Changes in Ultrasound Parameters of the Median Nerve at Different Positions of the Radiocarpal Joint in Patients with Carpal Tunnel Syndrome.

Ultrasound imaging (US) is being increasingly used to aid in the diagnosis of entrapment neuropathies. This study aims to evaluate the shear modulus and cross-sectional area (CSA) of the median nerve in patients with carpal tunnel syndrome (CTS). A total of 35 patients with CTS participated in the study. CSA and shear modulus testing were performed in shear wave elastography (SWE) mode in five positions of the right and left radiocarpal joints (intermediate position 0°, 45° of extension, maximum extension, 45° of flexion, and maximum flexion). There were significant side-to-side differences in the median nerve shear modulus at each wrist position as compared to the asymptomatic side. There were significant side-to-side differences in the median nerve CSA at each wrist position as compared to the asymptomatic side. Shear modulus increases in patients with CTS at different angular positions of flexion and extension of the radiocarpal joint. In individuals with CTS, the CSA of the median nerve is greater on the symptomatic side compared to the asymptomatic side. The CSA decreases in positions of maximum extension and 45° of flexion and in maximum flexion relative to the resting position.

The Use of Physiotherapy in the Conservative Treatment of Cubital Tunnel Syndrome: A Critical Review of the Literature.

BACKGROUND: The lack of a clear answer regarding the efficacy of physiotherapy in the treatment of cubital tunnel syndrome (CuTS) has led to attempts to critically assess the scientific studies conducted to date. MATERIALS AND METHODS: Two databases (MEDLINE via PubMed and PEDro) and Google Scholar were used to search for papers. The inclusion criteria were randomized controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of patients with CuTS. RESULTS: A total of 18 studies met the eligibility criteria, capturing a total of 425 participants. Seven papers were randomized controlled trials, three more described prospective studies without a control group, and eight papers contained case reports. An analysis of the literature evaluating the effectiveness of various forms of broadly defined physiotherapy indicates that their use can have a beneficial effect in reducing many subjective and objective symptoms and improving function. In the majority of papers included in this review, their authors indicated positive therapeutic effects. Only one randomized controlled trial reported no change following therapy. It can therefore be stated that the results of the research conducted so far are optimistic. However, only 7 of the 18 papers were randomized controlled trials, while 3 were prospective studies, and 8 papers were case studies, in which 23 people with CuTS were studied. CONCLUSIONS: The small number of randomized clinical trials and their considerable heterogeneity do not allow firm conclusions to be drawn about the effectiveness of physiotherapy in the conservative treatment of CuTS.

Relationship between respiratory muscles ultrasound parameters and running tests performance in adolescent football players. A pilot study.

Purpose: Assessing the relationship between ultrasound imaging of respiratory muscles during tidal breathing and running tests (endurance and speed) in adolescent football players. Methods: Ultrasound parameters of the diaphragm and intercostal muscles (shear modulus, thickness, excursion, and velocity), speed (30-m distance), and endurance parameters (multi-stage 20-m shuttle run test) were measured in 22 male adolescent football players. The relation between ultrasound and running tests were analysed by Spearman's correlation. Results: Diaphragm shear modulus at the end of tidal inspiration was moderately negatively (R =  - 0.49; p = 0.2) correlated with the speed score at 10 m. The diaphragm and intercostal muscle shear modulus ratio was moderately to strongly negatively correlated with the speed score at 10 m and 30 m (about R =  - 0.48; p = 0.03). Diaphragm excursion was positively correlated with the speed score at 5 m (R = 0.46; p = 0.04) and 10 m (R = 0.52; p = 0.02). Diaphragm velocity was moderately positively correlated with the speed score at 5 m (R = 0.42; p = 0.06) and 30 m (R = 0.42; p = 0.07). Ultrasound parameters were not significantly related to all endurance parameters (R ≤ 0.36; p ≥ 0.11). Conclusions: Ultrasound parameters of the respiratory muscles are related to speed score in adolescent football players. The current state of knowledge does not allow us to clearly define how important the respiratory muscles' ultrasound parameters can be in predicting some performance parameters in adolescent athletes.

