Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies.
Larissa T Baselgia, David L Bennett, Robert M Silbiger and 1 others
PMID 27449322WHAT IT FOUND
A negative median nerve neurodynamic test does not rule out carpal tunnel syndrome.
In this cohort, over half of confirmed CTS patients tested negative on these maneuvers, and those with negative tests showed worse warm sensation loss than those with positive tests.
Key findings
01More than 54% of patients with electrodiagnostically confirmed carpal tunnel syndrome had negative median nerve neurodynamic tests.
02Patients with negative neurodynamic tests showed a more pronounced deficit in warm detection thresholds than patients with positive tests, indicating greater small-fiber dysfunction.
03There were no significant differences in pain thresholds or mechanical pain sensitivity between patients with positive and negative neurodynamic tests.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was cross-sectional, so it cannot determine if neurodynamic test results change over time or with treatment. The sample size for the subgroup analysis was relatively small (24 positive vs 29 negative ULNT patients). Only one physiotherapist performed the neurodynamic tests, so inter-tester variability was not assessed in this specific dataset, although the method has moderate reliability in previous studies. The study excluded patients with diabetes or pregnancy, so findings may not apply to these common populations with CTS.
Declared interests
The authors declare no conflicts of interest. The study was supported by non-U.S. government funding.
The easy way to misread this
Do not interpret a negative neurodynamic test as evidence that the median nerve is healthy. This study shows that patients with negative tests often have worse small-fiber sensory loss than those with positive tests, meaning the test result reflects a specific type of dysfunction rather than the absence of disease.