The influence of scapular depression on upper limb neurodynamic test responses

Abstract

Objectives

Upper limb neurodynamic testing (ULNT) can be used clinically to assist in identifying neural tissue involvement in patients with upper quarter pain and dysfunction. Consideration for scapular positioning is a crucial component of ULNT standardization, as variations in positioning may dramatically impact sensory and motor responses. This study aimed to determine if there was a meaningful difference in test outcomes when the ULNT was performed in alternative scapular positions.

Methods

This cross-sectional study included 40 asymptomatic individuals. Repeated ULNT testing was performed on the dominant limb with the scapula blocked in neutral (ULNTb) and in scapular depression (ULNTd). Sensory responses, muscle activity, and range of motion outcomes were compared between the two test variations.

Results

Pre-positioning in scapular depression (ULNTd) led to reduced elbow extension range of motion, provoked greater upper trapezius muscle activity and an earlier onset and broader area of sensory responses compared to ULNTb.

Discussion

During ULNTb, the limbs were taken further into range and elicited reduced muscle activation and more localized sensory response providing a less vigorous version of the test. This study demonstrates that scapular positioning has a meaningful impact on ULNT test outcomes in healthy, asymptomatic individuals. The ULNTd can be considered a more vigorous version that may be appropriate when the cervical motions commonly utilized for structural differentiation are limited or contraindicated.     

Therapeutic heat and cold around the elbow on the response of median neurodynamic test 1

Objective

To compare the effects of the application of therapeutic heat and cold on the mechanical response of the median nerve neurodynamic testing.

Safety of lower extremity neurodynamic exercises in adults with diabetes mellitus: a feasibility study

Objectives: Neurodynamic exercises aim to improve neural mechanosensitivity in order to promote pain-free movement and function. People with diabetes mellitus (DM) may be candidates for neurodynamic exercises to address common DM-related impairments such as reduced lower extremity range of motion (ROM) and altered neural mechanosensitivity. However, no studies have examined the safety and immediate effects of neurodynamic exercise in people with DM. This study aims to determine the feasibility of applying neurodynamic exercises in adults with DM by evaluating the rate of adverse events and quantifying immediate changes in straight leg raise (SLR) ROM.

Methods: This quasi-experimental study included 20 people with DM who performed a series of neurodynamic exercises on their right leg. Their left leg was used as an internal control. SLR testing was performed before and immediately after these exercises. Adverse events were monitored, including provocation of their neuropathy symptoms or discomfort or pain.

Results: All participants completed the neurodynamic exercises without provocation of their neuropathy symptoms. No pain was reported and only one participant had minor discomfort with one exercise; a <30-s calf cramp. The right SLR ROM increased by an average of 5.2°–5.3° (p < 0.01) with no change on the left.

Discussion: This study demonstrated that lower extremity neurodynamic exercises are safe in adults with DM and may create small immediate improvements in SLR testing. Further research is indicated to investigate the safety and efficacy of neurodynamic exercises performed over multiple sessions.

Level of evidence: 3b     

The immediate effect of osteopathic cervical spine mobilization on median nerve mechanosensitivity: A triple-blind,randomized, placebo-controlled trial

Background

Neurodynamics is a clinical medium for testing the mechanical sensitivity of peripheral nerves which innervate the tissues of both the upper and lower limb. Currently, there is paucity in the literature of neurodynamic testing in osteopathic research, and where there is research, these are often methodologically flawed, without the appropriate comparators, blinding and reliability testing.

Analysis of the influence of rotator cuff impingements on upper limb kinematics in an elderly population during activities of daily living

Background

Despite a high prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on how this injured population adapts to perform tasks of daily living. The current study investigated the influence of rotator cuff impingements in this population on kinematics and shoulder loading differences, while completing activities of daily living.

Methods

Upper limb and trunk movement was measured for thirteen asymptomatic elderly and ten elderly subjects with rotator cuff impingements during five range of motion tasks and six activities of daily living. Thoracohumeral kinematics was derived from this data.

Findings

Symptomatic populations showed significantly decreased ranges of flexion/extension, abduction and internal and external rotation when compared to the asymptomatic population. The asymptomatic population had a 44% larger range of angle of elevation than the symptomatic population. Task was found to be a main effect for most variables examined including angle of elevation. Participants with impingements had significantly lower ranges of humeral rotations during the tasks with ranges of 40° (SD 40°) and 51° (SD 36°) respectively. Perineal care, hair-combing and reaching tasks were the most demanding in terms of the required range of motion. The reaching tasks resulted in the highest shoulder moment.

Interpretation

Developing adaptations for perineal care, hair-combing and reaching tasks should be prioritized when working with persons with rotator cuff impingements, as these tasks demanded the largest ranges of motion while producing high shoulder moments. Substantial differences existed between the experimental groups for a number of kinematic measures.     

