Reduced movement of median nerve in carpal tunnel during wrist flexion in patients with non-specific arm pain

doi:10.1016/S0140-6736(99)02958-X

The Lancet

Volume 354, Issue 9174, 17 July 1999, Pages 217-218

https://doi.org/10.1016/S0140-6736(99)02958-X Get rights and content

Summary

Magnetic resonance scans on patients with non-specific arm pain (repetitive strain injury) show reduced median-nerve movement in the carpal tunnel, suggesting that this common condition may involve nerve entrapment.

References (5)

J Greening et al.
Minor peripheral nerve injuries: an underestimated source of pain?
Man Ther
(1998)
J Greening et al.
Vibration sense in the upper limb in patients with repetitive strain injury and a group of at risk office workers
Int Arch Occup Environ Health
(1998)

There are more references available in the full text version of this article.

Cited by (70)

Neurofascialvascular training for carpal tunnel syndrome as an evolution of neurodynamic treatment: A case report
2024, Journal of Bodywork and Movement Therapies
In this case report a new approach called neurofascialvascular training (NFVT) is described. NFVT consists of two mechanisms which improve mechanosensitivity in carpal tunnel syndrome (CTS). The first involves increased blood flow in the nerve microcirculation, while the second stimulates the reciprocal sliding between the thin sheets of connective tissue inside the nerve. The goal of these two actions is to squeeze, mobilize and reduce intraneural edema. The novelty of this approach is the simultaneous involvement of multiple physiological systems to reduce nerve mechanosensitivity. This case report describes the rehabilitation progress achieved by NFVT in a patient with CTS.
A 64-year-old woman complaining of nocturnal pain and tingling with severe impairment of sleep quality for two years was diagnosed at CTS.
The patient underwent nine 30-min exercise sessions of NFVT.
At each session and at the last follow-up 3 months after the end of treatment the following tests were performed: the upper limb neurodynamic test1 (ULNT1), the Hand Grip Meter and the Phdurkan test. Furthermore ultrasound, numerical rating scale and the Boston Carpal Tunnel Questionnaire (BCTQ) were also adopted.
NFVT can improve symptoms and motor dysfunction in a patient with CTS.
In the presence of mild carpal tunnel syndrome, active neurofascialvascular training that increases peripheral blood flow and targets fascial tissue within the peripheral nervous system can resolve symptoms and produce significant improvement within a few months of starting treatment.
Carpal tunnel mechanics and its relevance to carpal tunnel syndrome
2023, Human Movement Science
The carpal tunnel is an elaborate biomechanical structure whose pathomechanics plays an essential role in the development of carpal tunnel syndrome. The purpose of this article is to review the movement related biomechanics of the carpal tunnel together with its anatomical and morphological features, and to describe the pathomechanics and pathophysiology associated with carpal tunnel syndrome. Topics of discussion include biomechanics of the median nerve, flexor tendons, subsynovial tissue, transverse carpal ligament, carpal tunnel pressure, and morphological properties, as well as mechanisms for biomechanical improvement and physiological restoration. It is our hope that the biomechanical knowledge of the carpal tunnel will improve the understanding and management of carpal tunnel syndrome.
Morphological and positional changes of the carpal arch and median nerve associated with wrist deviations
2020, Clinical Biomechanics
Citation Excerpt :
Conversely, wrist extension decreased the palmar bowing, arch area, and nerve circularity while displacing the nerve palmarly, accounting for the reduction of TCL-nerve distance. The decrease in nerve circularity and TCL-nerve distance with extension agree with the observations by Greening et al. (1999), suggesting increased physical contact between the ligament and nerve. However, previous studies reported that carpal tunnel area (including both palmar ligament and dorsal bone arches) decreased with wrist flexion and increased with wrist extension (Skie et al., 1990; Yoshioka et al., 1993).
Carpal tunnel and median nerve dynamically change with wrist motion. The purpose of this study was to investigate the morphological changes and positional migration of the carpal arch and median nerve, as well as nerve-arch positional relationship associated with wrist deviation in healthy volunteers.
Twenty asymptomatic male volunteers performed wrist motion from neutral to deviated positions combining flexion-extension and radioulnar deviation. Ultrasound images of the carpal arch and median nerve at the distal carpal tunnel were collected during wrist motion. Morphological and positional parameters of the carpal arch and median nerve were derived from the ultrasound images.
