.es/record/147844/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000147844 909CO $$ooai:zaguan.unizar.es:147844$$particulos$$pdriver 000147844 951__ $$a2025-09-22-14:49:25 000147844 980__ $$aARTICLE