Effect of Neurodynamic Mobilization on Median Nerve Conduction Velocity in Carpal Tunnel Syndrome

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to examine: The effect of neurodynamic mobilization on the sensory and motor median nerve conduction velocity in carpal tunnel syndrome. The effect of neurodynamic mobilization on the wrist pain in carpal tunnel syndrome. The effect of neurodynamic mobilization on the hand function in carpal tunnel syndrome.

Detailed Description
-----------------
The findings of this study will provide physiotherapists with information to know if neurodynamic mobilization techniques is effective on median nerve conduction velocity in carpal tunnel syndrome also this will improve our body of knowledge about the best modalities for treating carpal tunnel syndrome. The finding of this study may help carpal tunnel syndrome patients to avoid the exposing to complications as a result of compression of median nerve in carpal tunnel syndrome.

Official Title
-----------------
Effect of Neurodynamic Mobilization on Median Nerve Conduction Velocity in Carpal Tunnel Syndrome

Conditions
-----------------
Median Nerve Entrapment, Carpal Tunnel Syndrome

Intervention / Treatment
-----------------
* Other: conventional Treatment
* Other: Neurodynamic mobilization


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Forty carpal tunnel syndrome patients. All participants referred from a physician. Their ages range from 20-50 years old. Both genders will participate in the study. Their BMI ranges between 18.5-24.9kg/m2. All participants have carpal tunnel syndrome at least in one hand. All participants suffering from mild to moderate carpal tunnel syndrome. Exclusion Criteria: Previous or current disease or trauma that might affect one or both upper limbs. Metabolic diseases that might associated with entrapment neuropathy such as diabetes mellitus, thyroid diseases, and autoimmune diseases. Pregnant women. Participants with congenital hand deformities. History of hand surgery. Sever cases of carpal tunnel syndrome that suffering from weakness of hand grip and atrophy of thenar muscle.

Ages Eligible for Study
-----------------
Minimum Age: 20 Years
Maximum Age: 50 Years

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

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

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

Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional treatment group<br>Twenty patients will receive conventional treatment in the form of superficial heat, ultrasound with freq of 1 MHz, pulsed mode 1:4 for 5 min and stretching exercise to lumbrical muscles of the hand. | Other: conventional Treatment<br>* It consists of Superficial heat, Ultrasound therapy and stretching exercise to lumbrical muscles of the hand.<br>|
| Experimental: Neurodynamic mobilization therapy group<br>Twenty patients will receive neurodynamic mobilization therapy (upper limb tension test 1) in addition to conventional treatment. | Other: conventional Treatment<br>* It consists of Superficial heat, Ultrasound therapy and stretching exercise to lumbrical muscles of the hand.<br>Other: Neurodynamic mobilization<br>* It is the mobilisation of the nervous system as an approach to physical treatment of pain. The treatment and or assessment relies on influencing pain physiology via the mechanical treatment of neural tissues and non-neural structures surrounding the nervous system.<br>|

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

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessing the change in nerve conduction velocity of the median nerve. | By using Electromyography apparatus measuring nerve conduction velocity of the median nerve. (motor and sensory in m/s) | at baseline and after 4 weeks of intervention | 
| Assessing the change in wrist joint pain | By using Pressure pain threshold (PPT) is defined as the minimal amount of pressure that produces pain. A simple handheld pressure algometer (PA) with a spring is commonly used, although more sophisticated electrical devices with a strain or pneumatic pressure gauge have been developed. They hold the peak force or pressure (kp (kilopond) = 10 N, Newton = 100 kPa (kilopascal)) until tared, and some may also be connected to a computer and thus have continuous output. PPT measured with a probe 1.6 mm in diameter or larger reflects the tenderness of deep tissues as anesthesia of skin only affects the results of smaller probes. | at baseline and after 4 weeks of intervention | 
| Assessing the change in functional activity of the hand | By using Modified DASH questionnaire will be used for functional activity of the hand. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a 30-item questionnaire that looks at the ability of a patient to perform certain upper extremity activities. This questionnaire is a self-report questionnaire that patients can rate difficulty and interference with daily life on a 5 point Likert scale. The QuickDASH tool uses a 5-point Likert scale from which the patient can select an appropriate number corresponding to his/her severity/function level. | at baseline and after 4 weeks of intervention |