Neurodynamik: Wissensstand und Missverständnisse

Brigitte Tampin; Annina Schmid

doi:10.1055/a-2349-0552

MSK – Muskuloskelettale Physiotherapie, Table of Contents

MSK – Muskuloskelettale Physiotherapie 2024; 28(04): 253-263
DOI: 10.1055/a-2349-0552

CPTE-Fortbildung

Neurodynamik: Wissensstand und Missverständnisse

Brigitte Tampin

,

Annina Schmid

Abstract

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.

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References

Literatur
1 Jensen TS, Baron R, Haanpää M. et al. A new definition of neuropathic pain. Pain 2011; 152: 2204-2205
2 Allison GT, Nagy BM, Hall TM. A randomised clinical trial of manual therapy for cervico-brachial pain syndrome: a pilot study. Man Ther 2002; 7: 95-102
3 Elvey RL. Physical evaluation of the peripheral nervous system in disorders of pain and dysfunction. J Hand Ther 1997; 10: 122-129
4 Hall TM, Elvey RL, Davies N. et al. Efficacy of manipulative physiotherapy for the treatment of cervicobrachial pain. In: Australia MPAo ed, Tenth Biennial Conference of the Manipulative Physiotherapists Association of Australia. Melbourne: Manipulative Physiotherapists Association of Australia; 1997: 73-74
5 Dilley A, Lynn B, Pang SJ. Pressure and stretch mechanosensitivity of peripheral nerve fibres following local inflammation of the nerve trunk. Pain 2005; 117: 462-472
6 Marchettini P, Lacerenza M, Mauri E. et al. Painful peripheral neuropathies. Curr Neuropharmacol 2006; 4: 175-181
7 Bennett GJ. Can we distinguish between inflammatory and neuropathic pain?. Pain Res Manag 2006; 11: 11-15
8 Coppieters MW, Stappaerts KH, Wouters LL. et al. The immediate effects of a cervical lateral glide treatment technique in patients with neurogenic cervicobrachial pain. J Orthop Sports Phys Ther 2003; 33: 369-378
9 Van der Heide B, Bourgoin C, Eils G. et al. Test-retest reliability and face validity of a modified neural tissue provocation test in patients with cervicobrachial pain syndrome. J Man Manip Ther 2006; 14: 30-36
10 Tampin B, Slater H, Briffa NK. Neuropathic pain components are common in patients with painful cervical radiculopathy, but not in patients with nonspecific neckarm pain. Clin J Pain 2013; 20: 846-856
11 Walsh J, Hall T. Reliability, validity and diagnostic accuracy of palpation of the sciatic, tibial and common peroneal nerves in the examination of low back related leg pain. Man Ther 2009; 14: 623-629
12 Horowitz SH. The diagnostic workup of patients with neuropathic pain. Med Clin North Am 2007; 91: 21-30
13 Harden N, Cohen M. Unmet needs in the management of neuropathic pain. J Pain Symptom Manage 2003; 25: 12-17
14 Baron R, Binder A, Wasner G. Neuropathic pain: Diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 2010; 9: 807-819
15 Böttger K, Tampin B, Ballenberger N. et al. Somatosensory profiles in patients with non specific neck arm pain with and without positive neurodynamic tests. 7th International Congress on Neuropathic Pain. 2019 London
16 Schäfer A, Hall T, Lüdtke K. et al. Inter-rater reliability of a new classification system for patients with neural low back related leg pain. J Man Manip Ther 2009; 17: 109-117
17 Owen JH, Kostuik JP, Gornet M. et al. The use of mechanically elicited electromyograms to protect nerve roots during surgery for spinal degeneration. Spine 1994; 19: 1704-1710
18 Smyth MJ, Wright V. Sciatica and the intervertebral disc: An experimental study. J Bone Joint Surg Am 1958; 40A: 1401-1418
19 Kuslich SD, Ulstrom CL, Cami JM. The tissue origin of low back pain and sciatica: A report of pain responses to tissue stimulation during operations on the lumbar spine using local anaesthesia. Orthop Clin North Am 1991; 22: 181-187
20 Eliav E, Benoliel R, Tal M. Inflammation with no axonal damage of the rat saphenous nerve trunk induces ectopic discharge and mechanosensitivity in myelinated axons. Neurosci Lett 2001; 311: 49-52
21 Bove GM, Ransil BJ, Lin HC. et al. Inflammation induces ectopic mechanical sensitivity in axons of nociceptors innervating deep tissues. J Neurophysiol 2003; 90: 1949-1955
22 Dilley A, Lynn B, Greening J. et al. Quantitative in vivo studies of median nerve sliding in response to wrist, elbow, shoulder and neck movements. Clin Biomech 2003; 18: 899-907
23 Amir R, Argoff CE, Bennett GJ. et al. The role of sodium channels in chronic inflammatory and neuropathic pain. J Pain 2006; 7: 1-29
24 Eliav E, Herzberg U, Ruda MA. et al. Neuropathic pain from an experimental neuritis of the rat sciatic nerve. Pain 1999; 83: 169-182
25 Quintner JL, Bove G. From neuralgia to peripheral neuropathic pain: evolution of a concept. Reg Anesth Pain Med 2001; 26: 368-372