Ultrasound Diagnostic and Physiotherapy Approach for a Patient with Parsonage-Turner Syndrome-A Case Report.

Parsonage-Turner syndrome (PTS) is a rare neurological disorder that causes major diagnostic problems. This paper presents a case report of a patient with PTS and proposes a new physiotherapy program. CASE DESCRIPTION: a 23-year-old man presents a sudden severe pain of his right arm. The man is consulted by several doctors and physiotherapists. Three magnetic resonance imagings (MRI), a nerve conduction study (NCS), and needle electromyography (EMG) are performed. After 6 months, based on medical history, physical examination and ultrasound imaging (UI), the physiotherapist suggests PTS, which is confirmed by a neurologist. INTERVENTION: due to the lack of physiotherapy treatment standards in PTS, we apply neurodynamic techniques. OUTCOMES: neurodynamic techniques are effective in reducing pain and paraesthesia, improving sensation, and reducing nerve swelling (assessed by UI), as well as improving manual dexterity and overall health status. CONCLUSIONS: the patient with PTS is challenging for making an accurate diagnosis. This study shows an important role for UI, which shows changes in the musculocutaneous nerve, despite the lack of abnormalities in the MRI, NCS, and EMG, and helps in making an accurate diagnosis. This report also confirms that physiotherapy based on neurodynamic techniques may have beneficial effects in PTS.

Changes in Ultrasound Measurements of the Ulnar Nerve at Different Elbow Joint Positions in Patients with Cubital Tunnel Syndrome.

Ultrasound imaging (US) is increasingly being used in the diagnosis of entrapment neuropathies. The aim of the current study was to evaluate changes in stiffness (shear modulus), cross-sectional area (CSA), and trace length (TRACE) of the ulnar nerve in patients with cubital tunnel syndrome (CuTS), with shear wave elastography (SWE). A total of 31 patients with CuTS were included. CSA, shear modulus, and TRACE examinations were performed in the SWE mode in four positions of the elbow: full extension, 45° flexion, 90° flexion, and maximum flexion. There were significant side-to-side differences in the ulnar nerve elasticity value at 45°, 90°, and maximal elbow flexion (all, p < 0.001) but not at elbow extension (p = 0.36). There were significant side-to-side differences in the ulnar nerve CSA value at each elbow position (all, p < 0.001). There were significant side-to-side differences in the ulnar nerve trace value at each elbow position (all, p < 0.001). The symptomatic ulnar nerve in patients with CuTS exhibited greater stiffness (shear modulus), CSA, and TRACE values, compared with the asymptomatic side. US examinations (shear modulus, CSA, and TRACE evaluation) of the ulnar nerve can be helpful in supporting and supplementing the diagnosis in patients with CuTS.

Reliability of Ulnar Nerve Sensation Tests in Patients with Cubital Tunnel Syndrome and Healthy Subjects.

Static two-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) tests are commonly used to evaluate sensory disorders in the hand. The aim of this study was to evaluate the reliability of 2PD and SWM tests in the ulnar nerve innervation area in patients with cubital tunnel syndrome (CuTS) and healthy individuals. This was a two-group repeated-measures inter-rater and intra-rater reliability study. Twenty-one patients with CuTS and 30 healthy adults participated. The static 2PD test was performed using a standardized Dellon discriminator, whereas the SWM test was conducted using TOUCH TEST monofilaments. Two examiners performed both tests at the hypothenar eminence and the fourth and fifth digits (ulnar nerve innervation hand territory). First, examiner A conducted three series of 2PD and SWM tests twice with a 15-min rest period (within-day intra-rater reliability). Next, examiner B repeated the same examination 5 min after (inter-rater reliability). Examiner A conducted the same examination 7 days after (between-day intra-rater reliability). For single measurements, the inter-rater reliability and within-day intra-rater reliability in the 2PD was at least 0.81 in patients with CuTS or healthy subjects. The between-days intra-rater reliability for a single measurement varied from 0.56 to 0.95 in CuTS patients and healthy subjects. The between-days intra-rater reliability for mean value from three measurements was above 0.80. The kappa for SWM was above 0.8 and the percentage of agreement was at least 90% for all sessions and trials. In conclusion, the 2PD and SWM tests are reliable for assessing sensation in the ulnar nerve innervation area of the hand in patients with CuTS and healthy subjects.

