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Median Nerve Excursion During Neurodynamic Mobilization

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ClinicalTrials.gov Identifier: NCT03970408
Recruitment Status : Active, not recruiting
First Posted : May 31, 2019
Last Update Posted : May 31, 2019
Sponsor:
Information provided by (Responsible Party):
Aliaa Rehan Youssef, Cairo University

Brief Summary:
This study will compare changes in longitudinal median nerve excursion when neck flexion and ipsilateral rotation are added to the standard Median neurodynamic test1 (MNT1) position in patients with carpal tunnel syndrome (CTS) and normal controls.

Condition or disease Intervention/treatment
CTS Procedure: MNT1

Detailed Description:

Median nerve excursion will be assessed by ultrasonography during three positions: standard MNT1, neck flexion with MNT1, and ipsilateral rotation combined with MNT1. Both arms will be tested.

Arm will be held in abduction to 90° - 110° and external rotation to 90°, forearm supination, elbow extension and wrist and fingers extension using a custom made splint.

The standard MNT1 includes neck contralateral side flexion. Then, the researcher will move the neck passively into rotation and flexion. Passive range limit will be determined prior to testing using a goniometer and passive end feel. Movement order will be randomized using an excel random function.

Every position will be tested three times. A single researcher will do all movements passively. Nerve excursion will be measured in real time by the same ultrasonographer who is blinded to patients grouping.


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Study Type : Observational
Estimated Enrollment : 50 participants
Observational Model: Case-Control
Time Perspective: Cross-Sectional
Official Title: Effect of Neck Movements on Median Nerve Longitudinal Excursion During Neurodynamic Mobilization in Patients With Carpal Tunnel Syndrome
Actual Study Start Date : May 1, 2019
Estimated Primary Completion Date : September 1, 2019
Estimated Study Completion Date : October 1, 2019


Group/Cohort Intervention/treatment
Carpal tunnel syndrome

Patients with CTS who fulfill the following eligibility criteria:

Inclusion criteria

  • Females and male patients referred with a CTS diagnosis confirmed by nerve conduction studies and positive Tinel and Phalen tests.
  • Age ranging from 30-50 years old.
  • The selected patient will be able to tolerate the entire standard neurodynamic technique.

Exclusion criteria

  • Symptoms referred to the neck.
  • Sever CTS
  • More than 10% limitation of neck flexion, rotation, and side bending ranges.
  • History of disease, trauma, or surgery to neck, thorax, or upper limbs.
  • Presence of peripheral neuropathy or cervical radiculopathy.
  • History of systemic disease associated with neuropathies such as diabetes mellitus, connective tissue diseases, thyroid disease, or obesity.
Procedure: MNT1

Participants will in supine. Arm will be position in standard MNT1. Shoulder, elbow, wrist and fingers will be maintained in the required position using a costumed splint throughout all testing.

All movements will be limited to the range where pain or other symptoms are not provoked. Passive neck flexion and rotation will be added to MNT1 and will be applied as tensioning movements at level 3. All movements will be repeated three times and an average will be calculated. Myrin goniometer will be used to assess neck flexion and rotation. The movements order will be randomized using excel random generation function. Movements will be done by a single trained therapist. The end position will be held up to 10 seconds until median nerve excursion is recorded by US. For US capturing, the transducer will be positioned perpendicularly and aligned longitudinally with the median nerve at the wrist. Assessor will be blinded to participants grouping.

Other Name: Neurodynamic tension test

Healthy control
Asymptomatic healthy age-matched control with no symptoms or history of upper quadrant disease, dysfunction, trauma or surgery.
Procedure: MNT1

Participants will in supine. Arm will be position in standard MNT1. Shoulder, elbow, wrist and fingers will be maintained in the required position using a costumed splint throughout all testing.

All movements will be limited to the range where pain or other symptoms are not provoked. Passive neck flexion and rotation will be added to MNT1 and will be applied as tensioning movements at level 3. All movements will be repeated three times and an average will be calculated. Myrin goniometer will be used to assess neck flexion and rotation. The movements order will be randomized using excel random generation function. Movements will be done by a single trained therapist. The end position will be held up to 10 seconds until median nerve excursion is recorded by US. For US capturing, the transducer will be positioned perpendicularly and aligned longitudinally with the median nerve at the wrist. Assessor will be blinded to participants grouping.

