Hypoalgesic Effect of Median Nerve Neural Mobilization Compared to a Controlled Group

Study Overview
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Brief Summary
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The purpose of these study is to compare the effectivity of the Median Nerve Neural Mobilization technique to the complete absence of treatment in a group of patients who suffer cervicobrachial pain.

Detailed Description
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Median Nerve Neural Mobilization (MNNM) is a non invasive physical therapy technique that achieves pain relief through mechanical stimulation of the Median Nerve and the brachial plexus. It is believed that the hypoalgesic effect offered by the neural tissue mobilization procedure is a consequence of descending nervous system pain modulation activity and an improvement in the distinct biomechanical and sensitive properties of the involved neural tissue. The neural tissue mobilization procedure is associated to an increase in nerve mobility, edema, inflammation and intraneural pressure reduction without any known side effects when applied properly which is an important contrast to the wide variety of side effects caused by commonly used drug therapy to treat cervicobrachial pain. Despite the crescent interest among the scientific community in evidence based options to treat pain there is a current lack of enough controlled double blind clinical trials that measure the effectiveness of neural tissue mobilization techniques such as the (MNNM) and its specific effect over cervicobrachial pain. For this reason the present investigation consisted in the application of a treatment protocol based on Median Nerve Neural Mobilization in a controlled double blind clinical trial with the aim to assess its clinical effectiveness in treating pain symptoms.

Official Title
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Hypoalgesic Effect of Median Nerve Neural Mobilization in Cervicobrachial Pain Compared to a Controlled Group

Conditions
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Cervicobrachial Neuralgia

Intervention / Treatment
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* Procedure: Median Nerve Neural Mobilization
* Device: Goniometer


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of cervicobrachial pain confirmed by magnetic resonance imaging Presence of unilateral symptoms of arm pain, paresthesia or numbness in the upper extremity during at least 3 continuous months previous to the application of treatment. Positive results in all of the following tests: Spurling, Distraction, and Upper Limb Exclusion Criteria: Contraindication in the use of nonsteroidal anti-inflammatory drugs (NSAIDs) The use of any type of treatment, therapy, procedure or drug to relieve pain Patients who are under anticonvulsant, antidepressant or psychotropic medication Vertebral instability Vertebral osteoporosis Vertebral or spine infection. Neurologic diseases of genetic, infectious or neoplastic origin Cervical stenosis myelopathy Pregnancy Kinesiophobia Endocrine disorders and menopause History of spine surgery Intellectual disability, severe mental illness, intoxication, severe sleep deprivation, Alzheimer's disease.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Median Nerve Neural Mobilization<br>15 minute Median Nerve Neural Mobilization sessions 3 times a week during 6 continuous weeks.The maximum degree of elbow extension applied in the Median Nerve neural mobilization procedure was determined through the use of a Universal Goniometer Device. | Procedure: Median Nerve Neural Mobilization<br>* Nonsurgical noninvasive Median Nerve neural mobilization procedure was applied by a physical therapist continuously during 2 minutes in 5 different occasions with 1 minute of rest between each 2 minute application of the Neural Mobilization technique. The intervention was applied during a period of 6 weeks. The maximum level of elbow extension movement degree without the reproduction of symptoms during the application of the Median Nerve Neural mobilization treatment was determined through the baseline use of a Universal Goniometer Device.<br>* Other names: Median Nerve Neurodynamics;Device: Goniometer<br> <br> |
| Active Comparator: Waiting list control group<br>Patients assigned to a 6 week waiting list to receive treatment | Procedure: Median Nerve Neural Mobilization<br>* Nonsurgical noninvasive Median Nerve neural mobilization procedure was applied by a physical therapist continuously during 2 minutes in 5 different occasions with 1 minute of rest between each 2 minute application of the Neural Mobilization technique. The intervention was applied during a period of 6 weeks. The maximum level of elbow extension movement degree without the reproduction of symptoms during the application of the Median Nerve Neural mobilization treatment was determined through the baseline use of a Universal Goniometer Device.<br>* Other names: Median Nerve Neurodynamics;Device: Goniometer<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline using the Numeric Rating Scale for Pain at 1 hour | the Numeric Rating scale for Pain (NRS) is an 11 point scale for patient self reporting of pain in which 0 points represents the total absence of pain and 10 points the worst state of pain, it was employed to evaluate the presence and relieve of cervicobrachial pain symptoms. | at baseline for both arms and 1 hour after the application of treatment only in the experimental arm, corresponding to intervention days 1, 9 and 18. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline of the Physical function involving the affected upper limb using the Quik DASH Scale | The disabilities of the arm quick test (Quick DASH) is a self report short questionnaire designed to measure physical function and symptoms in people with any or several musculoskeletal disorders of the upper limb. | at baseline, corresponding to intervention days 1 and 18 of treatment | 
| Cervical Rotation Range of Motion (CROM) | Cervical rotation was assessed in units of rotation degrees, using the cervical range of motion device (CROM). | at baseline for both arms and 1 hour after the application of treatment only in the experimental arm, corresponding to intervention days 1 and 18 . |