The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review.

BACKGROUND: To date, various forms of physiotherapy are used in the treatment of cubital tunnel syndrome (CuTS). The effectiveness of physiotherapy for CuTS is inconclusive. The aim of this systematic review was to evaluate the effects of physiotherapy in the conservative treatment of CuTS. METHODS: The six databases were searched from December 2020 to March 2022. The inclusion criteria were randomised controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of adult participants with diagnosis CuTS. A total of 11 studies met the eligibility criteria, capturing a total of 187 participants. RESULTS: In three types of papers, pain, muscle strength, and limitation of upper limb function were the most frequently assessed characteristics. Physiotherapy was most often based on manual therapy, neurodynamic techniques, and electrical modalities. One clinical trial rated the risk of bias "high" and the other two "some concerns". In case-series designs, five studies rated the risk of bias as "serious" and three as "moderate". Most of the studies showed a significant improvement in the clinical condition, also in the follow-up study. Only one clinical trial showed no therapeutic effect. CONCLUSION: There is no possibility of recommending the best method of physiotherapy in clinical practice for people with CuTS based on the results of this systematic review. More high-quality studies are required.

Ultrasonography in Assessment of Respiratory Muscles Function: A Systematic Review.

INTRODUCTION: The purpose of this study was to evaluate the potential utility of respiratory muscles ultrasound (US) imaging for assessing respiratory function and identify US variables that best correlate with pulmonary parameters. MATERIALS AND METHODS: A search of 5 databases was conducted. Initially, there was no language, study design, or time frame restrictions. All studies assessing the relationship between pulmonary and US parameters were included. Two reviewers independently extracted and documented data regarding to examined population, age, gender, health condition, methodology, US, and pulmonary function measurements. All studies were qualitative synthesis. RESULTS: A total of 1,272 participants from 31 studies were included. Diaphragm thickness, diaphragm thickening ratio, and diaphragm excursion amplitude were mainly used as US parameters. Forced vital capacity, forced expiratory volume1sec, and maximal inspiratory pressure were mainly used as pulmonary parameters. The relationships between pulmonary and US parameters varied from negligible to strong (depend on examined population and methodology used). Data were not quantitatively synthesis due to high heterogeneity in terms of study design, population examined, and various pulmonary and US parameters. CONCLUSION: A strong relationship between US measurements and pulmonary parameters was demonstrated in some studies but not others. This review confirmed that US measurements can complement spirometry, but the exact role of the US remains to be confirmed. Further studies using standardized methodology are needed to obtain more conclusive evidence on the usefulness of US for assessing respiratory function.

Lateral Abdominal Muscles Shear Modulus and Thickness Measurements under Controlled Ultrasound Probe Compression by External Force Sensor: A Comparison and Reliability Study.

