Strength vs. endurance in myotome assessment-a case for (further studies on) repeated measurements.
Alexia Coulombe-Lévêque, Nicolas Dehors, René Pelletier and 3 others
PMID 41908174WHAT IT FOUND
In two patients with confirmed L5 radiculopathy, a single strength test missed weakness in one patient who only showed deficits after seven repeated contractions.
This suggests clinicians should use multiple trials when assessing myotome strength.
Key findings
01One patient showed immediate weakness, but the second patient had normal strength on the first trial and only showed a deficit after repeated measures.
02Both patients had significantly lower average strength in the affected limb compared to the healthy limb when all seven trials were considered.
03The authors suggest that clinical testing for myotome involvement should use multiple measurements rather than relying on a single strength test.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only two patients, so findings cannot be generalized to the broader population. It is unclear whether the delayed weakness in the second patient was due to true neuromuscular fatigue or simply random variability in strength scores. The results may not apply to other nerve roots or other muscle groups, as big toe extension is an awkward movement that may yield more variable data than elbow or knee tests. Confounding factors such as medication, comorbidities, and pain levels were not controlled for due to the small sample size.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that a lack of immediate weakness on a single strength test rules out radiculopathy. This paper describes two cases where repeated trials were necessary to detect deficits, but it does not prove that all patients with radiculopathy will show fatigue or delayed weakness.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →