Division of Physiotherapy and NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
J Orthop Sports Phys Ther. 2012 May;42(5):413-24. doi: 10.2519/jospt.2012.3988. Epub 2012 Mar 8.
The validity of upper-limb neurodynamic tests (ULNTs) for detecting peripheral neuropathic pain (PNP) was assessed by reviewing the evidence on plausibility, the definition of a positive test, reliability, and concurrent validity. Evidence was identified by a structured search for peer-reviewed articles published in English before May 2011. The quality of concurrent validity studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool, where appropriate. Biomechanical and experimental pain data support the plausibility of ULNTs. Evidence suggests that a positive ULNT should at least partially reproduce the patient's symptoms and that structural differentiation should change these symptoms. Data indicate that this definition of a positive ULNT is reliable when used clinically. Limited evidence suggests that the median nerve test, but not the radial nerve test, helps determine whether a patient has cervical radiculopathy. The median nerve test does not help diagnose carpal tunnel syndrome. These findings should be interpreted cautiously, because diagnostic accuracy might have been distorted by the investigators' definitions of a positive ULNT. Furthermore, patients with PNP who presented with increased nerve mechanosensitivity rather than conduction loss might have been incorrectly classified by electrophysiological reference standards as not having PNP. The only evidence for concurrent validity of the ulnar nerve test was a case study on cubital tunnel syndrome. We recommend that researchers develop more comprehensive reference standards for PNP to accurately assess the concurrent validity of ULNTs and continue investigating the predictive validity of ULNTs for prognosis or treatment response.
上肢神经动力学测试（ULNTs）检测周围神经性疼痛（PNP）的有效性，是通过对其合理性、阳性测试定义、可靠性和一致性有效性的证据进行评估来确定的。证据是通过对 2011 年 5 月之前发表的同行评议的英文文章进行有组织的搜索而确定的。对一致性有效性研究的质量，根据需要使用诊断准确性研究质量评估工具进行了评估。生物力学和实验性疼痛数据支持 ULNTs 的合理性。有证据表明，阳性 ULNT 至少应部分再现患者的症状，并且结构差异应改变这些症状。数据表明，当临床使用时，这种阳性 ULNT 的定义是可靠的。有限的证据表明，正中神经测试，而不是桡神经测试，有助于确定患者是否患有颈椎病。正中神经测试无助于诊断腕管综合征。这些发现应谨慎解释，因为诊断准确性可能因调查人员对阳性 ULNT 的定义而受到扭曲。此外，患有神经机械感觉敏感性增加而不是传导损失的 PNP 患者可能被电生理参考标准错误地归类为没有 PNP。对尺神经测试的一致性有效性的唯一证据是一项关于肘管综合征的病例研究。我们建议研究人员为 PNP 制定更全面的参考标准，以准确评估 ULNTs 的一致性有效性，并继续研究 ULNTs 对预后或治疗反应的预测有效性。
