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27-08-2012 | Sports medicine | Article

Neurodynamic technique shows promise for carpal tunnel pain


Free abstract

medwireNews: Soft tissue mobilization and nerve slider neurodynamic technique may help decrease pain intensity in patients with chronic carpal tunnel syndrome, research indicates.

However, the neurodynamic intervention did not change pressure sensitivity.

Although the physiologic mechanisms through which neurodynamic interventions exert their effects are unclear, the researchers propose a number of hypotheses.

"First, the neurodynamic interventions may decrease intraneural pressure at the carpal tunnel, potentially relieving nerve hypoxia and reducing nerve pain symptoms," César Fernández-de-las-Peñas (Universidad Rey Juan Carlos, Madrid, Spain) and colleagues write in the Journal of Manipulative and Physiological Therapeutics.

"Second, it has been suggested that neurodynamic interventions provide a peripheral stimulus, which may interrupt the sensitization process through a peripheral effect."

A total of 18 women with a clinical and electromyographic diagnosis of carpal tunnel syndrome participated in the trial.

The women were aged 31 to 59 years and the mean duration of hand symptoms was 2.4 years.

Before treatment, the average level of pain on the numerical pain rating scale (NPRS) was 5.4 out of 10.0, where 10.0 denotes maximum pain, and the worst level of pain experienced in the preceding week was 7.3.

Treatment involved soft tissue mobilization of the anatomical sites of potential entrapment of the median nerve, particularly muscle-fascia interfaces, followed by the nerve slider neurodynamic technique applied to the median nerve.

One week following this 30-minute therapy session, the average hand pain intensity decreased by 2.2 points to 3.2, with the worst level of pain decreasing to 5.1.

This 2.2-point decrease surpasses the minimal clinically important difference for the NPRS of 2.1, the researchers point out.

Pain pressure threshold testing over the median, radial, and ulnar nerves showed a significant treatment effect for levels over the C5-C6 zygapophyseal joint and significant increases were found bilaterally at 1-week follow up.

But Fernández-de-las-Peñas et al note that these changes were relatively small and not clinically relevant.

They conclude that, given the absence of a control group in their study, "future randomized controlled trials should be performed to determine if a cause-and-effect relationship exists between the treatment approach and the observed outcomes."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Lucy Piper, Senior medwireNews Reporter

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