Background: Carpal tunnel syndrome is the most common compression neuropathy and affects the median nerve at the wrist, leading to decreased nerve function at that level. The disability resulting from the typical symptomatology causes absence from work and, due to its high incidence, this condition is a major public health problem. In the management of carpal tunnel syndrome, an initial conservative approach is recommended in mild and moderate cases, opting for surgical treatment in severe cases only. Among the many conservative interventions, the use of manual therapy and neurodynamic techniques is increasingly common in clinical practice, which both consider the entire course of the nerve and the various potential entrapment sites. Since this pathology is considered an entrapment syndrome, the use of neurodynamics focuses on the sliding of the nerve and its release from mechanical interfaces in order to restore its physiological function. Aim of the study: In light of the neurophysiological premises of neurodynamics and the pathophysiology of nerve compression, this study aims to examine the effectiveness of neurodynamic techniques in the conservative treatment of carpal tunnel syndrome. Materials and Methods: The research was carried out by consulting the online databases Pubmed, PEDro and Scopus. Only articles published in the last 7 years were included, which analysed the effects of neurodynamic techniques, applied in isolation or in combination with manual therapy and therapeutic exercise, on specific therapeutic outcomes in patients with carpal tunnel syndrome. Articles combining other conservative interventions, articles in languages other than English and studies whose full texts were not available have been excluded. Results: Considering the inclusion and exclusion criteria applied, 937 articles were identified in the literature, of which only 11 (n = 1176 subjects) were deemed eligible for thesis writing. In all studies, the physiotherapist applied the sliding or tensioning neurodynamic techniques, while only 5 studies also involved the patient performing neurodynamic exercises independently. All analysed articles showed positive effects following conservative treatment with neurodynamic techniques in the different outcome measures, supporting the choice of their use in the conservative management of patients with carpal tunnel syndrome. Conclusions: Current scientific evidence seems to support conservative management strategies that contemplate, in addition to median nerve involvement in carpal tunnel, non-local changes and peripheral and central sensitisation processes, resulting in treatments that consider the entire nerve course and anatomical structures that may constitute potential pathological mechanical interfaces. Therefore, the use of neurodynamic techniques, in isolation or in combination with manual therapy techniques or therapeutic exercises, turns out to produce positive effects, both in the short and long term, on pain, functional status, symptom severity and nerve conduction in patients with carpal tunnel syndrome. Further studies are needed to determine which neurodynamic techniques, sliders or tensioners, are the most effective for this condition.
Background: La sindrome del tunnel carpale è la neuropatia da compressione sintomatica più comune e interessa il nervo mediano a livello del polso, determinando una diminuzione della funzione del nervo a quel livello. La disabilità indotta dalla sintomatologia tipica è motivo di assenza dal lavoro e, a causa dell’elevata incidenza, questa patologia costituisce un importante problema di salute pubblica. Nella gestione della sindrome del tunnel carpale è consigliato un primo approccio conservativo nei casi lievi e moderati, riservando il trattamento chirurgico ai casi più severi. Tra i molteplici interventi conservativi, nella pratica clinica è sempre più comune l’impiego della terapia manuale e delle tecniche neurodinamiche, le quali prevedono entrambe un approccio che considera l’intero decorso del nervo e i diversi potenziali siti di intrappolamento. L’utilizzo della neurodinamica in questa patologia, considerata una sindrome da intrappolamento, si fonda proprio sullo scorrimento del nervo e sulla sua liberazione da interfacce meccaniche, al fine di ripristinare la sua funzione fisiologica. Obiettivo dello studio: Considerata la patofisiologia della compressione nervosa e le premesse neurofisiologiche della neurodinamica, questo studio ha lo scopo di esaminare l’efficacia delle tecniche neurodinamiche nel trattamento conservativo della sindrome del tunnel carpale. Materiali e Metodi: La ricerca è stata effettuata consultando le banche dati online Pubmed, PEDro e Scopus. Sono stati inclusi solo articoli pubblicati negli ultimi 7 anni che analizzassero gli effetti delle tecniche neurodinamiche, applicate in isolamento oppure in associazione alla terapia manuale e all’esercizio terapeutico, su alcuni outcome terapeutici nei pazienti con sindrome del tunnel carpale. Sono stati esclusi gli articoli che combinavano altri interventi conservativi, gli articoli in lingua diversa