Sunday, January 8, 2012
Neurodynamic Research Roundup
Here are some links to recent studies on neurodynamics all via PubMed
Short-term effects of neurodynamic mobilization in 15 patients with secondary thumb carpometacarpal osteoarthritis
The study looked at ULNT 1 and it's effect on pain and strength for the thumb CMC. A small sample was used. Improvements in CMC strength and pain were seen after the first visit and 2nd and 3rd follow up visits. No change was seen in pain levels at the other measured sites.
Upper extremity neurodynamic tests: Range of motion asymmetry may not indicate impairment found by @texasortho
The authors found no differences in bilateral comparison for radial and ulnar nerves. Fitting, as they are less involved than the median nerve, or test 1/1a. There were significant differences in median nerve mobility in these healthy subjects even when corrected for measurement error. This suggests that it may not be an appropriate measure of impairment. They did not mention in the abstract whether or not it had to do with dominant vs non-dominant sides. I would expect the dominant side to have limitations due to forearm tightness and most having more restricted pronator teres, potentially limiting the supination and median nerve excusion.
When using neurodynamics as testing, I take note of loss of ROM, reproduction of Sx, or reproduction of any other complaints on the involved vs the uninvolved sides. I pre and post test after treatment. Often after some STM, SMT, and JM to the neural container, the ROM and Sx are all improved.
Upper Limb Neurodynamic Test 1 and symptoms reproduction in carpal tunnel syndrome. A validity study
The authors tested 47 subjects with suspected CTS using NCV and ULNT 1. When looking at Sx reproduction, and bilateral comparison limitations in the involved UE at the elbow, or Sx modified by cervical SB, the sensitivity was quite high, at 91.67%, specificity at 15%.
When only looking at Sx reproduction, the sensitivity was only 54.17%, but specificity was 70%. They concluded reproduction of Sx in the affected hand improves the estimation of the probability of the presence of CTS.
Having taken courses with Butler himself, the same question always popped up. He also recommended not only looking for specific Sx reproduction, but any difference in Sx, pain, or paraesthesia, whether or not head and neck movement changed the motion/Sx, and whether or not there were ROM changes when comparing sides.