Background

Upper limb neurodynamic tests (ULNT) are used to diagnose neuropathic conditions such as cervical radiculopathy (CR). Within the literature, a positive ULNT is defined in markedly variable ways, which is likely why the diagnostic accuracy of these tests lacks consistency across studies.

Objectives

To determine the diagnostic accuracy of single and combined upper limb neurodynamic tests ((ULNT)1,2a, 2b and 3) for cervical radiculopathy using test findings that are similar to those used in practice.

Design

Diagnostic accuracy study (prospective) design following the updated STARD 2015 reporting guideline.

Method

From 109 consecutively enrolled individuals with suspected CR. Of the 85 participants included, 27 (31.7%) were diagnosed with CR (mean age, 43.9years; Neck Disability Index 38,16%). ULNTs test were performed by a blind examiner to a CR reference standard of clinical diagnosis and magnetic resonance imaging verification provided by a neurosurgeon.

Results

In general, the single tests were better at ruling in CR versus ruling out. Of the single ULNT, the ULNT3 demonstrated the strongest post-test probability change with a positive finding (73.28%). Three of four test combinations demonstrated the highest clinical utility for changing the post-test probability with a positive finding at 83.29% and with LR+ = 12.89 (95%CI: 3.10–53.62). Having none of the test's positive was able to rule out CR with LR- = 0.08 (95%CI: 0.01–0.56).

Conclusion

ULNTs fail to significantly alter post-test probability when used singularly for diagnosis of CR. However, combinations of ULNT (3 out of 4 positive) can rule in CR, and rule out CR when all ULNT are negative.

中文翻译：

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上肢神经动力学检查在神经根型颈椎病诊断中的诊断准确性

背景

上肢神经动力学测试 (ULNT) 用于诊断神经病变，例如神经根型颈椎病 (CR)。在文献中，阳性 ULNT 的定义方式差异很大，这可能是这些测试的诊断准确性在不同研究中缺乏一致性的原因。

目标

使用与实践中使用的测试结果相似的测试结果，确定单次和组合上肢神经动力学测试（（ULNT）1、2a、2b 和 3）对神经根型颈椎病的诊断准确性。

设计

遵循更新后的 STARD 2015 报告指南的诊断准确性研究（前瞻性）设计。

方法

来自 109 名连续登记的疑似 CR 的个体。在包括的 85 名参与者中，27 名 (31.7%) 被诊断为 CR（平均年龄，43.9 岁；颈部残疾指数 38.16%）。ULNTs 测试由盲检员根据神经外科医生提供的临床诊断和磁共振成像验证的 CR 参考标准进行。

结果

一般而言，与排除相比，单项测试更擅长判定 CR。在单个 ULNT 中，ULNT3 表现出最强的测试后概率变化，并具有阳性结果 (73.28%)。四种测试组合中的三种证明了改变测试后概率的最高临床效用，阳性结果为 83.29%，LR+ = 12.89（95%CI：3.10–53.62）。没有任何测试阳性能够排除 CR，LR- = 0.08 (95% CI: 0.01–0.56)。

结论

当单独用于 CR 诊断时，ULNT 无法显着改变测试后概率。但是，ULNT 的组合（4 个正中的 3 个）可以排除 CR，并在所有 ULNT 为负时排除 CR。