Diagnostic accuracy of neurodynamic tests in upper-limb entrapment neuropathies: A systematic review and meta-analysis

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice Pub Date : 2025-03-22 DOI:10.1016/j.msksp.2025.103317

Daniel Albert-Lucena , Marcos José Navarro-Santana , María José Díaz-Arribas , Gabriel Rabanal-Rodríguez , Juan Antonio Valera-Calero , César Fernández-de-las-Peñas , Chad Cook , Gustavo Plaza-Manzano

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引用次数: 0

Abstract

Background

Upper-limb neurodynamic tests are commonly used to diagnose neuropathies in this area, including cervical radiculopathy and carpal tunnel syndrome, although their diagnostic accuracy remains uncertain across different conditions and criteria.

Objective

To assess the diagnostic accuracy of upper-limb neurodynamic tests and their variations and criteria for upper-limb entrapment neuropathies.

Methods

A systematic review with meta-analysis was conducted in different databases (for their inception in February 2025), including studies evaluating the diagnostic accuracy of these tests. Sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratios, diagnostic accuracy and the area under the curve (AUC) were calculated using a bivariate and univariate meta-analysis. The quality of evidence was evaluated using the GRADE approach, and meta-regression was performed to examine the influence of diagnostic criteria.

Results

Twelve studies were included. Likelihood ratios for neuropathic pain conditions were LR+:1.65 and LR-:0.57, for cervical radiculopathy were LR+:2 and LR-:0.47, and for carpal tunnel syndrome were LR+:1.45 and LR-:0.66. The upper-limb neurodynamic test 2A showed the highest diagnostic accuracy (AUC: 0.76), with LR+:2.59 and LR-:0.42 for cervical radiculopathy, while test 3 had the highest specificity (0.92; LR+:7, LR-:0.48). Diagnostic accuracy for carpal tunnel syndrome was lower (AUC: 0.62). Meta-regression showed significant diagnostic criteria interaction, favoring structural differentiation maneuvers (p = 0.002).

Conclusion

Upper-limb neurodynamic tests show moderate sensitivity and low to moderate specificity for diagnosing upper-limb entrapment neuropathies, with diagnostic accuracy varying across conditions. The certainty of evidence ranges from very low to moderate, emphasizing the need for cautious clinical interpretation. Diagnostic reference criteria significantly influence test performance.

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来源期刊

Musculoskeletal Science and Practice Health Professions-Physical Therapy, Sports Therapy and Rehabilitation

CiteScore

4.10

自引率

8.70%

发文量

152

审稿时长

48 days

期刊介绍： Musculoskeletal Science & Practice, international journal of musculoskeletal physiotherapy, is a peer-reviewed international journal (previously Manual Therapy), publishing high quality original research, review and Masterclass articles that contribute to improving the clinical understanding of appropriate care processes for musculoskeletal disorders. The journal publishes articles that influence or add to the body of evidence on diagnostic and therapeutic processes, patient centered care, guidelines for musculoskeletal therapeutics and theoretical models that support developments in assessment, diagnosis, clinical reasoning and interventions.