The aim of this study was to perform a reliability and agreement analysis and to compare lateral abdominal muscles (LAMs) thickness and elasticity results obtained by an experienced operator, by a non-experienced operator, and in an ultrasound imaging probe compression controlled (PCC) condition with minimal force necessary to obtain a proper ultrasound image. The sample consisted of 39 adolescents. An Aixplorer ultrasound scanner was used to evaluate the LAM. The probe in PCC condition was positioned in a prepared probe holder coupled with a pressure sensor. The LAM thickness and elasticity measurements were significantly (p < 0.05) different in the ultrasound PCC condition, compared to results obtained by both examiners. The abdominal oblique external and internal muscle thickness measurements were underestimated and all LAM shear moduli were overestimated during measurements without controlling the probe compression by an external sensor. The intra-class correlation coefficient was excellent in all conditions, but the smallest detectable differences were approximately 43-60% lower during the measurements collected in PCC condition. Differences in LAM measurements between PCC and 'on-hand' conditions may be clinically irrelevant when the force applied by the probe is consciously controlled by the examiner. However, during ultrasound measurements of the LAM morphology, the potential under/over estimation should always be considered when measurements are performed without controlling probe compression by an external sensor.

Shear wave elastography of the lateral abdominal muscles in C-shaped idiopathic scoliosis: a case-control study.

Considering that knowledge about lateral abdominal muscles (LAM) in idiopathic scoliosis (IS) is still very limited, the aims of this study were: (a) to compare LAM thickness and elasticity between C-shaped IS and non-scoliotic population; and (b) to compare LAM thickness and elasticity between C-shaped thoracic, thoracolumbar, and lumbar IS. A total of 259 adolescents were included in the final analysis; among these, 108 were IS and 151 were non-IS. LAM thickness and elasticity were measured at rest and during isometric contraction by an Aixplorer ultrasound scanner. Out of all LAM, only OE thickness was higher on the convex body side compared to the concave side in lumbar and thoracolumbar scoliosis. It may be related with muscle's atrophy/hypertrophy or other tissues displacement rather than different force generated by the muscle on both body sides, because an asymmetry in the elasticity of the LAM between the convex and concave side was not presented. The only TrA was stiffer in lumbar scoliosis compared to thoracolumbar and thoracic scoliosis. LAM elasticity was similar in IS and non-IS adolescents.

Influence of Chest and Diaphragm Manual Therapy on the Spirometry Parameters in Patients with Cerebral Palsy: A Pilot Study.

OBJECTIVE: To evaluate the influence of manual therapy of the chest and diaphragm on the spirometry parameters in patients with cerebral palsy (CP). METHOD: The study was carried out on 20 youths with CP. All participated in 6 sessions (3 sham and 3 actual), with measurements of spirometry at baseline, postsham therapies 1 and 3, before actual therapy, and postactual therapy sessions 1 and 3. Two manual techniques were included: soft tissue mobilization of the chest and the diaphragm. RESULTS: After the first actual therapy, there was a significant (p < 0.01) improvement in forced vital capacity (FVC) by 0.23 L (8% of the average predicted value) and forced expiratory volume in one second (FEV1) by 0.18 L (7% of the average predicted value) as compared to results before the therapy. Change in FVC parameter was clinically significant, whereas change in FEV1 was not clinically significant. After sham therapy, there was no improvement in spirometry parameters as compared to baseline results. CONCLUSION: Single-time manual therapy of the chest and diaphragm has a positive effect on FVC and FEV1.

Morphological changes of the lateral abdominal muscles in adolescent soccer players with low back pain: A prospective cohort study.

BACKGROUND: Most papers examining the lateral abdominal muscles (LAMs) and low back pain (LBP) are cross-sectional, with groups of participants being divided into a control and an LBP group. We hypothesized that morphological measurements of the LAMs in adolescent soccer players may predict future LBP incidence. The aim of this study was to examine the associations between the morphology of LAMs and LBP incidence rate among adolescent soccer players. METHODS: Ninety-seven adolescent male soccer players with no LBP at baseline were recruited into the prospective cohort study. The thickness of the LAMs was measured at baseline by ultrasound imaging in a supine rest position. Nine cases of LBP occurred during the follow-up 6-month observation. RESULTS: An obliquus internus (OI) asymmetry was related to increasing LBP risk (odds ratio = 19.99; 95%CI: 2.4-167.9). Spearman correlation also showed a linear relationship between OI asymmetry value and duration of LBP (R = 0.75, p = 0.02). An OI side-to-side difference greater than 1.25 mm suggests possible LBP incidence in the 6-month observation among adolescent soccer players. CONCLUSION: The morphological changes of the OI may be related to LBP's incidence in adolescent soccer players. The presence of OI asymmetry increases the odds of LBP by at least 2.4 times. Hypertrophy of the OI on one side of the body may contribute to trunk muscle imbalance.

