Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system
1 Uniklinik Balgrist, Department of Physiotherapy, Forchstrasse 340, 8008 Zurich, Switzerland
2 Uniklinik Balgrist, Department of Rheumatology, Forchstrasse 340, 8008 Zurich, Switzerland
3 Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Technikumstrasse 71, 8401 Winterthur, Switzerland
4 Horten Center for Patient-Oriented Research, Bolleystrasse 40, Postfach Nord, University of Zurich, Zurich, Switzerland
5 School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
BMC Musculoskeletal Disorders 2009, 10:11 doi:10.1186/1471-2474-10-11Published: 21 January 2009
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.
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.
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).
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.