Median nerve stiffness with three movement sequences of the upper limb neurodynamic test 1: An ultrasound shear-wave elastography study

• Published in: Musculoskeletal science & practice Vol. 75; p. 103221
• Main Authors: Ciuffreda, Gianluca, Estébanez-de-Miguel, Elena, Albarova-Corral, Isabel, Malo-Urriés, Miguel, Shacklock, Michael, Montaner-Cuello, Alberto, Bueno-Gracia, Elena
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2025
• Subjects: Adult; Biomechanics; Cross-Sectional Studies; Elasticity Imaging Techniques - methods; Elastography; Female; Humans; Male; Median nerve; Median Nerve - diagnostic imaging; Median Nerve - physiology; Middle Aged; Movement - physiology; Neurodynamic test; Physical Medicine and Rehabilitation; Upper Extremity - diagnostic imaging; Upper Extremity - physiology; Young Adult; Biomechanics; Neurodynamic test; Elastography; Median nerve
• ISSN: 2468-7812; 2468-7812
• DOI: 10.1016/j.msksp.2024.103221

During the Upper Limb Neurodynamic Test 1 (ULNT1) joint movement order can be varied to improve its diagnostic accuracy. However, nerve behavior with neurodynamic sequences still requires in vivo research. To quantify differences in median nerve (MN) stiffness measuring shear-wave velocity (SWV) with ultrasound elastography during three sequences of the ULNT1. Cross-sectional study. MN SWV was measured in 35 asymptomatic subjects at the wrist and elbow at the initial and final position (P1) of the standard (ULNT1-STD), proximal-to-distal (ULNT1-PROX) and distal-to-proximal (ULNT1-DIST) sequences of the ULNT1. Significantly different increases at P1 in nerve stiffness occurred between sequences and locations (p < 0.001). At the wrist, the ULNT1-PROX produced the smallest increase (44.32% ± 44.06, SWV: 4.49 ± 0.95 m/s), the ULNT1-STD produced a larger increase (82.13% ± 45.36, SWV: 5.67 ± 0.79 m/s, p < 0.001) and the ULNT1-DIST produced the largest (92.90% ± 55.37, SWV: 5.97 ± 0.79 m/s, p < 0.001). Differences between the ULNT1-DIST and ULNT1-STD did not reach significance. At the elbow, the ULNT1-PROX showed a 119.92% ± 53.51 increase (SWV: 4.08 ± 0.84 m/s), the ULNT1-DIST a 134.84% ± 53.83 (SWV: 4.34 ± 0.77 m/s), and the ULNT1-STD a 113.30% ± 59.28 (SWV: 3.98 ± 1.04 m/s). No significant differences were found among the sequences. The ULNT1-STD and ULNT1-DIST showed greater increases at MN stiffness at the wrist compared to the ULNT1-PROX. This supports a basis for future investigation of the mechanisms of neurodynamic testing in which emphasizing anatomical locations for improving diagnostic efficacy might be applied. •Median nerve stiffness was influenced by the sequence during neurodynamic testing.•Standard and distal-to-proximal sequences showed greater SWV values at the wrist.•All ULNT1 sequences resulted in a similar SWV at the elbow.•Sequencing may focus load in the nerve portion located near the first joint moved.•Caution should be taken to extend these results to pathological condition.