26 Bove GM, Light AR. Unmyelinated nociceptors of rat paraspinal tissues. J Neurophysiol 1995; 73: 1752-1762
27 Bove GM, Light AR. The nervi nervorum – Missing link for neuropathic pain?. Pain Forum 1997; 6: 181-190
28 Sauer SK, Bove GM, Averbeck B. et al. Rat peripheral nerve components release calcitonin gene-related peptide and prostaglandine E2 in response to noxious stimuli: evidence that nervi nervorum are nociceptors. Neuroscience 1999; 92: 319-325
29 Schmid AB, Coppieters MW, Ruitenberg MJ. et al. Local and remote immune-mediated inflammation after mild peripheral nerve compression in rats. J Neuropathol Exp Neurol 2013; 72: 662-680
30 Schmid AB, Bland JD, Bhat MA. et al. The relationship of nerve fibre pathology to sensory function in entrapment neuropathy. Brain 2014; 137: 3186-3199
31 Tampin B, Slater H, Hall T. et al. Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain. Pain 2012; 153: 2403-2414
32 Tamburin S, Cacciatori C, Praitano ML. et al. Median nerve small- and large-fiber damage in carpal tunnel syndrome: A quantitative sensory testing study. J Pain 2010; 2010: 205-212
33 Tampin B. Neuropathischer Schmerz. physioscience 2014; 10: 161-168
34 Schmid A, Tampin B. Spinally referred back and leg pain. In: Boden SC (ed). Lumbar Spine Online Textbook. 2018. Im Internet (Stand: 29.11.2022) www.wheelessonline.com/issls/lumbar-spine-online-textbook
35 Chien A, Eliav E, Sterling M. Whiplash (Grade II) and cervical radiculopathy share a similar sensory presentation: An investigation using quantitative sensory testing. Clin J Pain 2008; 24: 595-603
36 Nee RJ, Vicenzino B, Jull GA. et al. Neural tissue management provides immediate clinically relevant benefits without harmful effects for patients with nerve-related neck and arm pain: A randomised trial. Journal of Physiotherapy 2012; 58: 23-31
37 Wolny T, Saulicz E, Linek P. et al. Efficacy of manual therapy including neurodynamic techniques for the treatment of carpal tunnel syndrome: A randomized controlled trial. J Manipulative Physiol Ther 2017; 40: 263-272
38 Elvey RL. The clinical relevance of signs of adverse brachial plexus tension. In: Proceedings of the International Federation of Orthopaedic Manipulative Therapists. Cambridge, United Kingdom: International Federation of Orthopaedic Manipulative Therapists; 1988: 14-20
39 Ginn K. An investigation of tension development in upper limb soft tissues during the upper limb tension test. In: International Federation of Orthopaedic Manipulative Therapists. Cambridge, United Kingdom. 1988: 25-28
40 Kleinrensink GJ, Stoeckart R, Vleeming A. et al. Mechanical tension in the median nerve. The effects of joint positions. Clin Biomech 1995; 10: 240-244
41 Wright TW, Glowczewskie F, Wheeler D. et al. Excursion and strain of the median nerve. J Bone Joint Surg Am 1996; 78-A: 1879-1903
42 Supik LR, Broom MJ. Sciatic tension signs and lumbar disc herniation. Spine 1994; 19: 1066-1069
43 Poore GV. Clinical lecture on certain conditions of the hand and arm which interfere with the performance of professional acts, especially piano-playing. Br Med J 1887; 441-444
44 Devillé WLJM, van der Windt DAWM, Dzaferagic A. et al. The test of Lasègue: Systematic review of the accuracy in diagnosing herniated discs. Spine 2000; 25: 1140-1147
45 Freynhagen R, Rolke R, Baron R. et al. Pseudoradicular and radicular low-back pain – A disease continuum rather than different entities. Answers from quantitative sensory testing. Pain 2008; 135: 65-74
46 Kobayashi S, Shizu N, Suzuki Y. et al. Changes in nerve root motion and intraradicular blood flow during an intraoperative straight-leg-raising test. Spine 2003; 28: 1427-1434
47 Samuelsson L, Lundin A. Thermal quantitative sensory testing in lumbar disc herniation. Eur Spine J 2002; 11: 71-75
48 Butler DS. The sensitive nervous system. Adelaide, Australia: Noigroup Publications; 2000
49 Shacklock M. Clinical Neurodynamics. Elsevier Butterworth Heinemann; 2005
50 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. Arch Phys Med Rehabil 2006; 87: 1412-1417
51 Sterling M, Treleaven J, Jull G. Responses to a clinical test of mechanical provocation of nerve tissue in whiplash associated disorders. Man Ther 2002; 7: 89-94
52 Wainner RS, Fritz JM, Irrgang JJ. et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003; 28: 52-62
53 Petty NJ, Moore AP. Neuromusculoskeletal examination and assessment. A handbook for therapists. 2nd ed. Edinburgh: Churchill Livingstone; 2001