A simplified version of the weight-bearing ankle lunge test: Description and test–retest reliability

The purpose of this study was twofold: (1) to describe a new version of the weight-bearing ankle lunge test (WBLT) that is simple to administer, that allows clinicians and sports medicine practitioners to directly assess (in degrees) the ankle dorsiflexion range of motion in a very short period of time while adopting a comfortable testing position; as well as (2) to determine the test–retest reliability of the ankle dorsiflexion range of motion measure obtained from the new version of the WBLT. A total of 50 active adults completed this study. All participants performed the new version of the WBLT on three different occasions, with a two-week interval between testing sessions. Reliability was examined through the change in the mean between consecutive pairs of testing sessions (ChM), standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC₉₅), and intraclass correlation coefficient (ICC_2,k). The findings showed negligible or trivial ChM values for all the flexibility measures analysed (<1°). Furthermore, the SEM and MDC₉₅ scores for the ankle dorsiflexion measure were 1.3 and 3.8 respectively, and the ICC_2k was 0.95. Therefore, this study demonstrated that the ankle dorsiflexion measure obtained from the new version of the WBLT has excellent test–retest reliability scores. Thus, an observed change larger than 3.8° from baseline scores after performing a treatment would indicate that a real change in ankle dorsiflexion range of motion was likely.     

The effects of neurodynamic straight leg raise treatment duration on range of hip flexion and protective muscle activity at P1

Study design: Randomized, single blind, same subject crossover trial.

Objectives: To compare the effects of two neurodynamic treatment doses on range of hip flexion (ROM HF) and electromyographic (EMG) activity of semitendinosus, at first onset of pain (P1).

Methods: A total of 26 healthy participants without low back or leg pain received each treatment in a random order with at least 48 hours between sessions. Baseline ROM HF and EMG magnitude of semitendinosus at P1 were collected. Subjects then received either 361 or 362 minutes of oscillating end of range (grade IVz) straight leg raise (SLR) neurodynamic treatment and were re-assessed for baseline measures.

Results: There was no significant difference between groups in EMG magnitude (P50.190) and ROM HF (P50.739) at P1. There was also no significant difference within groups in EMG magnitude at P1 (P50.182); however, there was a significant improvement in ROM HF at P1 in both groups compared to baseline readings (P50.000), with increases of 6.7u and 5.1u for the 361- and 362-minute groups, respectively.

Conclusion: Findings indicate that 362 minutes of oscillating grade IVz SLR neurodynamic treatment has no additional benefit over 361 minute, on ROM HF or EMG magnitude of semitendinosus at P1. Using an oscillating SLR treatment may, however, help to increase pain-free ROM HF, although further studies are necessary to confirm this.     

Reliability and smallest real difference of the ankle lunge test post ankle fracture

This study aimed to determine the reliability and the smallest real difference of the Ankle Lunge test in an ankle fracture patient population.In the post immobilisation stage of ankle fracture, ankle dorsiflexion is an important measure of progress and outcome. The Ankle Lunge test measures weight bearing dorsiflexion, resulting in negative scores (knee to wall distance) and positive scores (toe to wall distance), for which the latter has proven reliability in normal subjects only.A consecutive sample of ankle fracture patients with permission to commence weight bearing, were recruited to the study. Three measurements of the Ankle Lunge Test were performed each by two raters, one senior and one junior physiotherapist. These occurred prior to therapy sessions in the second week after plaster removal. A standardised testing station was utilised and allowed for both knee to wall distance and toe to wall distance measurement.Data was collected from 10 individuals with ankle fracture, with an average age of 36 years (SD 14.8). Seventy seven percent of observations were negative. Intra and inter-rater reliability yielded intra class correlations at or above 0.97, p < .001. There was a significant systematic bias towards improved scores during repeated measurement for one rater (p = .01). The smallest real difference was calculated as 13.8 mm.The Ankle Lunge test is a practical and reliable tool for measuring weightbearing dorsiflexion post ankle fracture.     

The effect of a Hatha Yoga practice on hamstring flexibility

PurposeTo determine the effect of a 7-week Hatha yoga intervention on hamstrings flexibility using a digital goniometer. It was hypothesized that hamstring flexibility will increase in a young healthy adult population.MethodsThirty-one college-aged males and females (Mage= 21 ± 2.62) years participated in 110 minutes twice per week for a 7-week progressive yoga intervention. Pre and post-test measurements were taken to determine hamstring flexibility on the right and left leg using a digital goniometer.ResultsA paired samples t-test indicated a significant difference in the pre and post-test on hamstring flexibility (p < .05). Results for the right leg pre-test (t(30) = -6.64, p <0.05, 95% CI (-6.14, -3.25), d = 0.77. p < 0.05 as well as a significant difference in the left pre and post-ROM (t(30) = -6.93, p <0.05, 95% CI (-2.97, -6.79), d = 0.52, p < 0.05 indicated an improvement after the intervention. Average range of motion increase was 4 degrees in both legs.ConclusionHamstring flexibility can be improved with a progressive 7-week Hatha yoga session and may be used as a modality to improve flexibility and function in activities of daily living as well and athletic performance.     

