Efficacy of neurodynamic techniques in conservative treatment of carpal tunnel syndrome (CTS).

INTERVENTION: Arm. 1 ‐ Group 1 (neurodynamic techniques treatment) ‐ gliding and tension neurodynamic techniques of median nerve, one‐direction proximal and distal glide mobilisation and one‐direction proximal and distal tension mobilisation. a. neurodynamic techniques for medial nerve – position supine, neurodynamic sequence: arm adduction 90 degrees and external rotation, wrist and finger extension, forearm supination, elbow extension; one‐direction proximal glide mobilisation (movement – elbow extension –large amplitude of motion), one‐direction distal glide mobilisation (movement – wrist extension –large amplitude of motion), one‐direction proximal tension mobilisation (movement – elbow extension –small amplitude of motion et the end of the movement), one‐direction distal tension mobilisation (movement – wrist extension – small amplitude of motion et the end of the movement). Standard protocol consisted of three series of 60 repetitions of glide and tension neurodynamic techniques separated by inter‐series intervals of 15 s, twice a week for 10 sessions. The therapy will be performed by physiotherapists with more than 10 years of experience in neurodynamic techniques. The study will be performed in 2 medical clinics in the Silesia province of Poland. Approximate duration of each session – 15 minutes. Arm. 2 ‐ Group 2 (placebo treatment) – sham gliding and tension neurodynamic techniques of median nerve, one‐direction proximal and distal glide mobilisation and one‐direction proximal and distal tension mobilisation. a. neurodynamic techniques for medial nerve – position supine, without neurodynamic sequence – upper extremity in neutral position; one‐direction proximal glide mobilisation (movement – elbow extension –large amplitude of motion), one‐direction distal glide mobilisation (movement – wrist extension –large amplitude of motion), one‐direction proximal tension mobilisation (movement – elbow extension –small amplitude of motion et the end of the movement), one‐direction distal tension mobilisation (movement – wrist extension – small amplitude of motion et the end of the movement). Standard protocol consisted of three series of 60 repetitions of glide and tension neurodynamic techniques separated by inter‐series intervals of 15 s, twice a week for 10 sessions. The therapy will be performed by physiotherapists with more than 10 years of experience in neurodynamic techniques. The study will be performed in 2 medical clinics in the Silesia province of Poland. Approximate duration of each session – 15 minutes. CONDITION: carpal tunnel syndrome PRIMARY OUTCOME: Feeling two‐point discrimination: ; The examination of two‐point discrimination sensation was performed with the use of its static variety by assessing innervation density in slowly adapting touch receptors. A standardised Dellon discriminator was used for the study Nerve conduction: ; Examinations of nervous conduction is performed in the electromyography laboratory by experienced personnel. The examination is performed by an antidromic method using a Neuro‐Mep instrument, with superficial electrodes. ; Nerve conduction study is performed on median nerve. neuropathy symptom score (Boston Carpal Tunnel Questionnaire ‐ BCTQ) ; SECONDARY OUTCOME: Grip strength ; Dynamometer Jamar ; Sensation threshold ‐ Calibrated Softip Monofilament NerveTester – WEST‐hand, Connecticute Bioinstruments, USA) Severity of pain: ; Laitinen scale and a Numerical Pain Rating Scale (NPRS), which is a subjective method of pain evaluation by the patient, was used. The range of movement ; Inclinometer Saunders overall health status ‐ ; 36 Health Survey Questionnaire INCLUSION CRITERIA: ‐ Peripheral neuropathy (CTS) diagnosed by physician ; Kinesthetic differentiation of movement (radiocarpal joint) – Saunders Inclinometer Kinesthetic differentiation of strength (cylindric and pinch grip kinaesthetic differentiation) – Jamar Dynamometer ‐ Positive nerve conduction study test ‐ Subjective and objective symptoms of peripheral neuropathy ‐ Consent to participate in research ‐ No contraindications to therapy [Subjective and objective symptoms of peripheral neuropathy: numbness and tingling in the area of the median nerve; nighttime paresthesia; positive Phalen test; positive Tinel sign; pain in the wrist area radiating to the shoulder] Inclusion criteria for healthy participants in the control group: good general health, consent to participate in the research, and a lack of symptoms listed for CTS patients.