Reliabilität und Validität des Upper Limb Neurodynamic Tests bei symptomatischen Nackenpatienten

Zusammenfassung

Im klinischen Alltag dient der Upper Limb Neurodynamic Test (ULNT) zur Untersuchung der Mechanosensitivität von Nervengewebe bei Patienten mit muskuloskeletalen Beschwerden. Verschiedene Studien mit asymptomatischen Probanden bewerteten die Inter- und Intratester-Reliabilität hoch, während die wenigen Studien zur Validität bei Nackenbeschwerden widersprüchliche Resultate zeigten.

Dieser systematische Reviews bewertete 8 nach einer umfassenden Datenbanksuche eingeschlossene Studien zur Reliabilität oder Validität des ULNT mithilfe der QUADAS-Kriterien (Quality Assessment of Diagnostic Accuracy Studies).

Es scheint Evidenz zu bestehen, dass der ULNT zwischen mechanischen und neurodynamischen Ursachen unterscheiden kann. Die Sensitivität ist hoch, wohingegen die Spezifität aufgrund der hohen falsch-positiven Rate nicht ausreicht. Wahrscheinlich kann ein negativer ULNT Patienten mit neurogenen Nackenbeschwerden ausschließen.

Abstract

In clinical practice the upper limb neurodynamic test (ULNT) is used to test the neural tissues’ mechanosensitivity in patients with musculoskeletal complaints. Various studies with asymptomatic subjects proved high inter- and intra-tester reliability, while the small number of studies dealing with neck complaints showed inconclusive results.

This systematic review evaluated 8 studies concerning the reliability and validity of the ULNT using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria. The studies were selected after a comprehensive database search.

There seems to be evidence for ULNT to differentiate between mechanical and neurodynamic sources, whereas due to the high false positive rate its sensitivity is not sufficient. A negative ULNT may be able to exclude patients with neurogenic neck complaints.

Schlüsselwörter

ULNT - Nacken - Reliabilität - Validität - Sensitivität - Spezifität

Keywords

ULNT - neck - reliability - validity - sensitivity - specificity

• Literatur

• 1 Bertilson BC, Grunnesjö M, Strender LE. Reliability of clinical tests in the assessment of patients with neck/shoulder problems-impact of history. Spine 2003; 28: 2222-2231
• 2 Butler DS. Mobilisation of the Nervous System. Melbourne: Churchill Livingstone; 1991
• 3 Butler DS. The sensitive nervous system. Adelaide: Noigroup; 2000
• 4 Coppieters MW, Stappaerts KH, Everaert DG et al. Addition of test components during neurodynamic testing: effect on range of motion and sensory response. JOSPT 2001; 31: 226-235
• 5 Coppieters MW, Stappaerts KH, Janssens K et al. Reliability of detecting onset of pain and submaximal pain during neural provocation testing of the upper quadrant. Physiother Res Int 2002; 7: 146-156
• 6 Coppieters MW, Stappaerts KH, Wouters LL et al. Aberrant protective force generation during neural provocation testing and the effect of treatment in patients with neurogenic cervicobrachial pain. JMPT 2003; 26: 99-106
• 7 Coppieters MW, Stappaerts KH, Wouters LL et al. The immediate effects of a cervical lateral glide technique in patients with neurogenic cervicobrachial pain. JOSPT 2003; 33: 369-378
• 8 Coppieters MW, Hough AD, Dilley A. Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: an in vivo study using dynamic ultrasound imaging. JOSPT 2009; 39: 164-171
• 9 Covill LG, Petersen SM. Upper extremity neurodynamic tests: Range of motion asymmetry may not indicate impairment. Physiotherapy Theory and Practice 2012; 28: 535-541
• 10 Davidson M. The interpretation of diagnostic tests: A primer for physiotherapists. Australian Journal of Physiotherapy 2002; 48: 227-233
• 11 Davis DS, Anderson IB, Carson MG et al. Upper limb neural tension and seated slump tests: The false positive rate among healthy young adults without cervical or lumbar symptoms. JMMT 2008; 16: 136-141
• 12 De Bruin ED, Rozendal RH, Stussi E. Reliability of phase-velocity measurements of tibial bone. Physical Therapy 1998; 78: 1166-1174
• 13 Elvey RL. Physical evaluation of the peripheral nervous system in disorders of pain and dysfunction. J Hand Therapy 1997; 10: 122-129
• 14 Felder-Puig R, Mad P, Gartlehner G. Diagnostische Studien. Wien Med Wochenschr 2009; 159 /13–14 359-366
• 15 Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome. Clin Orthop Relat Res 2010; 469: 1089-1094
• 16 Greening J, Lynn B. Minor peripheral nerve injuries: an underestimated source of pain. Manual Therapy 1998; 3: 187-194
• 17 Greening J, Dilley A, Lynn B. In vivo study of nerve movement and mechanosensitivity of the median nerve in whiplash and non-specific arm pain patients. Pain 2005; 115: 248-253
• 18 Gross Portney L, Watkins MP. Foundations of clinical research. Applications to practice. New Jersey: Prentice-Hall Health; 2000
• 19 Hall TM, Elvey RL. Nerve trunk pain: physical diagnosis and treatment. Manual Therapy 1999; 4: 63-73
• 20 Van der Heide B, Allison GT, Zusman M. Pain and muscular responses to neural tissue provocation test in the upper limb. Manual Therapy 2001; 6: 154-162
• 21 Van der Heide B, Bourgoin C, Eils G et al. Test-Retest reliability and face validity of a modified neural tissue provocation test in patients with cervicobrachial pain syndrome. JMMT 2006; 14: 30-36
• 22 Hines T, Noakes R, Manners B et al. The upper limb tension test: inter-tester reliability for assessing the onset of passive resistance R1. The upper limb tension test: inter-tester reliability for assessing the onset of passive resistance R1 1993; 1: 95-98
• 23 Hough AD, Moore AP, Jones MP. Peripheral nerve motion measurement with spectral doppler sonography: a reliability study. J Hand Surg Br 2000; 25: 585-589
• 24 Kleinrensink GJ, Stoeckart R, Vleeming A et al. Mechanical tension in the median nerve. The effects of joint positions. Clinical Biomechanics 1995; 10: 240-244
• 25 Kleinrensink GJ, Stoeckart R, Mulder PG et al. Upper limb tension tests as tools in the diagnosis of nerve and plexus lesions. Anatomical and biomechanical aspects. Clinical Biomechanics 2000; 15: 9-14
• 26 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 27 Lohkamp M, Small K. Normal response to upper limb neurodynamic test 1 and 2a. Manual Therapy 2011; 16: 125-130
• 28 Nee JR, Yang CH, ChaoLiang C et al. Impact of order of movement on nerve strain and longitudinal excursion: A biomechanical study with implications for neurodynamic test sequencing. Manual Therapy 2010; 15: 376-381
• 29 Oesch P, Hilfiker R, Keller S et al. Assessments in der Rehabilitation. Bd. 2. Bewegungsapparat. Bern: Huber; 2011
• 30 Oliver SG, Rushton A. A study to explore the reliability and precision of intra and inter-rater measures of ULNT1 on an asymptomatic population. Manual Therapy 2011; 16: 203-206
• 31 Petersen CM, Zimmermann CL, Hall KD et al. Upper Limb Neurodynamic Test of the Radial Nerve: A study of responses in symptomatic and asymptomatic subjects. J Hand Ther 2009; 22: 344-354
• 32 Petersen SM, Covill LG. Reliability of the radial and ulnar nerve biased upper extremity neural tissue provocation tests. Physiother Theory Pract 2010; 26: 476-482
• 33 Pullos J. The upper limb tension test. Aust J Physiother 1986; 32: 258-259
• 34 Quintner JL. A study of upper limb pain and paraesthesiae following neck injury in motor vehicle accidents: assessment of the brachial plexus tension test of Elvey. British Journal of Rheumatology 1989; 28: 528-533
• 35 Raney NH, Petersen EJ, Smith TA et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J 2009; 18: 382-391
• 36 Reisch R, Williams K, Nee RJ et al. ULNT2 – Median nerve bias: examiner reliability and sensory responses in asymptomatic subjects. J Man Manip Ther 2005; 13: 44-55
• 37 Rubinstein SM, Pool JJ, van Tulder MW et al. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J 2007; 16: 307-319
• 38 Schmid AB, Brunner F, Luomajoki H et al. Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskeletal Disorders 2009; 10: 11-11
• 39 Selvaratnam PJ, Matyas TA, Glasgow EF et al. Noninvasive discrimination of plexus brachialis involvement in upper limb pain. Spine 1994; 19: 26-33
• 40 Shacklock M. Neurodynamics. Physiotherapy 1995; 81: 9-16
• 41 Shacklock M. Angewandte Neurodynamik. Neuromuskuloskelettale Strukturen verstehen und behandeln. München: Urban & Fischer; 2008
• 42 Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin 1979; 86: 420-428
• 43 Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation and sample size requirements. Physical Therapy 2005; 85: 257-268
• 44 Sterling M, Treleaven J, Jull G. Responses to a clinical test of mechanical provocation of nerve tissue in whiplash associated disorder. Man Ther 2002; 7: 89-94
• 45 Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. New York: Oxford University Press; 2003
• 46 Vanti C, Conteddu L, Guccione A et al. The upper limb neurodynamic test 1: intra- and intertester reliability and the effect of several repetitions on pain and resistance. JMPT 2010; 33: 292-299
• 47 Viikari-Juntura E. Interexaminer reliability of observations in physical examinations of the neck. Physical Therapy 1987; 67: 1526-1532
• 48 Wainner RS. Reliability of the clinical examination: How close is ”close enough”?. JOSPT 2003; 33: 488-491
• 49 Wainner RS, Fritz JM, Irrgang JJ et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003; 28: 52-62
• 50 Whiting P, Rutjes AW, Reitsma JB et al. The development of QUADAS: a tool of the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003; 3: 25-25
• 51 Whiting PF, Weswood ME, Rutjes AW et al. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol 2006; 6: 9-9
• 52 Yaxley GA, Jull GA. A modified upper limb tension test: an investigation of responses in normal subjects. Australian J Physiotherapy 1991; 37: 143-152
• 53 Zuluaga M. Intertherapist reliability study of the brachial plexus tension test. Australian J Physiotherapy 1986; 34: 5-5