dall’inglese e gli studi i cui full texts non erano disponibili. Risultati: Considerando i criteri di inclusione ed esclusione applicati, sono stati individuati in letteratura 937 articoli, di cui solo 11 (n = 1176 soggetti) ritenuti eleggibili per la stesura della tesi. In tutti gli studi il fisioterapista ha applicato le tecniche neurodinamiche di scorrimento o tensionamento, mentre solo 5 studi hanno previsto anche l’esecuzione di esercizi neurodinamici in autonomia da parte del paziente. Tutti gli articoli analizzati hanno mostrato effetti positivi in seguito al trattamento conservativo con tecniche neurodinamiche nelle diverse misure di outcome, supportando la scelta del loro utilizzo nella gestione conservativa dei pazienti con sindrome del tunnel carpale. Conclusioni: Le attuali evidenze scientifiche sembrano supportare strategie di gestione conservativa che considerano, oltre all’interessamento del nervo mediano nel tunnel carpale, anche cambiamenti non locali e processi di sensibilizzazione periferica e centrale, risultando in trattamenti che considerano l’intero decorso del nervo e le strutture anatomiche che possono costituire potenziali interfacce meccaniche patologiche. Si evidenzia quindi che l’utilizzo di tecniche neurodinamiche, in isolamento o in combinazione con tecniche di terapia manuale o con esercizi terapeutici, produce effetti positivi in termini di dolore, stato funzionale, severità dei sintomi e conduzione nervosa nei pazienti con sindrome del tunnel carpale, sia a breve che a lungo termine. Ulteriori studi sono necessari per determinare quali tecniche neurodinamiche, sliders o tensioners, sono più efficaci per questa patologia.
LE TECNICHE NEURODINAMICHE NEL TRATTAMENTO CONSERVATIVO DELLA SINDROME DEL TUNNEL CARPALE: REVISIONE DELLA LETTERATURA
BARISON, ALESSANDRO
2021/2022
Abstract
Background: Carpal tunnel syndrome is the most common compression neuropathy and affects the median nerve at the wrist, leading to decreased nerve function at that level. The disability resulting from the typical symptomatology causes absence from work and, due to its high incidence, this condition is a major public health problem. In the management of carpal tunnel syndrome, an initial conservative approach is recommended in mild and moderate cases, opting for surgical treatment in severe cases only. Among the many conservative interventions, the use of manual therapy and neurodynamic techniques is increasingly common in clinical practice, which both consider the entire course of the nerve and the various potential entrapment sites. Since this pathology is considered an entrapment syndrome, the use of neurodynamics focuses on the sliding of the nerve and its release from mechanical interfaces in order to restore its physiological function. Aim of the study: In light of the neurophysiological premises of neurodynamics and the pathophysiology of nerve compression, this study aims to examine the effectiveness of neurodynamic techniques in the conservative treatment of carpal tunnel syndrome. Materials and Methods: The research was carried out by consulting the online databases Pubmed, PEDro and Scopus. Only articles published in the last 7 years were included, which analysed the effects of neurodynamic techniques, applied in isolation or in combination with manual therapy and therapeutic exercise, on specific therapeutic outcomes in patients with carpal tunnel syndrome. Articles combining other conservative interventions, articles in languages other than English and studies whose full texts were not available have been excluded. Results: Considering the inclusion and exclusion criteria applied, 937 articles were identified in the literature, of which only 11 (n = 1176 subjects) were deemed eligible for thesis writing. In all studies, the physiotherapist applied the sliding or tensioning neurodynamic techniques, while only 5 studies also involved the patient performing neurodynamic exercises independently. All analysed articles showed positive effects following conservative treatment with neurodynamic techniques in the different outcome measures, supporting the choice of their use in the conservative management of patients with carpal tunnel syndrome. Conclusions: Current scientific evidence seems to support conservative management strategies that contemplate, in addition to median nerve involvement in carpal tunnel, non-local changes and peripheral and central sensitisation processes, resulting in treatments that consider the entire nerve course and anatomical structures that may constitute potential pathological mechanical interfaces. Therefore, the use of neurodynamic techniques, in isolation or in combination with manual therapy techniques or therapeutic exercises, turns out to produce positive effects, both in the short and long term, on pain, functional status, symptom severity and nerve conduction in patients with carpal tunnel syndrome. Further studies are needed to determine which neurodynamic techniques, sliders or tensioners, are the most effective for this condition.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/38653