Assessment of the Relationship between Y-Balance Test and Stabilometric Parameters in Youth Footballers.

OBJECTIVES: The purpose of the study was to evaluate the correlation between dynamic test results obtained on a stabilometric platform and the results achieved on the Y-balance test (Y-BT). METHOD: The study group consisted of 52 adolescent athletes, aged 14 to 17 years. Each participant was evaluated in the scope of their ability to maintain dynamic balance using the Y-BT as well as via dynamic tests on the 'Alfa' stabilometric platform. The following parameters were analysed: (a) from the Y-BT-relative reach of the right and left lower limbs in the anterior, posterolateral, and posteromedial directions, as well as the side-to side difference in relative reach for each direction and (b) from the 'Alfa' platform-path length and time to reach the target using right and left lower limbs in the anterior and posterior directions. RESULTS: A correlation between the results obtained on the stabilometric platform and the Y-BT was found only for the posteromedial direction. Statistical analysis demonstrated that the increased difference between the right and left lower limbs in the posteromedial test is related to an increase in time taken to reach the points located forward and to the left, and backwards and to the right, as well as an increase in the overall time required to complete the task on the stabilometric platform. CONCLUSIONS: The results from the Y-BT and stabilometric platform are weakly related in adolescents. These findings indicate that the Y-BT and stabilometric platform analyse different kinds of dynamic balance in adolescents. Thus, these tools should not be used interchangeably in clinical practice or scientific research.

Intrarater Reliability of Shear Wave Elastography for the Quantification of Lateral Abdominal Muscle Elasticity in Idiopathic Scoliosis Patients.

OBJECTIVE: To date, studies evaluating the reliability of shear wave elastography (SWE) measures of the lateral abdominal muscles (LAMs) in adolescent patients with idiopathic scoliosis (AIS) have never been performed. The aim of the study was to assess the intrarater reliability of SWE and thickness of the LAMs at rest and during isometric contraction (10% of maximal voluntary contraction). METHODS: This was a single-group, repeated-measures intrarater reliability study. Twenty-four patients with AIS between ages 10 and 17 years took part in the study. Two and 3 repeated SWE measurements were recorded in the supine resting position and during isometric contraction, respectively. Two sessions were performed with a 7-day interval. RESULTS: By using the mean of 2 measures in the supine, resting position, intraexaminer reliability point estimates (intraclass correlation coefficient [ICC]3.2) ranged from 0.75 to 0.84 for external oblique, internal oblique, and transversus abdominis muscles. During the isometric contraction, the ICC3.3 results ranged from 0.70 to 0.83. The ICC results for muscle thicknesses in both conditions ranged from 0.89 to 0.96. CONCLUSION: Measurements of LAM elasticity are reliable in patients with AIS. The superficial fat layer did not influence the measurement error between 2 sets of measurements in the examined adolescent population. The images extracted from SWE can successfully be used to assess LAM thicknesses with high reliability.

Shear wave elastography for assessing lateral abdominal muscles in thoracolumbar scoliosis: A preliminary study.

