UPPER LIMB NEURODYNAMIC DYSFUNCTION IN CERVICAL PAIN PATIENTS WITH AND WITHOUT REFERRED CERVICAL SYMPTOMS: A COMPARATIVE STUDY

van Bever Donker R.¹, Reddy P.¹, Diener I.²

¹University of KwaZulu-Natal, Physiotherapy, Durban, South Africa, ²University of Stellenbosch, Physiotherapy, Cape Town, South Africa

Background: Neck pain is common in workers around the world. Neck pain with neck related arm symptoms is more common than neck pain alone and has a significant association with disability. Neck related arm symptoms can be the result of mechanosensitive neural structures including the nerve roots or the peripheral nervous system. The peripheral nervous system has its own physiological response to injury or disruption. This response will cause the peripheral nerve affected to become mechanically sensitized to stretch and compression forces that would normally be tolerated. This sensitivity to stretch and compression forces is known as mechanosensitivity. Neurodynamic tests have been identified as an effective tool to determine the extent to which the mechanosensitivity of a nerve has affected its sensitivity to movement. Most studies focus on cadavers, asymptomatic subjects and neck and arm pain subjects, there are no studies, locally or globally, that determine whether there is a difference in the neurodynamics of subjects with neck pain and subjects with neck pain and NRAS.

Purpose: The purpose of this study is to establish neural mechanosensitivity of the brachial plexus in patients with neck pain without related arm symptoms in order to provide evidence based clinical rationale for the use of neurodynamic testing in these patients.
The objectives of this study:
1. To determine neural mechanosensitivity of the brachial plexus in patients with neck pain (group 1)
2. To determine neural mechanosensitivity of the brachial plexus in patients with neck pain and NRAS (group 2)
3. To determine neural mechanosensitivity of the brachial plexus in asymptomatic subjects (group 3)
4. To compare mechanosensitivity in group 1 to group 2 and group 3

Methods: A Quantitative comparative design was used with prospective cross-sectional sampling. The study population included participants who presented with no neck pain, neck pain alone and neck pain with NRAS who were attending the orthopaedic outpatients department/ physiotherapy departments at 2 hospitals. The ULNT1 was used as a measure for neural mechanosensitivity, and an electro-goniometer was used to measure elbow ROM. informed consent was sought prior to inclusion. The ULNT 1 was performed on both upper limbs of participants, and 2 readings taken for each upper limb; namely onset and tolerance. Data was captured on an excel spread-sheet, and analysed using SPSS v21. Confidence interval was set at 95% and statistical significance (p) 0.05.

Results: A one-way ANOVA was run for the differences in mean ranges between upper limbs for all three groups and found that the mean ranges were sufficiently different to gain statistical significance for the onset ROM (p=0.000) and the tolerance ROM (p=0.000).

Conclusion(s): The ULNT1 was found to be positive for decreased ROM of elbow extension in both the neck pain and neck with arm pain groups.

Implications: The ULNT1 has been demonstrated to accurately determine mechanosensitivity, the findings of this study support the notion that mechanosensitivity can be present in patients with and without referred symptoms to the arm, this information can assist the clinician in treatment planning to possibly include neural mobilisations.

Funding acknowledgements: School of Health Sciences UKZN

Topic: Musculoskeletal: upper limb

Ethics approval: Biomedical Research Ethics Committee of UKZN. Reference: BE063/13

All authors, affiliations and abstracts have been published as submitted.