Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome

Abstract

Study Design. Prospective randomized clinical trial. The trial is registered in the Chinese registry of clinical trials with a trial number of ChiCTR1800019908. Background. Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective. To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods. A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results. Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions. The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

Does hot pack application change the morphology of the median and ulnar nerves?

“…Neuromobilization, which is frequently applied in entrapment neuropathies, is added to routine physical therapy programs. [ 24 , 25 ] Peripheral nerve excursion in nerve mobilization is not only related to the tissues surrounding the nerve, but it also depends on the fascicles and fibrils of the nerve to slide against one another. [ 26 ] The demonstration of an increase in the nerve CSA following the 20-min hot pack application in our study may be evidence that possible short-term intraneural edema may facilitate the sliding of the nerve.…”

Therapeutic management of the painful nerve: a narrative review of common rehabilitation interventions

“…Neurodynamic treatment, also known as nerve gliding or nerve flossing, is the therapeutic movement of neural tissues relative to adjacent non-neural tissues with the goal of reducing pain by restoring normal intrinsic nerve pressures and thereby normal physiologic nerve function [6] . These maneuvers can be performed manually on a patient by a trained therapist [7] or taught as an exercise for carryover at home [8] .…”

Mechanism, application and effect evaluation of nerve mobilization in the treatment of low back pain: A narrative review

“…[33,34] These techniques work through a range of mechanisms of action, including the activation of descending pain inhibitory pathways, the reduction of central sensitization, the stimulation of mechanoreceptors, and the activation of the parasympathetic nervous system. [35–37] Most experts in the field agree that pain is regulated by the gate control theory, which is also supported by a diverse range of evidence, including animal studies, clinical trials, as well as physiological and biochemical experiments. [38–40] The gate control theory of pain was first proposed by Melzack and Wall in 1965 and has been widely accepted by the scientific community.…”