Effets d’un programme de réadaptation fondé sur les exercices neurodynamiques ciblant l’excursion du nerf médian offert à des individus atteints du syndrome du tunnel carpien

Neuromobilizations exercises are frequently advocated by physiotherapists to improve pain and function in individuals with Carpal Tunnel Syndrome (CTS). However, the effectiveness of these exercises remains uncertain since they remain in most part based on theoretical and empirical foundations. In fact, few studies have reported the effects of neurodynamic exercises on the biological integrity and biomechanical properties of the median nerve at the wrist (peripheral adaptations) and on the structure and function of cortical motor areas (central adaptations). The main objectives of this thesis were 1) to evaluate the psychometric properties of median nerve longitudinal excursion measurements using quantitative ultrasound imaging, 2) to characterize the peripheral and central adaptations potentially linked to the performance of neuromobilization exercises and 3) to evaluate the feasibility and effectiveness of a neuromobilization exercise program completed by individuals with CTS. To meet these objectives, four separate projects were conducted. Project # 1: Test- retest reliability and minimal detectable change in median longitudinal nerve excursion measurements were evaluated in a group of 11 asymptomatic individuals and seven individuals with CTS. Project # 2: The concurrent validity between longitudinal excursion measurements of an artificial median nerve model obtained with quantitative ultrasound imaging and a three- dimensional motion analysis system was evaluated. Project # 3: An exploratory clinical study was conducted to evaluate the potential peripheral and central adaptations following completion of a neuromobilization exercise program in a cohort of 14 individuals with CTS. Project # 4: A pilot randomized clinical trial was conducted to evaluate the feasibility of a preoperative neuromobilization exercise program performed by 15 individuals with CTS awaiting decompression surgery and to evaluate the efficacy of this program for these same individuals to improve the biological integrity, biomechanical properties of the median nerve; reduce pain, sensorimotor deficiencies and optimize upper limb functional capacity compared to a control group of 15 individuals with CTS that does not perform any exercise program before and after carpal surgery (standard care). In summary, the results of projects # 1 and 2 demonstrate that ultrasound imaging is a reliable and valid tool for measuring the biological integrity and longitudinal excursion of the iii median nerve. The results of project # 3 suggest that the clinical changes observed following neuromobilization exercises potentiate central adaptations while they have no or little effect on peripheral adaptations, including nerve excursion. The results of project # 4 demonstrate that, although the proposed neuromobilization exercise program is feasible and relatively safe when completed by individuals awaiting decompression surgery, they do not demonstrate the superiority of the proposed program in improving sensorimotor impairments, pain and upper extremity functional abilities in individuals with CTS immediately before or one month after carpal tunnel decompression surgery compared with standard care. However, pain subscales and biological integrity outcomes demonstrated moderate to large effect sizes or trends towards the statistically significance, thus supporting the need for further research.

Keyphrases: Carpal tunnel syndrome, Musculoskeletal manipulation, Pain, Physical therapy, Upper limb functional capabilities