Median Nerve Excursion During Neurodynamic Mobilization

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Effect of Neck Movements on Median Nerve Longitudinal Excursion During Neurodynamic Mobilization in Patients With Carpal Tunnel Syndrome

Conditions
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CTS

Intervention / Treatment
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* Procedure: MNT1


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Carpal tunnel syndrome<br>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<br>* 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.<br>* Other names: Neurodynamic tension test;|
| Healthy control<br>Asymptomatic healthy age-matched control with no symptoms or history of upper quadrant disease, dysfunction, trauma or surgery. | Procedure: MNT1<br>* 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.<br>* Other names: Neurodynamic tension test;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in longitudinal median nerve excursion with neck flexion | Changes in median nerve excursion, as measured by ultrasonography, when the neck is moved toward flexion combined with the standard MNT1 | One day | 
| Changes in longitudinal median nerve excursion with ipsilateral neck rotation | Changes in median nerve excursion changes, as measured by ultrasonography, when the neck is moved in ipsilateral rotation combined with the standard MNT1 | One day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Median nerve,, Carpal tunnel syndrome, Neurodynamic mobilization