Short-term Effects of Neurodynamic Techniques for Treating Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis

Abstract

Objectives We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological status, grip strength, and pinch strength in people with carpal tunnel syndrome (CTS); and (2) to estimate the effect of neurodynamic techniques compared to other physical therapy modalities and surgical interventions. Design Intervention systematic review with meta-analysis. Literature Search We searched the MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Physiotherapy Evidence Database, and Scopus databases from their inception to September 2020. Study Selection Criteria We included randomized controlled trials reporting the effect of neurodynamic techniques on pain, symptom severity, function, distal motor latency, grip strength, and pinch strength in people with CTS. Data Synthesis Using the DerSimonian-Laird method, we estimated pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of the evidence of each pairwise comparison. Results There were 22 trials included (n = 1203 people with CTS; mean age, 26.0 to 57.9 years; mean symptom duration, 4.1 to 62.8 months). There was very low–certainty evidence of neurodynamic techniques improving pain (SMD, −0.54; 95% CI: −0.95, −0.13) and function (SMD, −0.35; 95% CI: −0.61, −0.09). There was no significant effect on symptom severity (very low certainty), distal motor latency (very low certainty), and grip and pinch strength (low certainty). Conclusion Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low–certainty evidence. J Orthop Sports Phys Ther 2021;51(12):566–580. Epub 16 Nov 2021.doi:10.2519/jospt.2021.10533

Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome

“…However, study by Wolny and Linek (n = 180) found clinically important benefit for the neurodynamic group in the BCTQ symptom severity score (mean difference 1.22 points; 95% 1.1 to 1.4 points), BCTQ functional scale (mean difference 0.9; 0.7 to 1.1) and pain (mean difference 4.53 points; 95% CI 4.17 to 4.79) [62]. The results from the latter study are profoundly inconsistent with the other trials included in the systematic review [61]. Wolny and Linek have also published an open-label trial (n = 122) comparing neurodynamic techniques with no intervention (unblinded participants) showing essentially similar results as the sham-controlled trial [63].…”

“…A recent systematic review assessed the effect of neurodynamic techniques and found no clinically important benefit in pain or the BCTQ symptom severity score when they pooled data from trials with various control treatments [61]. Two sham-controlled trials were included in this review.…”

The Effect of Neurodynamic Techniques on the Dispersion of Intraneural Edema: A Systematic Review with Meta-Analysis

“…There is evidence about the positive effects of neurodynamic techniques on pain and functionality in peripheral entrapment neuropathies related to carpal tunnel syndrome [ 11 ], chronic low back pain [ 12 , 13 ], cervicobrachial pain syndrome [ 12 , 14 ], cubital tunnel syndrome [ 15 ], osteoarthritis pain of the hand [ 16 ], and plantar heel pain [ 12 ]. Although it is hypothesized that these techniques could have positive impacts on entrapment neuropathy symptoms by improving intraneural blood flow, axoplasmic flow, and neural connective tissue viscoelasticity and reducing intraneural edema and mechanosensitivity [ 9 ], they have not been validated.…”

Comparative Effects of Neurodynamics With and Without Wrist Splint in patients with Carpal Tunnel Syndrome

“…Prevalence of this syndrome in US population is 3.72% and its incidence is 139.4 females out of 100 000 and 67.2 males out of 100 000 11 . There are many causes for this syndrome such as metabolic diseases, tendinitis, tendinosis, repetitive wrist activities, gripping activities ,constant pressure over median nerve, fracture of carpal bones, poor posture, lesions of median nerve , any trauma, arthritic changes and pregnancy but many have idiopathic cause 12,13,14 . The most common characteristics is tenderness and pain especially at night 15,16 .…”

“…Kinesio taping can also be used for same purpose.When conservative treatment fails surgery is recommended in severe cases but there can be surgery related complications and failure 25 . Nonsurgical treatment also includes NSAIDs and Steroids 12,26,27 .…”