Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2009

Open Access 01-12-2009 | Research article

Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system

Authors: Annina B Schmid, Florian Brunner, Hannu Luomajoki, Ulrike Held, Lucas M Bachmann, Sabine Künzer, Michel W Coppieters

Published in: BMC Musculoskeletal Disorders | Issue 1/2009

Login to get access

Abstract

Background

Clinical tests to assess peripheral nerve disorders can be classified into two categories: tests for afferent/efferent nerve function such as nerve conduction (bedside neurological examination) and tests for increased mechanosensitivity (e.g. upper limb neurodynamic tests (ULNTs) and nerve palpation). Reliability reports of nerve palpation and the interpretation of neurodynamic tests are scarce. This study therefore investigated the intertester reliability of nerve palpation and ULNTs. ULNTs were interpreted based on symptom reproduction and structural differentiation. To put the reliability of these tests in perspective, a comparison with the reliability of clinical tests for nerve function was made.

Methods

Two experienced clinicians examined 31 patients with unilateral arm and/or neck pain. The examination included clinical tests for nerve function (sensory testing, reflexes and manual muscle testing (MMT)) and mechanosensitivity (ULNTs and palpation of the median, radial and ulnar nerve). Kappa statistics were calculated to evaluate intertester reliability. A meta-analysis determined an overall kappa for the domains with multiple kappa values (MMT, ULNT, palpation). We then compared the difference in reliability between the tests of mechanosensitivity and nerve function using a one-sample t-test.

Results

We observed moderate to substantial reliability for the tests for afferent/efferent nerve function (sensory testing: kappa = 0.53; MMT: kappa = 0.68; no kappa was calculated for reflexes due to a lack of variation). Tests to investigate mechanosensitivity demonstrated moderate reliability (ULNT: kappa = 0.45; palpation: kappa = 0.59). When compared statistically, there was no difference in reliability for tests for nerve function and mechanosensitivity (p = 0.06).

