Efficacy of neurodynamic techniques in conservative treatment of carpal tunnel syndrome (CTS).

• Register: ANZCTR
• Last refreshed on: 26 October 2021
• Main ID: ACTRN12617000672358
• Date of registration: 09/05/2017
• Prospective Registration: Yes
• Primary sponsor: The Jerzy Kukuczka Academy of Physical Education in Katowice
• Public title: Efficacy of neurodynamic techniques in conservative treatment of carpal tunnel syndrome (CTS).
• Scientific title: Efficacy of neurodynamic techniques in conservative treatment of carpal tunnel syndrome patients
• Date of first enrolment: 16/05/2017
• Target sample size: 350
• Recruitment status: Completed
• URL: https://anzctr.org.au/ACTRN12617000672358.aspx
• Study type: Interventional
• Study design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy;

Countries of recruitment

Poland

Contacts

• Name: Dr Pawel Linek

• Name: Dr Pawel Linek

Key inclusion & exclusion criteria

Inclusion criteria: - Peripheral neuropathy (CTS) diagnosed by physician
- Positive nerve conduction study test
- Subjective and objective symptoms of peripheral neuropathy
- Consent to participate in research
- No contraindications to therapy
[Subjective and objective symptoms of peripheral neuropathy: numbness and tingling in the area of the median nerve; nighttime paresthesia; positive Phalen test; positive Tinel sign; pain in the wrist area radiating to the shoulder]

Inclusion criteria for healthy participants in the control group: good general health, consent to participate in the research, and a lack of symptoms listed for CTS patients.

Exclusion criteria: - Lack of consent
- Lack of cooperation from the patient
- Pharmacological therapy which may affect the sensory disturbances
- Previous surgical treatment
- Cervical myelopathy
- Cervical and lumbar radiculopathy
- Rheumatoid diseases
- Pregnancy
- Fibromyalgia
- Mental illness

Age minimum: 20 Years
Age maximum: No limit
Gender: Both males and females

Health Condition(s) or Problem(s) studied

carpal tunnel syndrome;
carpal tunnel syndrome

Musculoskeletal - Other muscular and skeletal disorders

Neurological - Other neurological disorders

Physical Medicine / Rehabilitation - Physiotherapy

Intervention(s)

Arm. 1 - Group 1 (neurodynamic techniques treatment) - gliding and tension neurodynamic techniques of median nerve, one-direction proximal and distal glide mobilisation and one-direction proximal and distal tension mobilisation.
a. neurodynamic techniques for medial nerve – position supine, neurodynamic sequence: arm adduction 90 degrees and external rotation, wrist and finger extension, forearm supination, elbow extension; one-direction proximal glide mobilisation (movement – elbow extension –large amplitude of motion), one-direction distal glide mobilisation (movement – wrist extension –large amplitude of motion), one-direction proximal tension mobilisation (movement – elbow extension –small amplitude of motion et the end of the movement), one-direction distal tension mobilisation (movement – wrist extension – small amplitude of motion et the end of the movement).
Standard protocol consisted of three series of 60 repetitions of glide and tension neurodynamic techniques separated by inter-series intervals of 15 s, twice a week for 10 sessions.
The therapy will be performed by physiotherapists with more than 10 years of experience in neurodynamic techniques. The study will be performed in 2 medical clinics in the Silesia province of Poland. Approximate duration of each session – 15 minutes.

Arm. 2 - Group 2 (placebo treatment) – sham gliding and tension neurodynamic techniques of median nerve, one-direction proximal and distal glide mobilisation and one-direction proximal and distal tension mobilisation.
a. neurodynamic techniques for medial nerve – position supine, without neurodynamic sequence – upper extremity in neutral position; one-direction proximal glide mobilisation (movement – elbow extension –large amplitude of motion), one-direction d

Primary Outcome(s)

Nerve conduction:
Examinations of nervous conduction is performed in the electromyography laboratory by experienced personnel. The examination is performed by an antidromic method using a Neuro-Mep instrument, with superficial electrodes.
Nerve conduction study is performed on median nerve.[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

neuropathy symptom score (Boston Carpal Tunnel Questionnaire - BCTQ)
[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

Feeling two-point discrimination:
The examination of two-point discrimination sensation was performed with the use of its static variety by assessing innervation density in slowly adapting touch receptors. A standardised Dellon discriminator was used for the study[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

Secondary Outcome(s)

Kinesthetic differentiation of movement (radiocarpal joint) – Saunders Inclinometer[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

overall health status -
36 Health Survey Questionnaire[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

Grip strength
Dynamometer Jamar
[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

Kinesthetic differentiation of strength (cylindric and pinch grip kinaesthetic differentiation) – Jamar Dynamometer
[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

Sensation threshold - Calibrated Softip Monofilament NerveTester – WEST-hand, Connecticute Bioinstruments, USA)[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

The range of movement
Inclinometer Saunders[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

Severity of pain:
Laitinen scale and a Numerical Pain Rating Scale (NPRS), which is a subjective method of pain evaluation by the patient, was used.[Baseline and after therapy completion (5 weeks), and 6 months later post completion of therapy.]

Secondary ID(s)

Nill know

Source(s) of Monetary Support

The Jerzy Kukuczka Academy of Physical Education in Katowice,

Ethics review

Status: Approved
Approval date: 08/03/2012
Contact:

Bioethics Committee for Scientific Studies at the Physical Education College of Katowice

Results

• Results available: Yes
• Date Posted: 15/10/2021
• Date Completed: 26/10/2018