Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study.

Background: When performing the Upper Limb Neurodynamic Test 1 (ULNT1), the order of joint movement can be varied to place more stress onto certain nerve segments. However, the mechanisms underlying this phenomenon are still unclear. This study aimed to analyze the differences in the stiffness of the median nerve (MN) and the brachial plexus (BP) using ultrasound shear wave elastography during three sequences of the ULNT1: standard (ULNT1-STD), distal-to-proximal (ULNT1-DIST), and proximal-to-distal (ULNT1-PROX).

Accuracy of the Standard and Distal-to-Proximal Sequence of the Upper Limb Neurodynamic Test 1 for the Diagnosis of Carpal Tunnel Syndrome: The Role of Side-to-Side Comparisons.

: This study aimed to evaluate the diagnostic accuracy of two upper limb neurodynamic test 1 (ULNT1) sequences for detecting carpal tunnel syndrome (CTS) in patients with unilateral symptoms. The standard sequence (ULNT1-STD) and a distal-to-proximal sequence (ULNT1-DIST) were investigated. A local-initiated sequence may facilitate symptoms reproduction in CTS, and comparing the affected side with the unaffected side could improve the detection of altered median nerve mechanosensitivity when symptoms are not directly reproduced.

Median nerve stiffness with three movement sequences of the upper limb neurodynamic test 1: An ultrasound shear-wave elastography study.

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.

Effect of cervical contralateral lateral flexion on the median nerve and fascia at the wrist - Cadaveric study.

Background: Neurodynamic tests are an essential aspect of the physical examination of the patient when suspicion of neural involvement exists. A manoeuvre that is hypothesised to move nerves differentially relative to other structures (structural differentiation) has been proposed as a necessary part of neurodynamic testing for differential diagnosis. However, although the specificity of structural differentiation for peripheral nerve over muscle has been demonstrated in some body regions, no study has tested specificity of nerve movement relative to fascia.

Diagnostic accuracy of the upper limb neurodynamic test 1 using neurodynamic sequencing in diagnosis of carpal tunnel syndrome.

Background: The upper limb neurodynamic test 1 is used in the diagnosis of median nerve neuropathies such as carpal tunnel syndrome but its diagnostic validity remains limited. Neurodynamic sequencing has been suggested to increase the specificity of the neurodynamic tests, however, to date, information on the diagnostic accuracy of this variation in neurodynamic testing is required.

Objectives: The aim of this study was to analyze the diagnostic validity of the local sequence of ULNT1 (LS-ULNT1) (i.

Treatment of Sciatica and Lumbar Radiculopathy with an Intervertebral Foramen Opening Protocol: Pilot Study in a Hospital Emergency and In-patient Setting.

Aims: Perform a pilot study of a static nerve root foramen opening protocol for lumbar radiculopathy from disc hernia in an emergency hospital setting to establish if patients could execute the protocol, consistency would occur across outcomes, superior outcomes would occur in the experimental group, and if the protocol would be safe.

Methods: Patients with sciatica arrived of their own volition at the local emergency hospital department, were admitted for care and were randomized into two groups: 1) control (n = 10): forward bending, walking, and medication; and 2) experimental (n = 10) as control subjects, plus a static lumbar foramen opening protocol using flexion and contralateral lateral flexion (side-lying). Outcomes were back and leg pain (i.

Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging.

Background: The straight leg raise test (SLR) is one of the most utilized and studied physical tests in patients with low back pain (LBP) for the detection of lumbar disc herniation (LDH), showing high sensitivity and heterogeneous or low specificity. The high incidence of asymptomatic 'pathologic' findings in the magnetic resonance imaging (MRI) scans may cause verification bias to these results. We studied an extended SLR (ESLR) by adding location-specific structural differentiation movements (hip internal rotation or ankle dorsiflexion) to the traditional SLR for it to better differentiate neural symptoms from musculoskeletal.

