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A Study to Validate Diagnostic Strength of ULNT1 in Cervical Radiculopathy


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1 Gian Sagar College of Physiotherapy, Ram Nagar, Distt. Patiala (PUNJAB), India
     

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Introduction: Neural tissue provocation tests (NTPT) have been increasingly incorporated into clinical practice. Unfortunately, the early terminology used in describing these tests-'neural tension test' and 'adverse mechanical tension'- did little to further the acceptance, understanding or credibility of the physical treatment of neurogenic pain.

A more appropriate term is 'neural tissue provocation tests' as they are passive test applied in a manner to selectively stress different neural tissues in order to assess their sensitivity to mechanical provocation. Many experts in the field of neurodynamics have clearly stated the importance of the reproduction of a patient's symptoms, which implies the presence of pathology. The other feature which is vital to the interpretation of any neuromusculoskeletal clinical measure is the comparison between sides. It is essential to compare sides for there is tremendous variation in flexibility of the peripheral nervous system in both the lower and upper quarter.

Objectives: While there has been considerable research on neurodynamics, there has been little research investigating the diagnostic validity of such tests. The purpose of this study was to find out the rate of true positive (sensitivity) Upper limb neurodynamic test for median nerve (ULNT1) in patients with cervical spine mediated neural symptoms. This research also attempted to find bilateral variability, that is, difference in the angles of elbow extension within the range at which the responses were provoked, between the asymptomatic and symptomatic side of the patient.

Methods: Experimental same subject study design with 30 randomly selected patients in the age group of 20-60 years. Sample population was drawn from physiotherapy out-patient department of Gian Sagar Medical College and Hospital and New Hope Physiotherapy Centre, based on inclusion and exclusion criteria. Subjects with cervical pain and associated neural signs and symptoms (unilateral) went through ULNT1.

Results: Out of 30 patients, 26 were tested positive with ULNT1. True positive rate (sensitivity) was calculated using simple percentage. To find difference in the angles of elbow extension between asymptomatic and symptomatic side, paired t-test was used.

Conclusion: It was concluded that Neural tissue provocation test (ULNT1) is highly sensitive in diagnosing the patients with cervical spine mediated neural signs and symptoms. Significant difference in the angles of elbow extension existed between the asymptomatic and symptomatic sides.


Keywords

NTPT, Sensitivity, ULNT1, Range of Motion, Bilateral Variability
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  • Kelsey, JL 1978, ‘Epidemiology of radiculopathies’, Advances in Neurology, vol. 19, pp. 385–398.

  • Radhakrishnan, K, Litchy, WJ, O’Fallon, WM & Kurland, LT 1994, ‘Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990’, Brain, vol. 117, part 2, pp. 325–335.

  • Sweeney, PJ 1995, ‘Clinical evaluation of cervical radiculopathy and myelopathy’, Neuroimaging Clinics of North America, vol. 5, no. 3, pp. 321–327.

  • Shafaie, FF, Wippold, FJ, Gado, M, Pilgram, TK & Riew, KD 1999, ‘Comparison of computed tomography myelography and magnetic resonance imaging in the evaluation of cervical spondylotic myelopathy and radiculopathy’, Spine, vol. 24, no. 17, pp. 1781- 1785.

  • Han, JJ & Kraft, GH 2003, ‘Electrodiagnosis of neck pain’, Physical Medicine and Rehabilitation Clinics of North America, vol. 14, no. 3, pp. 549–567.

  • Tong, HC, Haig, AJ & Yamakawa, K 2002, ‘The Spurling test and cervical radiculopathy’, Spine, vol. 27, no. 2, pp. 156–159.

  • Viikari-Juntura, E, Porras, M & Laasonen, EM 1989, ‘Validity of clinical tests in the diagnosis of ischolar_main compression in cervical disc disease’, Spine, vol. 14, no. 3, pp. 253–257.

  • Kenneally, M, Rubenach, H & Elvey, RL 1988, ‘The upper limb tension test: the SLR of the arm, in Clinics in physical therapy. Physical therapy of the cervical and thoracic spine, 1st edn, ed Grant R, Churchill Livingstone, New York, pp 167-194.

  • Shacklock, MO 1995, ‘Clinical applications of neurodynamics’, in Moving in on pain, eds Shacklock MO, Buttersworth-Heinemann, Australia, pp. 123-131.

  • Butler, DS 1991, Mobilisation of the nervous system, Churchill Livingstone, Melbourne.

  • Kleinrensink, GJ, Stoeckart, R, Mulder, PGH, van der Hoek, G, Broek, TH, Vleeming, A & Snijders, CJ 2000, ‘Upper limb tension tests as tools in the diagnosis of nerve and plexus lesions. Anatomical and biomechanical aspects’, Clinical Biomechanics, vol. 15, no. 1, pp. 9-14.

  • Sandmark, H & Nisell, R 1995, ‘Validity of five common manual neck pain provoking tests’, Scandinavian Journal of Rehabilitation Medicine, vol. 27, no. 3, pp.131–136.

  • Wainner, R, Fritz, J, Irrgang, J, Delitto, A, Allison, S & Boninger, M 2005, ‘Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome’, Archives of Physical Medicine and Rehabilitation, vol. 86, no. 4, pp. 609–618.

  • Schmid, AB, Brunner, F, Luomajoki, H, Held, U, Bachmann, LM, Künzer, S & Coppieters, MW 2009, ‘Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system’, BMC Musculoskeletal Disorders, vol. 10, article no. 11.