Carpal arch height, area, and palmar bowing of the transverse carpal ligament (TCL) increased with flexion related wrist motion and decreased with extension related motion (P < 0.05). Arch width increased with radial flexion and decreased with extension and ulnar extension (P < 0.05). Median nerve circularity increased with flexion and radial flexion but decreased with extension, ulnar extension, and ulnar deviation (P < 0.05). Nerve centroid displaced ulnarly with radial deviation, radial flexion, and radial extension and displaced radially with ulnar deviation, ulnar flexion, and ulnar extension (P < 0.05). Nerve centroid displaced in the dorsal direction with flexion and radial flexion, but in the palmar direction with extension (P < 0.05). Nerve-TCL distance increased with flexion related motion and decreased with extension relation motion (P < 0.05).
The current study advances our understanding the effect of wrist motion on the carpal tunnel and its contents, which has implications for pathomorphological and pathokinematic changes associated with wrist disorders.
Neurodynamic Techniques Versus “Sham” Therapy in the Treatment of Carpal Tunnel Syndrome: A Randomized Placebo-Controlled Trial
2018, Archives of Physical Medicine and Rehabilitation
To evaluate the efficacy of neurodynamic techniques used as the sole therapeutic component compared with sham therapy in the treatment of mild and moderate carpal tunnel syndromes (CTS).
Single-blinded, randomized placebo-controlled trial.
Several medical clinics.
Volunteer sample of patients (N=250) diagnosed with CTS (n=150).
Neurodynamic techniques were used in the neurodynamic techniques group, and sham therapy was used in the sham therapy group. In the neurodynamic techniques group, neurodynamic sequences were used, and sliding and tension techniques were also used. In the sham therapy group, no neurodynamic sequences were used, and therapeutic procedures were performed in an intermediate position. Therapy was conducted twice weekly for a total of 20 therapy sessions.
Symptom severity (symptom severity scale) and functional status (functional status scale) of the Boston Carpal Tunnel Questionnaire.
A baseline assessment revealed no intergroup differences in all examined parameters (P>.05). After therapy, there was statistically significant intragroup improvement in nerve conduction study (sensory and motor conduction velocity and motor latency) only for the neurodynamic techniques group (P<.01). After therapy, intragroup statistically significant changes also occurred for the neurodynamic techniques group in pain assessment, 2-point discrimination sense, symptom severity scale, and functional status scale (in all cases P<.01). There were no group differences in assessment of grip and pinch strength (P>.05).
The use of neurodynamic techniques has a better therapeutic effect than sham therapy in the treatment of mild and moderate forms of CTS.
Neurodynamics
2017, Clinical Orthopaedic Rehabilitation: A Team Approach, Fourth Edition
Work related upper limb disorders
2014, Indian Journal of Rheumatology
Neuropathic arm pain (NAP), commonly referred to as ‘RSI’, diffuse upper limb disorder or type II work related upper limb disorder (WRULD) is a regional pain syndrome affecting the upper limb(s), characterized by persistent pain and dysaesthesiae. It is commonly associated with long periods of keyboard use, though may also occur in workers engaged in other types of repetitive stereotyped activities of the hands. Adverse ergonomics is commonly present. Sleep pattern is usually disturbed, and depression, headaches, chronic fatigue, and frustration are frequently experienced. The pathogenesis of NAP is probably linked to overloading of sensorineural mechanisms responsible for pain production and perception. Clinical findings include muscle tension and hyperalgesia in the upper limbs and shoulder girdles, adverse neural dynamics, and frequently (and importantly) proximal dorsal spinal dysfunction. Other factors that are often associated with the development of neurosensitisation include premorbid psychological profile, environmental stresses, misattributions and beliefs, adverse posture and ergonomics, iatrogenesis, and litigation. Conventional investigations such as cervicodorsal spinal radiographs, nerve conduction studies, and MRI are negative. Clinical management is structured on reduction of provocative stresses and treatment of neuromusculoskeletal dysfunction. The differential diagnosis is discussed in this article.

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Research LettersReduced movement of median nerve in carpal tunnel during wrist flexion in patients with non-specific arm pain

Summary

Man Ther

Vibration sense in the upper limb in patients with repetitive strain injury and a group of at risk office workers

Int Arch Occup Environ Health

Research Letters
Reduced movement of median nerve in carpal tunnel during wrist flexion in patients with non-specific arm pain