Diagnostic accuracy of neurodynamic tests in upper-limb entrapment neuropathies: A systematic review and...

Upper-limb neurodynamic tests are commonly used to diagnose neuropathies in this area, including cervical radiculopathy and carpal tunnel syndrome, although their diagnostic accuracy remains uncertain across different conditions and criteria.

To assess the diagnostic accuracy of upper-limb neurodynamic tests and their variations and criteria for upper-limb entrapment neuropathies.

A systematic review with meta-analysis was conducted in different databases (for their inception in February 2025), including studies evaluating the diagnostic accuracy of these tests. Sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratios, diagnostic accuracy and the area under the curve (AUC) were calculated using a bivariate and univariate meta-analysis. The quality of evidence was evaluated using the GRADE approach, and meta-regression was performed to examine the influence of diagnostic criteria.

Twelve studies were included. Likelihood ratios for neuropathic pain conditions were LR+:1.65 and LR-:0.57, for cervical radiculopathy were LR+:2 and LR-:0.47, and for carpal tunnel syndrome were LR+:1.45 and LR-:0.66. The upper-limb neurodynamic test 2A showed the highest diagnostic accuracy (AUC: 0.76), with LR+:2.59 and LR-:0.42 for cervical radiculopathy, while test 3 had the highest specificity (0.92; LR+:7, LR-:0.48). Diagnostic accuracy for carpal tunnel syndrome was lower (AUC: 0.62). Meta-regression showed significant diagnostic criteria interaction, favoring structural differentiation maneuvers (p = 0.002).

Upper-limb neurodynamic tests show moderate sensitivity and low to moderate specificity for diagnosing upper-limb entrapment neuropathies, with diagnostic accuracy varying across conditions. The certainty of evidence ranges from very low to moderate, emphasizing the need for cautious clinical interpretation. Diagnostic reference criteria significantly influence test performance.