An Experimental Pain Model to Investigate the Specificity of the Neurodynamic Test for the Median Nerve in the Differential Diagnosis of Hand Symptoms

Coppieters MW, Alshami AM, Hodges PW. An experimental pain model to investigate the specificity of the neurodynamic test for the median nerve in the differential diagnosis of hand symptoms. Objective: To indirectly assess the specificity of the neurodynamic test for the median nerve using an experimental pain model. Design: Repeated-measures design. Setting: Laboratory setting. Participants: Twenty asymptomatic participants in whom hand symptoms were induced by infusion of hypertonic saline into the thenar muscles. Interventions: Not applicable. Main Outcome Measures: Pain intensity of the induced hand symptoms and size of the painful area were evaluated in 8 different arm positions, which correspond with different stages of the neurodynamic test for the median nerve. These positions have a variable degree of median nerve provocation at the wrist. Results: Because the induced symptoms had a non-neural origin, changes in symptom provocation with the neurodynamic test would have indicated poor specificity. However, there were no statistically significant differences in pain perception (P≥.22) and the recorded differences were negligible from a clinical perspective. Conclusions: Taking into consideration the limitations of an experimental pain model, this study indirectly confirms the specificity of the neurodynamic test for the median nerve. The results of this study, together with previous studies that demonstrated a high sensitivity, support the use of the neurodynamic test for the median nerve to differentially diagnose neurogenic disorders, such as carpal tunnel syndrome, from other wrist and hand pathologies. © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.