Influence of shoulder external rotation on sensory responses to the upper limb neurodynamic test 1 in men and women with and without non-specific neck pain: a cross-sectional study.

Abstract

Objective: To compare symptom intensity and sensory characteristics evoked during the standard Upper Limb Neurodynamic Test 1 (ULNT1) and a modified version without shoulder external rotation in men and women with and without nonspecific neck pain (NSNP). Methods: A cross-sectional study including 110 participants (55 with NSNP and 55 asymptomatic controls; 28 women and 27 men in each group) was conducted. Both ULNT1 versions were performed bilaterally in randomized order. Symptom intensity (Numerical Rating Scale), sensation type, and location were recorded after each test. Data were analyzed using a linear mixed-effects model with aligned rank transformation considering group, sex, and test as fixed factors. Results: Participants with NSNP reported higher symptom intensity than asymptomatic controls in both ULNT1 versions (p < 0.001). The standard ULNT1 elicited higher intensity than the modified version (p < 0.05). No significant main effect of sex or interaction effects were observed. Pain sensations were more frequent in women with NSNP, whereas tingling predominated in men with NSNP. Thumb-related symptoms were more common in the NSNP group, while forearm sensations were more frequent among asymptomatic participants. Conclusion: Individuals with NSNP show greater symptom intensity and distinct sensory profiles during both the standard and modified ULNT1, consistent with increased neural mechanosensitivity. Shoulder external rotation slightly amplifies these responses but without clinically meaningful differences. These findings highlight consistent differences in sensory responses between individuals with and without NSNP during neurodynamic testing, supporting more consistent clinical interpretation of ULNT1 and guiding test selection when shoulder rotation is restricted or not tolerated.