54 Bragard K. Die Nervendehnung als diagnostisches Prinzip ergibt eine Reihe neuer Nervenphänomene. Munch Med Wochenschr 1929; 76: 1999-2003
55 Butler DS. Mobilisation of the nervous system. Melbourne: Churchill Livingstone; 1991
56 Elvey RL, Hall TM. Neural tissue evaluation and treatment. In: Donatelli RA, Hrsg. Physical Therapy of the Shoulder. New York: Churchill Livingstone; 1997: 131-152
57 Jepsen JR, Laursen LH, Hagert C-G. et al. Diagnostic accuracy of the neurological upper limb examination I: Inter-rater reproducibility of selected findings and patterns. BMC Neurol 2006; 16: 8
58 Schmid AB, Brunner F, Luomajoki H. et al. Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskeletal Disorders 2009; 10: 11
59 Vanti C, Conteddu L, Guccione A. et al. The Upper Limb Neurodynamic Test 1: Intra-and intertester reliability and the effect of several repetitions on pain and resistance. J Manipulative Physiol Ther 2010; 33: 292-299
60 Van den Hoogen HJ, Koes BW, Devillé W. et al. The inter-observer reproducibility of Lasègue‘s sign in patients with low back pain in general practice. Br J Gen Pract 1996; 46: 727-730
61 Van Dillen LR, Sahrmann SA, Norton BJ. et al. Reliability of physical examination items used for classification of patients with low back pain. Phys Ther 1998; 78: 979-988
62 Hall TM, Elvey RL. Nerve trunk pain: Physical diagnosis and treatment. Man Ther 1999; 4: 63-73
63 Nee RJ, Jull G, Vicenzino B. et al. The validity of upper-limb neurodynamic tests for detecting peripheral neuropathic pain. J Orthop Sports Phys Ther 2012; 42: 413-425
64 Hall T, Quintner J. Responses to mechanical stimulation of the upper limb in painful cervical radiculopathy. Aust J Physiother 1996; 42: 277-285
65 Sterling M, Treleaven J, Edwards S. et al. Pressure pain thresholds in chronic whiplash associated disorder: Further evidence of altered central pain processing. Journal of Musculoskeletal Pain 2002; 10: 69-81
66 Tampin B, Briffa NK, Hall T. et al. Inter-therapist agreement in classifying patients with cervical radiculopathy and patients with non-specific neck-arm pain. Man Ther 2012; 17: 445-450
67 Van der Windt DA, Simons E, Riphagen II. et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev 2010;
68 Van der Heide B, Bourgoin C, Eils G. et al. Untersuchung der klinischen Effektivität eines modifizierten neuralen Provokationtstests bei Patienten mit zervikobrachialen Schmerzen. physioscience 2005; 1: 19-25
69 Baselgia LT, Bennett DL, Silbiger RM. et al. negative neurodynamic tests do not exclude neural dysfunction in patients with entrapment neuropathies. Arch Phys Med Rehabil 2017; 98: 480-486
70 Boyd BS, Wanek L, Gray AT. et al. Mechanosensitivity during lower extremity neurodynamic testing is diminished in individuals with Type 2 Diabetes Mellitus and peripheral neuropathy: A cross sectional study. BMC Neurol 2010; 10: 75
71 Ellis R, Blyth R, Arnold N. et al. Is there a relationship between impaired median nerve excursion and carpal tunnel syndrome? A systematic review. J Hand Ther 2017; 30: 3-12
72 Ridehalgh C, Moore A, Hough A. Sciatic nerve excursion during a modified passive straight leg raise test in asymptomatic participants and participants with spinally referred leg pain. Man Ther 2015; 20: 564-569
73 Tuzuner S, Ozkaynak S, Acikbas C. et al. Median nerve excursion during endoscopic carpal tunnel release. Neurosurgery 2004; 54: 1155-1161
74 Attal N, Cruccu G, Baron R. et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010; 17: 1113-e1188
75 Baron R, Freynhagen R, Tölle TR. et al. The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain 2010; 150: 420-427
76 Saldaña MT, Navarro A, Pérez C. et al. Patient-reported-outcomes in subjects with painful lumbar or cervical radiculopathy treated with pregabalin: Evidence from medical practice in primary care settings. Rheumatol Int 2010; 30: 1005-1015
77 Bono CM, Ghiselli G, Gilbert TJ. et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J 2011; 11: 64-72
78 Leininger B, Bronfort G, Evans R. et al. Spinal manipulation or mobilization for radiculopathy: A systematic review. Phys Med Rehabil Clin N Am 2011; 22: 105-125
79 Nelson R, Hall T. Bilateral dorsal foot pain in a young tennis player managed by neurodynamic treatment techniques. Man Ther 2011; 16: 641-645
80 Salt E, Wright C, Kelly S. et al. A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. Man Ther 2011; 16: 53-65
81 Schäfer A, Hall T, Müller G. et al. Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: A prospective cohort study. Eur Spine J 2011; 20: 482-490
82 Ridehalgh C. Therapie von nervenbezogenen muskuloskelettalen Schmerzen. manuelletherapie 2020; 24: 15-20