Sensory Nerve Conduction Velocity Predicts Improvement of Hand Function with Nerve Gliding Exercise Following Carpal Tunnel Release Surgery

Abstract

This study aims to investigate the effects of nerve gliding exercise following carpal tunnel release surgery (NGE-CTRS) and the probing factors affecting the effect of NGE-CTRS on hand function. A total of 86 patients after CTRS participated. Grip strength (grip-s), pinch strength (pinch-s), Semmes-Weinstein monofilament test (SWMT), two-point discrimination (2PD), numbness, pain, and Phalen test (Phalen) were measured and compared between pre- and post-NGE-CTRS. The results showed that the combination of surgery and NGE significantly improved the postoperative grip-s, pinch-s, SWMT, 2PD, numbness, and Phalen; however, no improvement was observed in pain. Background factors that influenced the improved grip-s and pinch-s included gender and preoperative sensory nerve conduction velocity (SCV). Additionally, numbness and Phalen were not affected by age, gender, fault side, bilateral, trigger finger, dialysis, thenar eminence atrophy, motor nerve conduction velocity, SCV, the start of treatment, and occupational therapy intervention. In conclusion, the combination of surgical procedures and NGE showed a high improvement. SCV and time-to-start treatment of intervention for carpal tunnel syndrome may be useful in predicting the function after the intervention.

The Relevance of Collision Tests and Quantitative Sensory Testing in Diagnostics and Postoperative Outcome Prediction in Carpal Tunnel Syndrome

“…In our study, improvement based on the Hi-Ob scale was seen in 54.3% of the patients in comparison to other studies showing an improvement in about or sometimes above 80% of patients ( 22 , 23 , 26 , 36 , 37 ). The observation time was not very long; therefore, we might anticipate further improvement after the end of our study.…”

“…In all our patients, an open, minimally invasive method was performed, with a surgical incision above the flexor cord or on the level of the metacarpus with immediate neuromobilization and fitness exercises after the operation. Surgical treatment of CTS, regardless of the method used, is thought to be a safe therapy ( 21 – 23 ). None of our patients reported any complications, and none of them required reoperation within the period of observation.…”

Multiple Concurrent Decompressions for the Treatment of Upper Extremity Pain

“…Nerve glide exercises serve to stretch and minimize adhesions through direct mobilization, reduce perineural edema, improve venous return, and decrease pressure within the nerve. 13 , 14 , 15 In the early postoperative period, patients often report changes in their symptoms, such as increased tingling, sensation, and, in some cases, improvement in motor and sensory function. In our cohort, the patients reported improvements in the severity of their pain and quality of life early and were maintained until the final follow-up.…”

The effect of median nerve mobilization on two point discrimination

“…While the sensory fibers of the median nerve pass more superficially in the thenar region, the motor fibers pass deeply. In the applied median nerve mobilization; In the stretching position on the wall, the radix of the median nerve is relaxed by moving the head to the opposite side, and the nerve’s trace is stretched by extending the arm 21 , 22 , 23 ) . Thus, a stretch is obtained along the median nerve line, and the increase in the activation of the sensory fibers of the median nerve superficial in the thenar region with this application is thought to be the reason for the improvement in TPD values.…”

“…There are studies in the literature showing that as the sensitivity of the median nerve increases, an improvement can be seen in the dermatomes it spreads and the functionality of the hand muscles innervated by the nerve 23 ) . Previous studies have included nerve gliding exercises, often involving the distal part of the median nerve, in disease states mostly caused by nerve compression and injury, and results on sensory discrimination appear to be inconsistent 13 , 23 ) .…”