Preoperative Neuromobilization Exercises for Individuals With Carpal Tunnel Syndrome
Condition: Carpal Tunnel Syndrome
MeSH terms: Carpal Tunnel Syndrome; Syndrome
Study type: Interventional

Summary: 
      Carpal tunnel syndrome is one of the major known disorders of the wrist and hand that causes
      pain, tingling sensations, weakness of the hand and functional limitations in daily tasks
      (for example: handling objects with the hands). In the early stages of the syndrome, some
      individuals may benefit from wearing wrist splint or cortisone infiltration. For those with
      ongoing symptoms, surgery is often indicated. However, some individuals may experience
      worsening of their condition while waiting for surgery. To aid those individuals,
      physiotherapists often recommend exercises that aim to "glide" the nerve inside the arm.
      Specifically, these exercises involve arm and neck movements in a specific order, with the
      aim of improving the motion of the median nerve in relation with its environment. These nerve
      gliding exercises may have a favorable effect on the median nerve and may improve pain and
      upper limb functional abilities. In this study, the investigators aim to evaluated the
      feasibility and effects of a preoperative nerve gliding exercises completed by individuals
      undergoing surgery
    

Detailed description: 
      Carpal Tunnel Syndrome (CTS) is a common disorder characterized by alterations of the median
      nerve integrity at the carpal tunnel. The syndrome is classically recognized by chief
      complains of nocturnal or intermittent pain and paresthesia involving the median nerve
      sensory territory of the hand. In more severe condition, worsening of pain and paresthesia as
      well as thenar muscle atrophy may be present and lead to disability.

      Many conservative treatments for CTS are available. Yet, the current literature only support
      the use of wrist splints and cortisone infiltration, which have been shown to provide only
      temporary relief for many individuals. Those with ongoing symptoms or severe conditions are
      often offered carpal tunnel decompression surgery. However, the costs related to the surgery
      and the increasing delays on waiting lists warrants the need for better conservative
      management. A preoperative rehabilitation exercise program based on nerve gliding exercise is
      advocated by physical therapists to manage physical impairments and functional limitations
      associated with CTS. These exercises can be implement at low cost in the setting of an
      home-based program.

      The investigators aim to examine the feasibility and the efficacy of a preoperative home
      rehabilitation program based on nerve gliding exercises completed by individuals with carpal
      tunnel Syndrome waiting for decompression surgery.

      In this trial, individuals awaiting carpal tunnel decompression surgery will be randomly
      allocated to either complete a preoperative nerve-gliding exercise program (experimental
      group) or no intervention (control group). Thirty participants confirmed with CTS by their
      attending hand surgeons and enlisted for carpal tunnel decompression will be recruited for
      this study conducted at the hospital of the Université de Montréal (CHUM), Montreal, Quebec,
      Canada. All individuals enrolled in the study will be prioritized on the surgical waiting
      list to receive their surgery five weeks after initiating the study in order to ensure
      consistency between different timeframes of the study.

      The effects of the nerve-gliding exercise program will be assessed at baseline (T0) using
      standardized questionnaires, quantitative ultrasound measurements (including static and
      dynamic evaluations) of the median nerve, pinch grip strength and will be repeated after four
      weeks (T1; preoperative period) and four weeks following surgery (T2; postoperative period).

      Feasibility metrics will be analyzed using descriptive statistics. A significant interaction
      between the group allocation (experimental vs. control) and time (T0 vs. T1 vs. T2) on the
      main outcomes will be evaluated using two-way mixed ANOVAs.
    

Intervention name(s): Nerve gliding exercise
Intervention type(s): Other
Intervention description(s): A 4-week home-based nerve-gliding exercise program (NGEP) including isolated and coupled upper limb and neck movements. A specific mobilization was elaborated for each week of the program allowing to gradually increase the range of movement and inter-articular coordination.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be allocated in two groups to receive either the experimental intervention (i.e., nerve gliding exercise program) or control intervention (i.e., no treatment)
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Carpal Tunnel Syndrome; Ultrasound Imaging; Preoperative Care; Exercise Therapy