Neurodynamic Sequencing in Patients With Carpal Tunnel Syndrome

Study Overview
=================
Brief Summary
-----------------
Carpal tunnel syndrome is a compressive neuropathy of median nerve in the fascial tunnel at wrist which causes pain, numbness ,and tingling in the extremities. Common treatment options used in the treatment of carpal tunnel syndrome are conservative and surgical treatment option is better, this question is still a topic requiring more and more clinical trials. Neuromobilisation described by Butler is one of the treatment options which are used in the treatment of carpal tunnel syndrome in conjunction with other conservative measures. This proposed study will find out the effectiveness of Neuromobilisation in treatment of carpal tunnel syndrome. As there is very little evidence available which Neuromobilisation technique is effective and what are the types of patients which can get benefit from this technique. This study will find out the effect of Neuromobilisation in patients suffering from carpal tunnel syndrome of non traumatic origin. This is a randomized clinical trial. Target population is patients suffering from carpal tunnel syndrome of non-traumatic origin. Data will be collected from District Headquarter Hospital Faisalabad. This study will include 56 participants according to the selection criteria. The participants will be randomly divided into two groups through sealed opaque envelop method. Group A will recruit 28 patients which fulfill the inclusion criteria. These patients will be treated by nerve sequencing proximal to distal in 3 sets of 15 repetitions in one session on alternate days for 4 weeks. Group B will recruit 28 patients which fulfill the inclusion criteria. These patients will be treated by nerve sequencing distal to proximal in 3 sets of 10 repetitions in one session for 4 weeks. The Statistical analysis will be performed through SPSS Software 21.

Official Title
-----------------
Effects of Neurodynamic Sequencing on Pain, Wrist Range of Movement and Functional Disability in Patients With Carpal Tunnel Syndrome

Conditions
-----------------
Carpal Tunnel Syndrome

Intervention / Treatment
-----------------
* Other: Neurodynamic Slider Technique from Proximal to Distal
* Other: Neurodynamic Slider Technique from Distal to Proximal


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients positive for provocative test ( Phalen's test, Wrist decompression test and tinnel test). Exclusion Criteria: Inflammation around the wrist Tumor around the wrist Rheumatoid Arthritis Osteoporosis Joint Hypermobility

Ages Eligible for Study
-----------------
Minimum Age: 25 Years
Maximum Age: 55 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Interventional Group A<br>These patients will be treated by nerve sequencing proximal to distal in 3 sets of 15 repetitions in one session on alternate days for 4 weeks. For this, participants will be given a comfortable supine lying position. ULTT method will be implemented to the ipsilateral upper limb given in the table below | Other: Neurodynamic Slider Technique from Proximal to Distal<br>* Neurodynamic Slider Technique from proximal to distal at wrist, elbow and neck<br>|
| Active Comparator: Interventional Group B<br>These patients will be treated by nerve sequencing distal to proximal in 3 sets of 10 repetitions in one session for 4 weeks. For this, participants will be given a comfortable supine lying position. ULTT method will be implemented to the ipsilateral upper limb | Other: Neurodynamic Slider Technique from Distal to Proximal<br>* Neurodynamic Slider Technique from proximal to distal at wrist, elbow and neck<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain at wrist joint | Pain will be assessed by using Numerical Pain Rating Scale Pain will be assessed by using Numerical Pain Rating Scale | 4 weeks | 
| Wrist Range of Movement at wrist joint | Range of motion will be assessed by using Goniometer | 4 weeks | 
| Functional Ability at wrist joint | Functional Ability will be assessed by using Boston Carpal tunnel syndrome | 4 weeks |