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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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  • 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