The influence of hip abduction and external rotation on sacroiliac motion

Although the sacroiliac joint (SIJ) is conventionally accepted as a sagittal joint with little mobility in other planes, recent research has shown evidence for reduced hip abduction and axial rotation in patients with sacroiliac pain. A sample of healthy individuals was investigated to determine whether innominate motion about the sacroiliac joint can be predicted from abduction and external rotation displacement of the femur. The motion of the innominate and femur were tracked as the hip was passively rotated by standardized increments of 10° into (1) abduction; (2) external rotation; and (3) a combination of external rotation and abduction. Although sagittal and transverse plane innominate motion both increased significantly as the hip was rotated further into either abduction or external rotation, external rotation was the strongest predictor of change in innominate angle. A combination of external rotation and abduction led to greater increases in these innominate angles at a smaller degree of hip rotation. The results support the use of abduction and external rotation hip displacements (both singularly and in combination) for assessing SIJ mobility at least in the axes investigated. Further research that investigates the use of these tests in people with SIJ disorders is warranted.     

Range of motion in the upper and lower cervical spine in people with chronic neck pain

Reduced cervical range of motion (ROM) is a common finding in people with neck pain. With few exceptions, only the angle between head and thorax has been measured. Our aim was to use an extended model to compare active cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic non-traumatic neck pain and controls. We also investigated associations between ROM measures, symptoms and self-rated functioning.In this cross-sectional study, 102 subjects with neck pain and 33 healthy controls participated. An electromagnetic tracker system was used to measure the kinematics to construct a three-segment model including the thorax, cervical spine and head. Neutral flexion/extension were defined at subjects’ self-selected seated posture.We found that in the neck pain group, extension in the upper cervical levels and predominately flexion for the lower levels were reduced. The ratio between ROM for the upper and lower levels was altered in the neck pain group so that the lower levels contributed to a lesser extent to the total sagittal ROM compared to controls. These findings could not be explained by a greater forward head posture but must have other origins. For the neck pain group, ROM measures were weakly associated to pain and self-rated functioning. Altogether, this implies that using a three-segment model for assessment of ROM can be a valuable improvement for characterisation of patients and treatment evaluation.     

上肢康复操在维持性血液透析患者中的应用研究

目的 评价上肢康复操在维持性血液透析患者中的应用效果。 方法 选取2021年10月—12月于山东省某三级甲等医院血液净化中心行维持性血液透析治疗的患者77例,按随机数字表分为试验组38例和对照组39例,试验组在常规护理的基础上进行上肢康复操训练,对照组只接受常规护理。分别比较干预前和干预3个月后两组的双手握力、肩关节活动度、动静脉内瘘血流量及非内瘘侧头静脉直径。 结果 试验组36例、对照组38例完成研究。干预前两组双手握力、肩关节活动度、动静脉内瘘血流量及非内瘘侧头静脉直径比较,差异无统计学意义（P>0.05）;干预后试验组与对照组比较,内瘘侧握力（t=-2.350,P=0.022）、非内瘘侧握力（t=-3.693,P<0.001）,内瘘侧肩关节外展（t=-2.468,P=0.016）、外旋（t=-5.167,P<0.001）、内旋（t=-2.059,P=0.043）,动静脉内瘘血流量（t=-2.020,P=0.047）、非内瘘侧头静脉直径（t=-5.229,P<0.001）均增加,差异具有统计学意义。 结论 上肢康复操训练有助于改善维持性血液透析患者的上肢功能及维护动静脉内瘘。     

The flexion–rotation test performed actively and passively: a comparison of range of motion in patients with cervicogenic headache

Limitation in cervical spine range of motion (ROM) is one criterion for diagnosis of cervicogenic headaches (CHs). The flexion–rotation test, when performed passively (FRT-P), has been shown to be a useful test in diagnosis of CH. Few investigations have examined the flexion-rotation test when performed actively (FRT-A) by the individual, and no studies have examined the FRT-A in a symptomatic population. The purpose of this study was to compare ROM during the FRT-A and FRT-P in patients with CH and asymptomatic individuals and to compare ROM between sides for these two versions of the test. Twelve patients with CH and 10 asymptomatic participants were included in the study. An eight-camera Motion Analysis system was used to measure head motion relative to the trunk during the FRT-P and the FRT-A. Cervical rotation ROM was measured in a position of full cervical flexion for both tests. No significant difference was observed between right and left sides for cervical rotation ROM during the FRT-P nor the FRT-A when performed by asymptomatic participants. In patients with CH, a significant difference was observed between sides for the FRT-P (P = 0.014); however, the FRT-A failed to reveal bilateral descrepancy in rotation ROM.     

膝关节功能障碍的综合康复疗效分析

目的：研究保守治疗膝关节功能障碍的临床疗效。方法：对３１例膝关节功能障碍患者进行关节功能牵引、肌力训练、关节内注射和理疗等综合治疗。结果：关节活动度治疗有效率９０．３％,肌力训练有效率６７．７％。结论：对于膝关节功能障碍采用保守治疗仍能取得一定的疗效。等速训练可能有助于扩大关节活动度。