Gianluca Ciuffreda , Elena Estébanez-de-Miguel , Isabel Albarova-Corral , Miguel Malo-Urriés , Michael Shacklock , Alberto Montaner-Cuello , Elena Bueno-Gracia
{"title":"Median nerve stiffness with three movement sequences of the upper limb neurodynamic test 1: An ultrasound shear-wave elastography study","authors":"Gianluca Ciuffreda , Elena Estébanez-de-Miguel , Isabel Albarova-Corral , Miguel Malo-Urriés , Michael Shacklock , Alberto Montaner-Cuello , Elena Bueno-Gracia","doi":"10.1016/j.msksp.2024.103221","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>During the Upper Limb Neurodynamic Test 1 (ULNT1) joint movement order can be varied to improve its diagnostic accuracy. However, nerve behavior with neurodynamic sequences still requires in vivo research.</div></div><div><h3>Objective</h3><div>To quantify differences in median nerve (MN) stiffness measuring shear-wave velocity (SWV) with ultrasound elastography during three sequences of the ULNT1.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Methods</h3><div>MN SWV was measured in 35 asymptomatic subjects at the wrist and elbow at the initial and final position (P1) of the standard (ULNT1-STD), proximal-to-distal (ULNT1-PROX) and distal-to-proximal (ULNT1-DIST) sequences of the ULNT1.</div></div><div><h3>Results</h3><div>Significantly different increases at P1 in nerve stiffness occurred between sequences and locations (p < 0.001). At the wrist, the ULNT1-PROX produced the smallest increase (44.32% ± 44.06, SWV: 4.49 ± 0.95 m/s), the ULNT1-STD produced a larger increase (82.13% ± 45.36, SWV: 5.67 ± 0.79 m/s, p < 0.001) and the ULNT1-DIST produced the largest (92.90% ± 55.37, SWV: 5.97 ± 0.79 m/s, p < 0.001). Differences between the ULNT1-DIST and ULNT1-STD did not reach significance.</div><div>At the elbow, the ULNT1-PROX showed a 119.92% ± 53.51 increase (SWV: 4.08 ± 0.84 m/s), the ULNT1-DIST a 134.84% ± 53.83 (SWV: 4.34 ± 0.77 m/s), and the ULNT1-STD a 113.30% ± 59.28 (SWV: 3.98 ± 1.04 m/s). No significant differences were found among the sequences.</div></div><div><h3>Conclusion</h3><div>The ULNT1-STD and ULNT1-DIST showed greater increases at MN stiffness at the wrist compared to the ULNT1-PROX. This supports a basis for future investigation of the mechanisms of neurodynamic testing in which emphasizing anatomical locations for improving diagnostic efficacy might be applied.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"75 ","pages":"Article 103221"},"PeriodicalIF":2.2000,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Musculoskeletal Science and Practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468781224003163","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 0
Abstract
Background
During the Upper Limb Neurodynamic Test 1 (ULNT1) joint movement order can be varied to improve its diagnostic accuracy. However, nerve behavior with neurodynamic sequences still requires in vivo research.
Objective
To quantify differences in median nerve (MN) stiffness measuring shear-wave velocity (SWV) with ultrasound elastography during three sequences of the ULNT1.
Design
Cross-sectional study.
Methods
MN SWV was measured in 35 asymptomatic subjects at the wrist and elbow at the initial and final position (P1) of the standard (ULNT1-STD), proximal-to-distal (ULNT1-PROX) and distal-to-proximal (ULNT1-DIST) sequences of the ULNT1.
Results
Significantly different increases at P1 in nerve stiffness occurred between sequences and locations (p < 0.001). At the wrist, the ULNT1-PROX produced the smallest increase (44.32% ± 44.06, SWV: 4.49 ± 0.95 m/s), the ULNT1-STD produced a larger increase (82.13% ± 45.36, SWV: 5.67 ± 0.79 m/s, p < 0.001) and the ULNT1-DIST produced the largest (92.90% ± 55.37, SWV: 5.97 ± 0.79 m/s, p < 0.001). Differences between the ULNT1-DIST and ULNT1-STD did not reach significance.
At the elbow, the ULNT1-PROX showed a 119.92% ± 53.51 increase (SWV: 4.08 ± 0.84 m/s), the ULNT1-DIST a 134.84% ± 53.83 (SWV: 4.34 ± 0.77 m/s), and the ULNT1-STD a 113.30% ± 59.28 (SWV: 3.98 ± 1.04 m/s). No significant differences were found among the sequences.
Conclusion
The ULNT1-STD and ULNT1-DIST showed greater increases at MN stiffness at the wrist compared to the ULNT1-PROX. This supports a basis for future investigation of the mechanisms of neurodynamic testing in which emphasizing anatomical locations for improving diagnostic efficacy might be applied.
期刊介绍:
Musculoskeletal Science & Practice, international journal of musculoskeletal physiotherapy, is a peer-reviewed international journal (previously Manual Therapy), publishing high quality original research, review and Masterclass articles that contribute to improving the clinical understanding of appropriate care processes for musculoskeletal disorders. The journal publishes articles that influence or add to the body of evidence on diagnostic and therapeutic processes, patient centered care, guidelines for musculoskeletal therapeutics and theoretical models that support developments in assessment, diagnosis, clinical reasoning and interventions.