  • Quintner, JL 1989, ‘A study of upper limb pain and paraesthesiae following neck injury in motor vehicle accidents: assessment of the brachial plexus tension test of Elvey’, Rheumatology, vol. 28, no. 6, pp. 528-533.

  • Pullos, J 1986, ‘The upper limb tension test’, Australian Journal of Physiotherapy, vol. 32, no. 4, pp. 258-259.

  • Davis, DS, Anderson, BI, Carson, MG, Caroline, LE & Lindsey, BS 2008, ‘Upper limb neural tension and seated slump tests: The false positive rate among healthy young adults without cervical or lumbar symptoms’, Journal of Manual & Manipulative Therapy, vol. 16, no. 3, pp. 136–141.

  • Jaberzadeha, S, Scutter, S & Nazeran, H 2005, ‘Mechansensitivity of the median nerve and mechanically produced motor responses during upper limb neurodynamic test 1’, Physiotherapy, vol. 91, no. 2, pp. 94-100.

  • Coppieters, MW, Stappaerts, KH, Everaert, DG & Staes, FF 2001b, ‘Addition of test components during neurodynamic testing: effect on range of motion and sensory responses’, Journal of Orthopaedic & Sports Physical Therapy, vol. 31, no. 5, pp. 226-237.

  • Van der Heide, B, Allison, GT & Zusman, M 2001, ‘Pain and muscular responses to a neural tissue provocation test in the upper limb’, Manual Therapy, vol. 6, no. 3, pp. 154-162.

  • Van der Heide, B, Bourgoin, C, Eils, G, Garnevall, B & Blackmore, M 2006, ‘Test-retest reliability and face validity of a modified neural tissue provocation test in patients with cervicobrachial pain syndrome’, Journal of Manual and Manipulative Therapy, vol. 14, No. 1, pp. 30-36(7).

  • Lohkamp, M & Small, K 2011, ‘Normal response to Upper Limb Neurodynamic Test 1 and 2A’, Manual Therapy, vol. 16, no. 2, pp. 125-130.

  • Van Hoof, T, Vangestel, C, Forward, M, Verhaeghe, B, Van Thilborgh, L, Plasschaert, F, De Muynck, M, Vanderstraeten, G & D’Herde, K 2008b, ‘The impact of muscular variation on the neurodynamic test for the median nerve in a healthy population with Langer’s axillary arch’, Journal of Manipulative and Physiological Therapeutics, vol. 31, no. 6, pp. 474-83.


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  • A Study to Validate Diagnostic Strength of ULNT1 in Cervical Radiculopathy

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Authors

Siddharth Sharma
Gian Sagar College of Physiotherapy, Ram Nagar, Distt. Patiala (PUNJAB), India
Anu Sharma
Gian Sagar College of Physiotherapy, Ram Nagar, Distt. Patiala (PUNJAB), India
Amandeep Singh
Gian Sagar College of Physiotherapy, Ram Nagar, Distt. Patiala (PUNJAB), India
Jagmohan Singh
Gian Sagar College of Physiotherapy, Ram Nagar, Distt. Patiala (PUNJAB), India

Abstract


Introduction: Neural tissue provocation tests (NTPT) have been increasingly incorporated into clinical practice. Unfortunately, the early terminology used in describing these tests-'neural tension test' and 'adverse mechanical tension'- did little to further the acceptance, understanding or credibility of the physical treatment of neurogenic pain.

A more appropriate term is 'neural tissue provocation tests' as they are passive test applied in a manner to selectively stress different neural tissues in order to assess their sensitivity to mechanical provocation. Many experts in the field of neurodynamics have clearly stated the importance of the reproduction of a patient's symptoms, which implies the presence of pathology. The other feature which is vital to the interpretation of any neuromusculoskeletal clinical measure is the comparison between sides. It is essential to compare sides for there is tremendous variation in flexibility of the peripheral nervous system in both the lower and upper quarter.

Objectives: While there has been considerable research on neurodynamics, there has been little research investigating the diagnostic validity of such tests. The purpose of this study was to find out the rate of true positive (sensitivity) Upper limb neurodynamic test for median nerve (ULNT1) in patients with cervical spine mediated neural symptoms. This research also attempted to find bilateral variability, that is, difference in the angles of elbow extension within the range at which the responses were provoked, between the asymptomatic and symptomatic side of the patient.

Methods: Experimental same subject study design with 30 randomly selected patients in the age group of 20-60 years. Sample population was drawn from physiotherapy out-patient department of Gian Sagar Medical College and Hospital and New Hope Physiotherapy Centre, based on inclusion and exclusion criteria. Subjects with cervical pain and associated neural signs and symptoms (unilateral) went through ULNT1.

Results: Out of 30 patients, 26 were tested positive with ULNT1. True positive rate (sensitivity) was calculated using simple percentage. To find difference in the angles of elbow extension between asymptomatic and symptomatic side, paired t-test was used.

Conclusion: It was concluded that Neural tissue provocation test (ULNT1) is highly sensitive in diagnosing the patients with cervical spine mediated neural signs and symptoms. Significant difference in the angles of elbow extension existed between the asymptomatic and symptomatic sides.


Keywords


NTPT, Sensitivity, ULNT1, Range of Motion, Bilateral Variability

References