Differential movement of the median nerve and biceps brachii at the elbow in human cadavers.

Background: It is important to establish if mechanical testing for physical problems in the human is specific or non-specific for structures - e.g. muscle and nerve.

Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip internal rotation or ankle dorsiflexion.

Background: The straight leg raise (SLR) is the most commonly applied physical tests on patients with sciatica, but the sensitivity and specificity ratings for disc hernia and neural compression leave areas for improvement. Hip internal rotation tensions the lumbosacral nerve roots and ankle dorsiflexion tensions the sciatic nerve along its course. We added these movements to the SLR (extended SLR = ESLR) as structural differentiators and tested inter-rater reliability in patients with LBP, with and without sciatica.

Effect of cervical contralateral lateral flexion on displacement and strain in the median nerve and flexor digitorum superficialis at the wrist during the ULNT1 - Cadaveric study.

Introduction: A key issue in neurodynamic testing is whether a manoeuvre designed to produce differential biomechanical behaviour (structural differentiation) of nerve compared to adjacent muscle is mechanically accurate. The aim of this study was to investigate the capacity of cervical contralateral lateral flexion to produce differential biomechanical behaviour of the median nerve at the wrist (mechanical specificity) in relation to the adjacent muscle (flexor digitorum superficialis) at different ranges of upper limb neurodynamic test 1 in cadavers.

Material And Methods: A cross-sectional study was carried out.

Effect of ankle dorsiflexion on displacement and strain in the tibial nerve and biceps femoris muscle at the posterior knee during the straight leg raise: Investigation of specificity of nerve movement.

Background: A structural differentiation maneuver has been proposed to differentiate between muscle and nerve involvement during the straight leg raise test. However, to date, the mechanical specificity of this maneuver for the tibial nerve at the posterior knee has not been tested. The aim of this study was to investigate the specificity of ankle dorsiflexion as a differentiation maneuver between the tibial nerve and the biceps femoris muscle at the posterior knee during the straight leg raise in cadavers.

Differential movement of the sciatic nerve and hamstrings during the straight leg raise with ankle dorsiflexion: Implications for diagnosis of neural aspect to hamstring disorders.

Introduction: In hamstrings injuries, sciatic nerve and muscle disorders can coexist. Therefore, differential diagnosis to include or exclude nerve involvement is an important aspect of evaluation. The objective of this paper is to investigate the mechanical behaviour of the sciatic nerve and biceps femoris muscle in the proximal thigh with the ankle dorsiflexion manoeuvre at different degrees of hip flexion during the straight leg raise in cadavers.

Normalization of Spinal Cord Displacement With the Straight Leg Raise and Resolution of Sciatica in Patients With Lumbar Intervertebral Disc Herniation: A 1.5-year Follow-up Study.

Study Design: A controlled radiologic follow-up study.

Objective: The aim of this study was to ascertain whether changes in cord excursion with straight leg raise test (SLR) at 1.5-year follow-up time accompany changes in clinical symptoms.

Dimensional changes of the carpal tunnel and median nerve during manual mobilization of the carpal bones - Anatomical study.

Study Design: Cross-sectional study.

Background: The carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic and therapeutic manual techniques that appear to move and change tunnel shape is part of clinical practice.

Dimensional changes of the carpal tunnel and the median nerve during manual mobilization of the carpal bones.

Introduction: The carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic, such that the dimensions of the tunnel and median nerve change with position, movement and application of externally applied force with mechanical devices. Therapeutic manual techniques that appear to move and change tunnel shape are part of clinical practice.

Reliability of measurement of the carpal tunnel and median nerve in asymptomatic subjects with ultrasound.

Background: Morphology of the carpal tunnel changes with varying wrist postures and compressive forces applied to the wrist. These changes may affect the morphology and pressure on the median nerve and could be used as part of the treatment of the carpal tunnel syndrome patients. Reliability of the ultrasonographic measurements of the median nerve has been widely studied.

