EMG at Performing ULTN 1 in Breast Cancer Patients
Condition: Physiotherapy
Study type: Interventional

Summary: 
      Upper limb neural mechanosensitivity is a painful disturbance that breast cancer patients
      often undergo following axillary surgery. It is assessed by the upper limb neurodynamic test
      for the median nerve, called upper limb neurodynamic test 1 (ULNT1). Design: A matched
      case-control observational study. Objective: to check the increased upper limb
      mechanosensitivity by shoulder range of motion (ROM) during ULNT1 and to determine, for the
      first time, the evoked electromyographic (EMG) muscle activity. Participants: 62 cases who
      underwent breast cancer surgery and 64 matched control women. Setting: Torrejon Hospital,
      Physical Therapy Department, Madrid (Spain). Intervention: To record EMG muscle activity
      during ULNT1 performance and to measure shoulder ROM. Key outcomes: mechanosensitivity,
      breast cancer, pain, EMG, shoulder ROM, median nerve.
    

Detailed description: 
      Upper limb neural mechanosensitivity is a painful disturbance that breast cancer patients
      often undergo following axillary surgery. It is assessed by the upper limb neurodynamic test
      for the median nerve, called upper limb neurodynamic test 1 (ULNT1).A neural provocation test
      is a sequence of movements designed to assess the mechanics and physiology of part of the
      nervous system by elongating the length of the nerve bedding and by increasing the pressure
      in and around the peripheral nerve .The most reliable test to assess the upper limb neural
      mechanosensitivity is the neural provocation test for the median nerve, called upper limb
      neurodynamic test 1 (ULNT1). This test consists of depressing shoulder girdle in a neutral
      position, shoulder abduction and lateral rotation, elbow extension, forearm supination and
      wrist extension. Cervical contralateral lateral flexion may be included to further increase
      the loading of the brachial plexus and, as a sensitizing maneuver, to differentiate
      structurally between neural and non-neural involvement. The ULNT1 is considered as positive
      when symptoms are reproduced on affected upper limb, or side-to-side differences in ROM, or
      symptoms modified by lateral neck side-bending. Likewise, It is also necessary to assess the
      EMG activity of the involved muscles to verify the early and increased protective muscle
      response suggested throughout the neural strain performance.

      It is also necessary to assess the EMG activity of the involved muscles to verify the early
      and increased protective muscle response suggested throughout the neural strain performance.
      Design: A matched case-control observational study. Objective: to check the increased upper
      limb mechanosensitivity by shoulder ROM during ULNT1 and to determine, for the first time,
      the evoked EMG muscle activity. Participants: 62 cases who underwent breast cancer surgery
      and 64 matched control women. Setting: Torrejon Hospital, Physical Therapy Department, Madrid
      (Spain). Intervention: To record EMG muscle activity during ULNT1 performance and to measure
      shoulder ROM. Key outcomes: mechanosensitivity, breast cancer, pain, EMG, shoulder ROM,
      median nerve.
    

Intervention name(s): ULNT 1 and EMG recording
Intervention type(s): Other
Intervention description(s): While the ULNT 1 was performing, EMG muscle activity form biceps brachii and triceps brachii were recorded. The maneuver was stopped to measure abduction, external rotation and elbow flexion range of motion (ROM) with a goniometer. Three measurements were performed: measure 1) when the first sense of tightness perceived by the subject appeared; measure 2) when evoked muscle activity increased on EMG record; measure 3) when sense of final resistance perceived by the investigator appeared. Considering the increase of symptoms with contralateral or decrease of symptoms with ipsilateral cervical side bending as mandatory positivity criterion.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Diagnostic
Keywords: Nerve Pain; Electromyography; Median Nerve; Breast Neoplasms