Other Name: Neurodynamic tension test




Primary Outcome Measures :
  1. Changes in longitudinal median nerve excursion with neck flexion [ Time Frame: One day ]
    Changes in median nerve excursion, as measured by ultrasonography, when the neck is moved toward flexion combined with the standard MNT1

  2. Changes in longitudinal median nerve excursion with ipsilateral neck rotation [ Time Frame: One day ]
    Changes in median nerve excursion changes, as measured by ultrasonography, when the neck is moved in ipsilateral rotation combined with the standard MNT1



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Ages Eligible for Study:   30 Years to 50 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Patients will be selected from primary care clinics.
Criteria

Inclusion Criteria:

  • Clinical diagnosis of mild to moderate CTS.
  • Must be able to tolerate the entire standard MNT1 position.

Exclusion Criteria:

  • Severe CTS.
  • Symptoms referred to the neck.
  • Limited neck flexion, rotation, and side bending ranges (>10%).
  • History of upper quadrant trauma, dysfunction or surgery.
  • History of peripheral neuropathy or cervical radiculopathy.
  • History of systemic disease associated with neuropathies such as diabetes mellitus, connective tissue diseases, thyroid disease, or obesity.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03970408


Locations
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Egypt
Cairo University Hospital
Cairo, Egypt
Sponsors and Collaborators
Aliaa Rehan Youssef
Investigators
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Principal Investigator: Aliaa Rehan Youssef, Phd Cairo University

Publications:
Balogun, J. a, & Abereoje, O. K. (1989). Inter- and lntratester Reliability of Measuring Neck Motions with Tape Measure and Myrin Gravity reference goniometer. Orthopaedic & Sports Physical Therapy, 10(7), 248-253.
Butler, D. S., & Jones, M. A. (1991). Mobilization of the Nervous System. In D. S. Butler & M. A. Jones (Eds.), clinical resoning (1st ed., pp. 91-105). Australia: Elsevier Health Sciences.
Duncan, S. F. M., & Kakinoki Ryosuke. (2017). Carpal Tunnel Syndrome and Related Median Neuropathies. In M. E. Cooke & S. F. M. Duncan (Eds.), Challenges and Complications. (1st ed., pp. 7-11). USA: Springer.
Gonzalezsuarez, C., Nathleendizon, J., Cua, R., Cabungcalfidel, B., Dones, V., Lesniewski, P., & Thomas, J. C. (2016). Determination of the longitudinal median nerve mobility in different neurodynamic techniques. Hand Therapy, 21(1), 16-24.
Hsieh, Y. H., Shih, J. T., Lee, H. M., & Ho, Y. J. (2010). Ultrasonography of median nerve mobility in the diagnosis of carpal tunnel syndrome. Formosan Journal of Musculoskeletal Disorders, 1(1), 16-19.
Kostopoulos, D. (2004). Treatment of carpal tunnel syndrome : a review of the non-surgical approaches with emphasis in neural mobilization. Journal of Bodywork and Movement Therapies, 8(1), 2-8.
Luchetti, R., & Amadio, P. (2007). Normal anatomy and variations of the median nerve in the carpal tunnel. In H. M. Schmidt (Ed.), Carpal Tunnel Syndrome (pp. 13-20). Berlin Heidelberg: Springer.
Mohamed, F., Hassan, A., Abdel-Magied, R., & Wageh, R. (2016). Manual therapy intervention in the treatment of patients with carpal tunnel syndrome: median nerve mobilization versus medical treatment. Egyptian Rheumatology and Rehabilitation, 43(1), 27-34.
Shacklock, M. (2005). Clinical Neurodynamics: In A new system of musculoskeletal treatment (1st ed., pp. 22-121). Australia: Elsevier Health Sciences.

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Responsible Party: Aliaa Rehan Youssef, Associate professor of Orthopedic Physical Therapy, Cairo University
ClinicalTrials.gov Identifier: NCT03970408     History of Changes
Other Study ID Numbers: HMahmoud
First Posted: May 31, 2019    Key Record Dates
Last Update Posted: May 31, 2019
Last Verified: May 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Aliaa Rehan Youssef, Cairo University:
Median nerve,
Carpal tunnel syndrome
Neurodynamic mobilization

Additional relevant MeSH terms:
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Carpal Tunnel Syndrome
Median Neuropathy
Mononeuropathies
Peripheral Nervous System Diseases
Neuromuscular Diseases
Nervous System Diseases
Nerve Compression Syndromes
Cumulative Trauma Disorders
Sprains and Strains
Wounds and Injuries