Bei neuromuskuloskelettalen Schmerzen gehören neurodynamische Tests zur physiotherapeutischen Standarduntersuchung. Oftmals aber werden sie falsch interpretiert. Tatsächlich eignen sie sich weder für die Diagnostik einer Nervenläsion, noch attestieren sie eine Verkürzung oder verminderte Gleitfähigkeit eines Nervs. Ein Update zum aktuellen Wissensstand zur Neurodynamik rückt diese und andere Missverständnisse ins rechte Licht. Dreh- und Angelpunkt ist die erhöhte neurale Mechanosensitivität.
The aim of this study was to investigate, using quantitative sensory testing (QST) parameters and the painDETECT (PD-Q) screening questionnaire, the presence of neuropathic pain (NeP) in patients with unilateral painful cervical radiculopathy (CxRAD) and in patients with unilateral nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP).All patients completed the PD-Q before QST. QST was performed bilaterally in the maximal pain area and the affected dermatome in 23 patients with painful C6 or C7 radiculopathy and in 8 patients with NSNAP following a C6/7 dermatomal pain distribution.Patients with CxRAD demonstrated a significant loss of sensory function in mechanical (P≤0.021) and vibration sense (P≤0.003) on the symptomatic side compared with the asymptomatic side in both tested body regions and in the dermatome reduced cold detection (P=0.021) and pressure pain sensitivity (P=0.005), findings consistent with nerve root damage. These sensory alterations in the maximal pain area/symptomatic side are confirmative for the presence of NeP. In contrast to these QST data, only 30% of patients with CxRAD demonstrated a NeP component according to the PD-Q score. In patients with NSNAP, a significant side-to-side difference was demonstrated for warm detection threshold in the dermatome (P=0.030). The PD-Q score indicated that NeP components were unlikely in this group.QST data suggest that NeP is likely to be observed in patients with painful CxRAD, but not in patients with NSNAP.
The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal pain area, the corresponding dermatome and foot of 23 patients with painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal pain distribution, 31 HC and 22 patients with FM. For both neck-arm pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection P<.009) in the maximal pain area and dermatome (thermal detection, vibration detection, pressure pain sensitivity P<.04), consistent with peripheral neuronal damage. Both neck-arm pain groups demonstrated increased cold sensitivity in their maximal pain area (P<.03) and the foot (P<.009), and this was also the dominant sensory characteristic in patients with NSNAP. Both neck-arm pain groups differed from patients with FM, the latter characterised by a widespread gain of function in most nociceptive parameters (thermal, pressure, mechanical pain sensitivity P<.027). Despite commonalities in pain characteristics between the 2 neck-arm pain groups, distinct sensory profiles were demonstrated for each group.
Entrapment neuropathies are the most prevalent type of peripheral neuropathy and often a challenge to diagnose and treat. To a large extent, our current knowledge is based on empirical concepts and early (often biomechanical) studies. This Viewpoint will challenge some of the current beliefs with recent advances in both basic and clinical neurosciences. J Orthop Sports Phys Ther 2018;48(2):58–62. doi:10.2519/jospt.2018.0603
Background: Lumbar discectomy is considered a safe, efficacious and cost-effective treatment for selected cases of patients with leg pain associated with the presence of a disc protrusion. But despite technically successful surgery, 30 % of patients complain of persistent pain on long-term follow up. Identification of possible predictors for a negative outcome is important, in the search for appropriate pre- and/or post-operative care and prevention of persistent disability. There is some evidence in the literature that quantitative sensory testing (QST) measures may play a role in prediction of patients’ pain persistency, however, this has never been investigated in patients undergoing lumbar discectomy.
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