Reliability and diagnostic accuracy of the peripheral nervous system palpation tests. A narrative review

Objectives Due to the use of increasingly large peripheral nervous system (PNS) palpation tests in clinical assessment, it becomes relevant for the modern physiotherapist, be aware of the reliability and validity of these tests. The aim of this narrative review is to investigate the repeatability and diagnostic accuracy of the peripheral nervous system palpation tests. Materials and methods Literature search has been carried out between September 2009 and December 2010 in electronic databases PubMed, EMBASE, CINAHL, PEDro and Cochrane Library. Following keywords have been used for research: ‘palpation’ [MeSH]; ‘peripheral nervous system’ [MeSH]; ‘spinal nerves’ [MeSH]. ‘Palpation nerve’, ‘neurodynamics’, ‘clinical examination’, ‘diagnostic testing’, ‘clinical tests’, ‘Tinel sign’ have been also used, because it was suggested by some analyzed articles. Research was conducted with no date restrictions and was limited to articles on adult subjects, in English and Italian languages. Results PNS palpation tests seem little investigated for its reliability, both for the validity. Most of the articles concern the Tinel‘s test. At the present, the inter-examiner reliability of PNS palpation tests is considered low to moderate. The diagnostic accuracy of the Tinel’s test in carpal tunnel syndrome appear unsatisfactory, particularly with regard to sensitivity. Conclusions This literature review has provided poor results, both for the little amount of scientific works, both in terms of reliability and validity of these tests. Research in this area should aim to standardize procedure and interpretation of palpation test. Finally, it should be interesting not only to investigate the accuracy of each diagnostic test, but also to study different clusters or combination of tests.