EFFECT OF NEURODYNAMIC MOBILIZATION ON FLUID DISPERSION IN MEDIAN NERVE AT THE LEVEL OF THE CARPAL TUNNEL: A CADAVERIC STUDY

Review written by Dr Tom Walters info

BACKGROUND & OBJECTIVE

Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the peripheral nervous system with approximately six percent of the United States population being affected by this clinical condition. Although the pathophysiology of this condition is not fully understood, intraneural edema is consistently observed in these cases. Intraneural edema can have irreversible consequences on nerve function and may be further compounded in the carpal tunnel as lymphatic drainage is minimal in this region. Without the ability to adequately reduce this edema, a type of miniature compartment syndrome may result leading to impaired neural physiology and mechanics, including a reduced nerve glide. Neurodynamic mobilization (NDM) has been shown to be a useful treatment adjunct when treating CTS, but the exact mechanism through which positive outcomes are produced remains unclear. The aim of this study was to examine the effects of NDM on intraneural fluid dynamics associated with CTS and determine if a difference exits between a nerve sliding technique (SLT) and a tensioning technique (TT).

METHODS

Seven unembalmed cadavers (14 upper limbs) were positioned in supine with the shoulder abducted to 90° and the forearm position in full supination. The median nerve was exosed with special attention being given to preserving surrounding connective tissue and the epineurium. The nerve was then injected just below the epineurium with 0.125 cubic centimeters of solution. Once fluid stabilization was determined, NDM proceeded and was randomized as to which side (right or left) was mobilized first and which mobilization (SLT or TT) was performed first. Mobilization were performed for five minutes. In between mobilization techniques, a digital caliper was used to collect data at three and five minutes post mobilization. This procedure was then repeated with the other mobilization technique and all data was compared to measurements obtained at baseline (just after the initial injection).

RESULTS

After solution stabilization (29.7 ± 7.2 mm), longitudinal fluid dispersion increased significantly following the first sequence of NDM with up to 37.7 ± 15mm observed for TT and 36.5 ± 8mm observed for SLT. No significant difference was found between

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