BACKGROUND: There are no studies on the scoliotic population in which lateral abdominal muscle (LAM) was measured. OBJECTIVE: The aim of the study was to deliver the first results on LAM elasticity assessed by shear wave elastography (SWE) in right-side and left-side thoracolumbar scoliosis patients. METHOD: Twelve patients (mean age 12.25) with thoracolumbar scoliosis were included in the study. Muscle thickness and SWE of the obliquus external (OE), obliquus internal, and transversus abdominis (TrA) were measured with an ultrasound scanner. Measurements were taken at rest and during isometric contraction. RESULTS: An analysis showed that in right-side scoliosis, the OE muscle on the convex side was stiffer by 7.25 kPa compared to the concave side. The OE muscle on the convex side in right-side scoliosis was also stiffer by 11.6 kPa compared to the convex side in left-side scoliosis. In left-side scoliosis, the TrA muscle on the concave side was stiffer by 7.84 kPa compared to the convex side. CONCLUSION: Changes in LAM elasticity of thoracolumbar scoliosis were observed. A different pattern of LAM stiffness in different curve directions may be expected. OE and TrA shear moduli are the most sensitive to change in adolescent spinal deformation.

Long-term patient observation after conservative treatment of carpal tunnel syndrome: a summary of two randomised controlled trials.

BACKGROUND: Physiotherapy of carpal tunnel syndrome (CTS) involves manual therapy based on neurodynamic techniques. Until now, two randomized controlled trials have shown that immediately after therapy, CTS patients who received neurodynamic techniques had significant improvement in nerve conduction, pain, symptom severity (SSS), functional state (FSS), muscle strength (MS) and two-point discrimination (2PD). However, long-term effects seem to be more important, as they are the only ones that can significantly improve the patient's health and influence economic and social costs. Thus, the objective of this study was to evaluate the long-term (six months) effects of neurodynamic techniques in the conservative treatment of CTS patients. METHODS: Carpal tunnel syndrome patients (107) from two previously published randomised clinical trials were observed for six months after the treatment based on neurodynamic techniques. RESULTS: The sensory conduction velocity, motor conduction velocity, and motor latency were not subject to statistically significant changes within six months after therapy (p > 0.05). In both groups, there was further pain reduction (p < 0.05). In Group B, the symptom severity improved significantly (p < 0.05), while the functional status in both groups remained unchanged (p > 0.05). In both groups, there was muscle strength improvement (p < 0.05). Two-point discrimination remained unchanged six months after the therapy. CONCLUSION: The use of manual therapy based on neurodynamic techniques maintains the beneficial effects 6 months after therapy in CTS patients.

Supersonic Shear Imaging for Quantification of Lateral Abdominal Muscle Shear Modulus in Pediatric Population with Scoliosis: A Reliability and Agreement Study.

The aim of this study was to assess the intra- and inter-rater reliability/agreement of the lateral abdominal muscle (LAM) stiffness and thickness measurements at rest and during contraction and to determine the relationship between the superficial fat thickness and the LAM stiffness measurements. LAM stiffness and thickness were measured using supersonic shear wave elastography (SSI) in pediatric participants. The reliability of LAM stiffness and thickness measurements ranged from moderate to excellent. There was an inverse correlation between fat thickness and between-rater difference in the resting external oblique stiffness (r > -0.37) and the contracted external and internal oblique stiffness (r > -0.40). SSI is a reliable method for assessing LAM stiffness and thickness in pediatric populations. To remove potential systematic errors: (i) the first round of measurements should be performed to familiarize patients with procedures; (ii) the examiner should pay more attention while performing LAM measurements on the opposite side of the body.

Assessment of manual dysfunction in occupationally active women with carpal tunnel syndrome.