Reduced Spinal Cord Movement With the Straight Leg Raise Test in Patients With Lumbar Intervertebral Disc Herniation.

Study Design: Controlled radiological study.

Objective: To explore whether impairment of neural excursion during the straight leg raise test occurs in patients with sciatic symptoms secondary to lumbar intervertebral disc herniation (LIDH).

Summary Of Background Data: Earlier studies have shown that during the straight leg raise (SLR) test in asymptomatic volunteers tensile forces are consistently transmitted throughout the neural system and the thoracolumbar spinal cord slides distally.

Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial.

Objective: The purpose of this randomized trial was to compare the efficacy of manual therapy, including the use of neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS).

Methods: The study included 140 CTS patients who were randomly assigned to the manual therapy (MT) group, which included the use of neurodynamic techniques, functional massage, and carpal bone mobilizations techniques, or to the electrophysical modalities (EM) group, which included laser and ultrasound therapy. Nerve conduction, pain severity, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire were assessed before and after treatment.

Normal multiplanar movement of the spinal cord during unilateral and bilateral straight leg raise: Quantification, mechanisms, and overview.

The purpose of this investigation was to provide a full set of normal data describing neural biomechanics within the vertebral canal in all three planes with unilateral and bilateral SLR tests to allow for clinical comparison with clinical cases. This is done following the notion that, due to neural continuum, tensile forces are transmitted through the lumbosacral nerve roots and dura to the conus medullaris (linear dependency principle). In this controlled radiologic study 10 asymptomatic volunteers were scanned with 1.

Slump Test: Effect of Contralateral Knee Extension on Response Sensations in Asymptomatic Subjects and Cadaver Study.

Study Design: Part 1: A randomized, single-blind study on the effect of contralateral knee extension on sensations produced by the slump test (ST) in asymptomatic subjects. Part 2: A cadaver study simulating the nerve root behavior of part 1.

Objective: Part 1: Test if contralateral knee extension consistently reduces normal stretch sensations with the ST.

Part 3: Developing Methods of In Vivo MRI Measurement of Spinal Cord Displacement in the Thoracolumbar Region of Asymptomatic Subjects With Unilateral and Bilateral Straight Leg Raise Tests.

Study Design: Controlled radiological study.

Objective: Verify (1) whether conus medullaris displacement varies with the range of hip flexion and (2) whether the acquired data support the "principle of linear dependence."

Summary Of Background Data: We have previously quantified normal displacement of the conus with unilateral and bilateral straight leg raise (SLR) and have described the "principle of linear dependence.

Correlation analysis of demographic and anthropometric factors, hip flexion angle and conus medullaris displacement with unilateral and bilateral straight leg raise.

Purpose: It has been shown that the conus medullaris displaces significantly and consistently in response to both unilateral and bilateral SLRs. Point of interest is represented by whether the magnitude of this displacement can be predicted in asymptomatic subjects. The purpose was to investigate whether any correlations existed between demographic and anthropometric factors and hip flexion angle with magnitude of conus medullaris displacement with the unilateral and bilateral SLR.

Effect of glenohumeral forward flexion on upper limb myoelectric activity during simulated mills manipulation; relations to peripheral nerve biomechanics.

Background: It is generally accepted that muscles may activate via the common nociceptive flexion reflex (NFR) in response to painful stimuli associated with tensile or compressive forces on peripheral nerves. Following the basic assumption that the radial nerve may be stressed around the elbow during the execution of the Mills manipulation, two positions considered to have different mechanical effects on the radial nerve and the brachial plexus were tested in order to i) explore whether muscles are activated in certain patterns with concomitant changes in nerve tension, ii) establish whether muscle responses can be modified with mechanical unloading of the brachial plexus.

Methods: Muscle responses were quantified bilaterally in eight subjects (N = 16) during Mills Manipulation (MM) pre-manipulative positioning and a Varied position that putatively produces less mechanical tension in the brachial plexus.