147844 20260418110656.0 doi 10.3390/jcm13237122 sideral 141274 ART-2024-141274 eng Ciuffreda, Gianluca Universidad de Zaragoza (orcid)0000-0001-8484-3811 Accuracy 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 2024 Access copy available to the general public Unrestricted Background/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. info:eu-repo/semantics/openAccess by https://creativecommons.org/licenses/by/4.0/deed.es 2.9 2024 MEDICINE, GENERAL & INTERNAL 65 / 332 = 0.196 2024 Q1 T1 0.919 2024 Medicine (miscellaneous) 2024 Q1 5.2 2024 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Bueno Gracia, Elena Universidad de Zaragoza (orcid)0000-0002-0026-9224 Argüello Espinosa, María Irache Shacklock, Michael Navarrete Navarro, Sonia Vicente Garza, Inés Rodríguez Mena, Diego Estébanez de Miguel, Elena Universidad de Zaragoza (orcid)0000-0002-5161-7479 1003 027 Universidad de Zaragoza Dpto. Anatom.Histolog.Humanas Area Anatom.Embriol.Humana 1006 413 Universidad de Zaragoza Dpto. Fisiatría y Enfermería Área Fisioterapia 13, 23 (2024), 7122 [17 pp.] J. clin.med. Journal of Clinical Medicine 2077-0383 1821140 http://zaguan.unizar.es/record/147844/files/texto_completo.pdf Versión publicada 2693450 http://zaguan.unizar.es/record/147844/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:147844 articulos driver 2026-04-18-11:05:07 ARTICLE