Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Exp Brain Res. 2010 Nov;207(1-2):85-94. doi: 10.1007/s00221-010-2436-7. Epub 2010 Oct 16.
The aim of the current study was to identify whether hyperexcitability of the central nervous system is a prognostic factor for individuals with carpal tunnel syndrome (CTS) likely to experience rapid and clinical self-reported improvement following a physical therapy program including soft tissue mobilization and nerve slider neurodynamic interventions. Women presenting with clinical and electrophysiological findings of CTS were involved in a prospective single-arm trial. Participants underwent a standardized examination and then a physical therapy session. The physical therapy sessions included both soft tissue mobilization directed at the anatomical sites of potential median nerve entrapment and a passive nerve slider neurodynamic technique targeted to the median nerve. Pressure pain thresholds (PPT) over the median, radial and ulnar nerves, C5-C6 zygapophyseal joint, carpal tunnel and tibialis anterior muscle were assessed bilaterally. Additionally, thermal detection and pain thresholds were measured over the carpal tunnel and thenar eminence bilaterally to evaluate central nervous system excitability. Subjects were classified as responders (having achieved a successful outcome) or non-responders based on self-perceived recovery. Variables were entered into a stepwise logistic regression model to determine the most accurate variables for determining prognosis. Data from 72 women were included in the analysis, of which 35 experienced a successful outcome (48.6%). Three variables including PPT over the C5-C6 joint affected side <137 kPa, HPT carpal tunnel affected side <39.6º and general health >66 points were identified. If 2 out of 3 variables were present (LR + 14.8), the likelihood of success increased from 48.6 to 93.3%. We identified 3 factors that may be associated with a rapid clinical response to both soft tissue mobilization and nerve slider neurodynamic techniques targeted to the median nerve in women presenting with CTS. Our results support that widespread central sensitization may not be present in women with CTS who are likely to achieve a successful outcome with physical therapy. Future studies are now necessary to validate these findings.
本研究旨在确定中枢神经系统的高兴奋性是否是腕管综合征（CTS）患者的预后因素，这些患者在接受包括软组织松解和神经滑液神经动力学干预在内的物理治疗方案后，可能会迅速出现临床自我报告的改善。患有临床和电生理发现为 CTS 的女性参与了一项前瞻性单臂试验。参与者接受了标准化检查，然后进行了物理治疗。物理治疗包括针对潜在正中神经卡压解剖部位的软组织松解，以及针对正中神经的被动神经滑液神经动力学技术。双侧评估正中神经、桡神经和尺神经、C5-C6 椎间关节、腕管和胫骨前肌的压力疼痛阈值（PPT）。双侧评估腕管和大鱼际的热探测和疼痛阈值，以评估中枢神经系统兴奋性。根据自我感知的恢复情况，将受试者分为有反应者（获得成功结果）或无反应者。将变量输入逐步逻辑回归模型，以确定最准确的变量来确定预后。共有 72 名女性的数据纳入分析，其中 35 名女性获得成功（48.6%）。有 3 个变量包括患侧 C5-C6 关节的 PPT<137kPa、HPT 腕管患侧<39.6°和一般健康评分>66 分。如果 3 个变量中有 2 个存在（LR+14.8），成功的可能性从 48.6%增加到 93.3%。我们确定了 3 个因素，这些因素可能与女性 CTS 对软组织松解和神经滑液神经动力学技术针对正中神经的快速临床反应相关。我们的研究结果支持这样一种观点，即广泛的中枢敏化可能不存在于那些通过物理治疗可能获得成功结果的 CTS 女性中。现在需要进一步的研究来验证这些发现。