Conclusion

This study demonstrates that clinical tests which evaluate increased nerve mechanosensitivity and afferent/efferent nerve function have comparable moderate to substantial reliability. To further investigate the clinometric properties of these tests, more studies are needed to evaluate their validity.
Appendix
Available only for authorised users
Literature
1.
Ropper AH, Brown RH: Adams and Victor's Principles of Neurology. 2005, New York: McGraw-Hill, Medical Publishing Division, 8
2.
Lee DH, Claussen GC, Oh S: Clinical nerve conduction and needle electromyography studies. J Am Acad Orthop Surg. 2004, 12: 276-287.CrossRefPubMed
3.
4.
Hoitsma E, Reulen JP, de Baets M, Drent M, Spaans F, Faber CG: Small fiber neuropathy: a common and important clinical disorder. J Neurol Sci. 2004, 227: 119-130. 10.1016/j.jns.2004.08.012.CrossRefPubMed
5.
Bove GM, Ransil BJ, Lin HC, Leem JG: Inflammation induces ectopic mechanical sensitivity in axons of nociceptors innervating deep tissues. J Neurophysiol. 2003, 90: 1949-1955. 10.1152/jn.00175.2003.CrossRefPubMed
6.
Dilley A, Lynn B, Pang SJ: Pressure and stretch mechanosensitivity of peripheral nerve fibres following local inflammation of the nerve trunk. Pain. 2005, 117: 462-472. 10.1016/j.pain.2005.08.018.CrossRefPubMedPubMedCentral
7.
McLellan DL, Swash M: Longitudinal sliding of the median nerve during movements of the upper limb. J Neurol Neurosurg Psychiatry. 1976, 39: 566-570. 10.1136/jnnp.39.6.566.CrossRefPubMedPubMedCentral
8.
Coppieters MW, Alshami AM, Babri AS, Souvlis T, Kippers V, Hodges PW: Strain and excursion of the sciatic, tibial, and plantar nerves during a modified straight leg raising test. J Orthop Res. 2006, 24: 1883-1889. 10.1002/jor.20210.CrossRefPubMed
9.
Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH: The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am. 1981, 63: 380-383.PubMed
10.
Coppieters MW, Butler DS: Do 'sliders' slide and 'tensioners' tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008, 13: 213-221. 10.1016/j.math.2006.12.008.CrossRefPubMed
11.
Spurling RG, Scoville WB: Lateral rupture of the cervical intervertebral discs: a common cause of shoulder and arm pain. Surg Gynecol Obstet. 1944, 78: 350-358.
12.
Supik LF, Broom MJ: Sciatic tension signs and lumbar disc herniation. Spine. 1994, 19: 1066-1069. 10.1097/00007632-199405000-00013.CrossRefPubMed
13.
Butler DS: The Sensitive Nervous System. 1991, Edinburgh: Churchill Livingstone
14.
Elvey RL: Brachial plexus tension tests and the pathoanatomical origin of arm pain. Aspects of Manipulative Therapy. Edited by: Idczak RM. 1980, Melbourne: Lincoln Institute of Health Sciences, 105-110.
15.
16.
Byng J: Overuse syndromes of the upper limb and the upper limb tension test: a comparison between patients, asymptomatic keyboard workers and asymptomatic non-keyboard workers. Man Ther. 1997, 2: 157-164. 10.1054/math.1997.0296.CrossRefPubMed
17.
Grant R, Forrester C, Hides J: Screen based keyboard operation: the adverse effects on the neural system. Aust J Physiother. 1995, 41: 99-105.CrossRefPubMed
18.
Kelley S, Jull G: Breast surgery and neural tissue mechanosensitivity. Aust J Physiother. 1998, 44: 31-37.CrossRefPubMed
19.
Yaxley G, Jull G: A modified upper limb tension test: an investigation of responses in normal subjects. Aust J Physiother. 1991, 37: 143-152.CrossRefPubMed
20.
Coppieters M, Stappaerts K, Janssens K, Jull G: Reliability of detecting 'onset of pain' and 'submaximal pain' during neural provocation testing of the upper quadrant. Physiother Res Int. 2002, 7: 146-156. 10.1002/pri.251.CrossRefPubMed
21.
Coppieters MW, Stappaerts KH, Everaert DG, Staes FF: Addition of test components during neurodynamic testing: effect on range of motion and sensory responses. J Orthop Sports Phys Ther. 2001, 31: 226-235.CrossRefPubMed
22.
Heide Van der B, Bourgoin C, Eils G, Garnevall B, Blackmore M: Test-retest reliability and face validity of a modified neural tissue provocation test in patients with cervicobrachial pain syndrome. J Man Manip Ther. 2006, 14: 30-36.CrossRef
23.
Selvaratnam PJ, Matyas TA, Glasgow EF: Noninvasive discrimination of brachial plexus involvement in upper limb pain. Spine. 1994, 19: 26-33. 10.1097/00007632-199401000-00006.CrossRefPubMed
24.
Breig A, Troup JD: Biomechanical considerations in the straight-leg-raising test. Cadaveric and clinical studies of the effects of medial hip rotation. Spine. 1979, 4: 242-250. 10.1097/00007632-197905000-00011.CrossRefPubMed
25.
Butler DS: The Sensitive Nervous System. 2000, Unley: NOI Group Publications
26.
Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S: Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003, 28: 52-62. 10.1097/00007632-200301010-00014.CrossRefPubMed
27.
Elvey RL: Physical evaluation of the peripheral nervous system in disorders of pain and dysfunction. J Hand Ther. 1997, 10: 122-129.CrossRefPubMed
28.
Jepsen JR, Laursen LH, Hagert CG, Kreiner S, Larsen AI: Diagnostic accuracy of the neurological upper limb examination ll: relation to symptoms of patterns of findings. BMC Neurol. 2006, 6: 10-10.1186/1471-2377-6-10.CrossRefPubMedPubMedCentral
29.
Sim J, Wright CC: The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005, 85: 257-268.PubMed
30.
Kendall FP, McCreary EK, Provance PG: Muscles Testing and Function. 1993, Baltimore: Williams and Wilkins, 4
31.
Aminoff MJ, A GD, Simon RP: Clinical Neurology. 2005, New York: McGraw-Hill Medical, 6
32.
33.
Kirkwood B, Sterne J: Essential Medical Statistics. 2006, Oxford: Blackwell Publishing
34.
Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics. 1977, 33: 159-174. 10.2307/2529310.CrossRefPubMed
35.
Zuluaga M: Intertherapist reliability study of the brachial plexus tension test. Aust J Physiother. 1986, 34: 57-
36.
Viikari-Juntura E: Interexaminer reliability of observations in physical examinations of the neck. Phys Ther. 1987, 67: 1526-1532.PubMed
37.
Wainner RS, Fritz JM, Irrgang JJ, Delitto A, Allison S, Boninger ML: Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Arch Phys Med Rehabil. 2005, 86: 609-618. 10.1016/j.apmr.2004.11.008.CrossRefPubMed
38.
Coppieters MW, Alshami AM, Hodges PW: An experimental pain model to investigate the specificity of the neurodynamic test for the median nerve in the differential diagnosis of hand symptoms. Arch Phys Med Rehabil. 2006, 87: 1412-1417. 10.1016/j.apmr.2006.06.012.CrossRefPubMed
39.
Coppieters MW, Kurz K, Mortensen TE, Richards NL, Skaret IA, McLaughlin LM, Hodges PW: The impact of neurodynamic testing on the perception of experimentally induced muscle pain. Man Ther. 2005, 10: 52-60. 10.1016/j.math.2004.07.007.CrossRefPubMed
40.
Jepsen JR, Laursen LH, Hagert CG, Kreiner S, Larsen AI: Diagnostic accuracy of the neurological upper limb examination l: inter-rater reproducibility of selected findings and patterns. BMC Neurol. 2006, 6: 8-10.1186/1471-2377-6-8.CrossRefPubMedPubMedCentral
41.
Manschot S, van Passel L, Buskens E, Algra A, van Gijn J: Mayo and NINDS scales for assessment of tendon reflexes: between observer agreement and implications for communication. J Neurol Neurosurg Psychiatry. 1998, 64: 253-255. 10.1136/jnnp.64.2.253.CrossRefPubMedPubMedCentral
42.
Waddell G, Main CJ, Morris EW, Venner RM, Rae PS, Sharmy SH, Galloway H: Normality and reliability in the clinical assessment of backache. Br Med J (Clin Res Ed). 1982, 284: 1519-1523.CrossRef
43.
Jepsen J, Laursen L, Larsen A, Hagert CG: Manual strength testing in 14 upper limb muscles: a study of inter-rater reliability. Acta Orthop Scand. 2004, 75: 442-448.CrossRefPubMed
44.
Bohannon RW: Manual muscle testing: does it meet the standards of an adequate screening test?. Clin Rehabil. 2005, 19: 662-667. 10.1191/0269215505cr873oa.CrossRefPubMed
45.
Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC: A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007, 16: 307-319. 10.1007/s00586-006-0225-6.CrossRefPubMed
46.
Shacklock MO: Positive upper limb tension test in a case of surgically proven neuropathy: analysis and validity. Man Ther. 1996, 1: 154-161. 10.1054/math.1996.0265.CrossRefPubMed
Metadata
Title
Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system
Authors
Annina B Schmid
Florian Brunner
Hannu Luomajoki
Ulrike Held
Lucas M Bachmann
Sabine Künzer
Michel W Coppieters
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2009
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-10-11

Other articles of this Issue 1/2009

BMC Musculoskeletal Disorders 1/2009 Go to the issue

Study protocol

Optimising corticosteroid injection for lateral epicondylalgia with the addition of physiotherapy: A protocol for a randomised control trial with placebo comparison

Research article

Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study

Research article

Psychopathology predicts the outcome of medial branch blocks with corticosteroid for chronic axial low back or cervical pain: a prospective cohort study

Research article

A modified QuickDASH-9 provides a valid outcome instrument for upper limb function

Research article

Impact of associated injuries in the Floating knee: A retrospective study

Correspondence

The Keele community knee pain forum: action research to engage with stakeholders about the prevention of knee pain and disability