OBJECTIVES: The aim of this study is to evaluate 2-point discrimination sense (2PD), strength and kinesthetic differentiation of strength (KDS), range of motion (ROM) and kinesthetic differentiation of movement (KDM) dysfunctions in occupationally active women with mild and moderate forms of carpal tunnel syndrome (CTS) compared to a healthy group. MATERIAL AND METHODS: The 2PD sense, muscle strength and KDS, as well as the ROM and KDM of the radiocarpal articulation were assessed. RESULTS: The results of the 2PD sense assessment showed significantly higher values in all the examined fingers in the CTS women group compared to healthy women (p < 0.01). There was a significant difference in the percentage value of error in the strength and KDS of pincer and cylindrical grips (p < 0.01) in the CTS women group compared to healthy women. There was no difference in the ROM of flexion and extension between studied groups (p > 0.05). There was a significant difference in the percentage value of error in the KDM of flexion and extension movement of the radiocarpal articulation (p < 0.01) between the studied groups. CONCLUSIONS: There are significant differences in the 2PD sense, KDS and KDM in occupationally active women with mild and moderate forms of CTS compared to healthy women. There are no significant differences in ROM in professionally active women with mild and moderate forms of CTS compared to healthy women. Int J Occup Med Environ Health. 2019;32(2):185-96.

Reliability of two-point discrimination test in carpal tunnel syndrome patients.

OBJECTIVES: To evaluate the reliability (intra and inter) of two-point discrimination (2PD) test in carpal tunnel syndrome (CTS) patients. PARTICIPANTS: Eighty-six adults with unilateral right hand CTS. METHODS: Two examiners performed measurements of 2PD sensation (using Dellon discriminator) on the first three fingers on both hands. The first examiner performed three series of measurements at 1-minute intervals. After 7 days, measurements were repeated by the same examiner (intra-rater). For inter-rater reliability, the examination (by second examiner) was also repeated after 7 days. RESULTS: For the first measurement, inter-rater reliability (ICC2,1) at the affected site ranged from 0.96 to 0.97; values at the non-affected site ranged from 0.79 to 0.89. Analysis of the averages of two measurements (ICC2,2) yielded values at the affected site of 0.98; values at the non-affected site ranged from 0.92 to 0.94. The average of two measurements reduces the smallest detectable difference (SDD) value < 1 mm in all cases. Intra-rater reliability was at least good for all tested fingers for the first measurement, but to record SDD < 1 mm it is necessary to use an average of the first two measurements. CONCLUSIONS: The execution of two repeated measurements provides adequate reliability in measurements of 2PD test in CTS patients. For clinical trials, we recommend using at least the average of two measurements of 2PD, which reduce SDD (below 1 mm). This may be particularly important in assessing the effectiveness of therapy.

Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial.

OBJECTIVE:: The aim of this study was to evaluate the efficacy of manual therapy based on neurodynamic techniques in conservative treatment of carpal tunnel syndrome. DESIGN:: Randomized controlled trial. SETTING:: Several medical outpatient clinics in the south of Poland. PARTICIPANTS:: The study included 103 patients with mild and moderate carpal tunnel syndrome (mean age = 53.95, SD = 9.5) years, who were randomly assigned to a neurodynamic techniques group (experimental group, n = 58) or a group without treatment (control group, n = 45). INTERVENTION:: Neurodynamic techniques were used in the experimental group. Treatment was conducted twice weekly (20 sessions). Control group did not receive treatment. MAIN MEASURES:: Nerve conduction study, pain, symptom severity and functional status of Boston Carpal Tunnel Questionnaire, and strength of cylindrical and pincer grips were assessed at baseline and immediately after treatment (nerve conduction study one month after treatment). RESULTS:: Baseline assessment revealed no group differences in any assessed parameters ( P > 0.05). There were significant differences between groups after treatment, including nerve conduction (e.g. sensory conduction velocity: experimental group: 38.3 m/s, SD = 11.1 vs control group: 25.9 m/s, SD = 7.72, P < 0.01). Significant changes also occurred in pain (experimental group: 1.38, SD = 1.01 vs control group: 5.46, SD = 1.05, P < 0.01), symptom severity (experimental group: 1.08, SD = 0.46 vs control group: 2.87, SD = 0.68, P < 0.01), and functional status (experimental group: 1.96, SD = 0.64 vs control group: 2.87, SD = 1.12, P < 0.01). There were no group differences in strength ( P > 0.05). CONCLUSION:: The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.