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2015 Young Investigator Award Winner: Cervical Nerve Root Displacement and Strain During Upper Limb Neural Tension TestingPart 1 A Minimally Invasive Assessment in Unembalmed Cadavers

Lohman, Chelsea M., PhD, ATC, CSCS; Gilbert, Kerry K., PT, ScD; Sobczak, Stéphane, MPT, MO, PhD; Brismée, Jean-Michel, PT, ScD; James, C. Roger, PhD, FACSM; Day, Miles, MD; Smith, Michael P., PhD, ATC; Taylor, LesLee, PhD, LAT, ATC; Dugailly, Pierre-Michel, PhD; Pendergrass, Timothy, PT, ScD, MS, COMT; Sizer, Phillip J., PT, PhD, OCS, FAAOMPT

doi: 10.1097/BRS.0000000000000686
Cervical Spine
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Study Design. A cross-sectional cadaveric examination of displacement and strain measured at the level of the cervical nerve roots during upper limb neural tension testing (ULNTT) with median nerve bias.

Objective. To determine the displacement and strain of cervical nerve roots C5–C8 during ULNTT with minimal disruption of surrounding tissues.

Summary of Background Data. Clinical examination of neural pathology involving cervical nerve roots is difficult because of the transient nature of pathologies, such as cervical radiculopathy, entrapment neuropathies, and thoracic outlet syndrome. Cadaveric studies have demonstrated significant displacement and strain in lumbosacral nerve roots during neurodynamic testing of the lower extremity. Examination into the biomechanical behaviors of cervical nerve roots during ULNTT has not been performed.

Methods. Eleven unembalmed cadavers were positioned supine as though undergoing ULNTT. Radiolucent markers were implanted into cervical nerve roots C5–C8. Posteroanterior fluoroscopic images were captured at resting and ULNTT positioning. Images were digitized and displacement and strain were calculated.

Results. ULNTT resulted in significant inferolateral displacement (average, 2.16 mm–4.32 mm, P < 0.001) of cervical nerve roots C5–C8. There was a significant difference in inferolateral displacement between the C5 and C6 nerve roots (3.15 mm vs. 4.32 mm, P = 0.009). ULNTT resulted in significant strain (average, 6.80%–11.87%, P < 0.001) of cervical nerve roots C5–C8. There was a significant difference in strain between the C5 and C6 nerve roots (6.60% vs. 11.87%, P = 0.03).

Conclusion. ULNTT caused significant inferolateral displacement and strain in cervical nerve roots C5–C8. These results provide the mechanical foundation for the use of ULNTT in clinical evaluation of pathology in the cervical region, such as in cervical radiculopathy, entrapment neuropathies, and thoracic outlet syndrome.

Level of Evidence: 2

Upper limb neural tension testing (ULNTT) was performed on 11 unembalmed cadavers. Displacement and strain were measured in cervical nerve roots from C5 to C8. Significant inferolateral displacement and strain were observed during ULNTT, suggesting ULNTT may be a valuable clinical examination tool to evaluate cervical nerve root pathology.

*Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ

Center for Rehabilitation Research and Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, Lubbock, TX

Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Universite Libre de Bruxelles, Bruxelles, Belgium

§Department of Medical Education, Albany Medical College, Albany, NY; and

Research Unit in Osteopathy, Universite Libre de Bruxelles, Bruxelles, Belgium.

Address correspondence and reprint requests to Chelsea M. Lohman, PhD, ATC, CSCS, Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E Still Circle, Mesa, AZ 85206; E-mail: clohman@atsu.edu

Acknowledgment date: June 30, 2014. Revision date: September 24, 2014. Acceptance date: October 24, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Epimed International (grant no. 120116PR) funds were received in support of this work.

Relevant financial activities outside the submitted work: expert testimony, royalties.

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