School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada.
School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada.
J Manipulative Physiol Ther. 2020 Jul-Aug;43(6):566-578. doi: 10.1016/j.jmpt.2019.10.007. Epub 2020 Aug 26.
Neuromobilization exercises are increasingly advocated in the conservative management of individuals with carpal tunnel syndrome (CTS), as they may mitigate CTS-related signs and symptoms via potential peripheral (ie, musculoskeletal) and central (ie, neurophysiological) adaptations. However, the mechanisms underlying these adaptations have not been studied extensively. Hence, this exploratory and mechanistic study aims to evaluate the potential peripheral and central adaptations that may result in individuals with CTS who have completed a neuromobilization program.
Fourteen individuals with CTS were evaluated before and 1 week after the completion of a 4-week neuromobilization program that incorporated median nerve sliding exercises. Pain and upper limb functional abilities were assessed using standardized questionnaires. The biological integrity and mechanical properties of the median nerve and the corticospinal excitability were quantified using musculoskeletal ultrasound imaging and transcranial magnetic stimulation, respectively.
Upon completion of the program, participants reported both large and moderate improvements in pain (P ≤ .03) and upper limb functional abilities (P = .02), respectively. The biological integrity and mechanical properties of the median nerve remained unchanged (P ≥ .22), whereas a small significant increase in corticospinal excitability (P = .04) was observed.
The proposed neuromobilization program appears promising to improve pain and upper limb functional abilities in individuals with CTS. These improvements may be preferentially mediated via central, rather than peripheral, adaptations. Future studies, especially with a larger sample size, longer intervention duration, and additional measurement times, are needed to strengthen current evidence.
神经动员练习在腕管综合征（CTS）的保守治疗中越来越受到推崇，因为它们可能通过潜在的外周（即肌肉骨骼）和中枢（即神经生理）适应来减轻 CTS 相关的体征和症状。然而，这些适应的机制尚未得到广泛研究。因此，这项探索性和机制研究旨在评估可能导致完成神经动员计划的 CTS 个体出现的潜在外周和中枢适应。
14 名 CTS 患者在完成为期 4 周的神经动员计划（包括正中神经滑动练习）后 1 周进行评估。使用标准化问卷评估疼痛和上肢功能能力。使用肌肉骨骼超声成像和经颅磁刺激分别定量评估正中神经的生物完整性和机械特性以及皮质脊髓兴奋性。
完成计划后，参与者报告疼痛（P≤.03）和上肢功能能力（P=.02）分别有较大和中度改善。正中神经的生物完整性和机械特性保持不变（P≥.22），而皮质脊髓兴奋性则有小的显著增加（P=.04）。
拟议的神经动员计划似乎有望改善 CTS 患者的疼痛和上肢功能能力。这些改善可能主要通过中枢适应而不是外周适应介导。需要未来进行研究，特别是具有更大样本量、更长干预时间和更多测量时间的研究，以加强当前证据。
