Nerve Gliding Research Articles

The emerging field of ultrasound-guided nerve decompression surgery: a narrative review.

The development of high-frequency ultrasound technology has transformed musculoskeletal diagnostic practices, offering detailed, multi-plane visualization of superficial structures with remarkable precision and comfort. This non-invasive, pain-free modality is particularly suited for patients of all ages, including children. Ultrasound serves as a valuable adjunct to clinical evaluations by facilitating the identification of conditions such as tumours, tenosynovitis, fractures, and nerve entrapments. Portable ultrasound devices have further expanded its utility to clinical, surgical, and emergency settings. Dynamic assessments, such as nerve gliding and entrapment detection, benefit from its precision, enabling targeted therapeutic interventions with minimal risks. The integration of ultrasound into surgical techniques, termed ultrasonosurgery, allows for minimally invasive management of conditions like carpal tunnel syndrome and other nerve compressions. By leveraging high-resolution imaging, these procedures can be performed under local anaesthesia, minimizing traditional surgical complications. This innovative approach aligns with contemporary healthcare trends emphasizing wide-awake surgeries, office-based care, mini-invasive procedures, and technological advancements. Such practices not only streamline patient care but also reduce costs and improve outcomes.

EFFECTS OF DEEP TRANSVERSE FRICTION MASSAGE ALONG WITH NERVE GLIDING EXERCISES IN THE MANAGEMENT OF CARPAL TUNNEL SYNDROME PATIENTS

Background: Carpal Tunnel Syndrome (CTS) is a prevalent condition characterized by discomfort, pain, and functional impairment due to median nerve compression. Conservative treatment approaches aim to manage symptoms and improve functionality. Among these, manual therapies such as Deep Transverse Friction Massage (DTFM) and Nerve Gliding Exercises (NGEs) have shown promise in addressing both neural and mechanical dysfunctions. This study evaluates the combined effects of DTFM and NGEs in alleviating CTS symptoms and enhancing functional outcomes. Objective: To investigate the effects of Deep Transverse Friction Massage combined with Nerve Gliding Exercises in the management of Carpal Tunnel Syndrome. Methods: This randomized clinical trial employed a non-probability purposive sampling technique to recruit 56 participants aged 20–40 years with CTS, confirmed by positive Phalen’s, Tinel’s, and Duncan’s tests, and moderate pain levels (VAS 4–7). Patients were randomly assigned to Group A (DTFM + NGEs) or Group B (NGEs alone). The intervention spanned four weeks, with two sessions per week. Outcome measures included pain (Visual Analog Scale), wrist range of motion (goniometer), grip strength (handheld dynamometer), and functional disability (Boston Scale). Statistical analyses were conducted using SPSS version 20, employing the Friedman test for intragroup analysis and the Mann-Whitney U test for intergroup comparisons. Results: Group A showed significant improvements across all variables compared to Group B. Pain reduction demonstrated a highly significant difference (p < 0.000) post-intervention, with improved wrist flexion (p = 0.05) and extension (p = 0.056). Grip strength increased significantly (p < 0.000), and functional disability scores were notably better in Group A (p < 0.000). The findings indicate the superior efficacy of the combined intervention over nerve gliding exercises alone. Conclusion: The combination of Deep Transverse Friction Massage and Nerve Gliding Exercises proved significantly more effective than NGEs alone in managing pain, improving wrist mobility, enhancing grip strength, and reducing functional disability in patients with Carpal Tunnel Syndrome.

Penyuluhan Pemberian Transcutaneous Electrical Nerve Stimulation (TENS) dan Tendon and Nerve Gliding Exercise untuk Menurunkan Nyeri Carpal Tunnel Syndrome pada Pekerja Kantor Dinas Kesehatan Lingkungan di Sulawesi Tenggara

Carpal tunnel syndrome is a condition where the median nerve in the wrist is compressed, causing symptoms such as tingling, numbness and pain in the hand. Outreach activities are carried out to educate workers about carpal tunnel syndrome such as signs of symptoms, how to prevent it and how to reduce pain complaints with tendon and nerve gliding exercise which can be done at home. The method used in this outreach was to provide leaflets and ask several pretest posttest questions to determine the knowledge of workers about carpal tunnel syndrome. The results of this activity showed an increase in understanding regarding the definition, signs and symptoms of carpal tunnel syndrome with a percentage before counseling of 10% increasing to 100% understanding of the causes of carpal tunnel syndrome. The percentage before counseling was 5% and increased to 100% as well as an understanding of tendon and nerve gliding exercise. stretching obtained before counseling 0% increased to 100%.

EKSTRAK JAHE DAN KOMBINASI EKSTRAK JAHE DENGAN NERVE GLIDING EXERCISE UNTUK MENURUNKAN NYERI PERGELANGAN TANGAN

Abstract Wrist pain is a condition where an individual experiences discomfort in the wrist, which both traumatic and non-traumatic factors can cause. Non-traumatic wrist pain often results from inflammation in the tissues around the carpal tunnel, leading to its narrowing. This condition is commonly seen in activities that involve prolonged and repetitive hand movements, such as in batik artisans. This study aimed to determine the effect of ginger extract and the combination of ginger extract with nerve gliding exercise on wrist pain in batik artisans in Papringan Village, Banyumas. This study employed a pre-experimental design with a two-group pretest-posttest approach. The population consisted of batik artisans in Papringan Village, with a sample size of 20 individuals selected using a total sampling technique. Data analysis included both univariate and bivariate analyses. The study found a significant effect of ginger extract and the combination of ginger extract with nerve gliding exercise on reducing wrist pain. Wrist pain experienced a reduction and had a substantial effect, as evidenced by a high correlation coefficient.

Effectiveness of Contrast Bath and Nerve Gliding Exercises in Carpal Tunnel Syndrome Among Software Workers

Carpal Tunnel Syndrome (CTS) is a complex symptom resulting from compression of the median nerve at the carpal tunnel. Locations of monitors, keyboard (or) mouse are associated with musculoskeletal problems. Among musculoskeletal problems, Carpal tunnel syndrome (CTS) is commonly reported in computer professionals. The purpose of this study was to examine the effectiveness of contrast bath and nerve gliding exercises for carpal tunnel syndrome in software workers. 30 subjects (20 males and 10 females) were participating in this study based on inclusion and exclusion criteria. They were assigned into groups Group A and B with 15 subjects each. Group A (Experimental group) received Contrast bath and Nerve Gliding Exercises, while Group B (Control group) received conventional exercises for the wrist. The outcome measures used were NPRS and ROM. Statistical analysis was done using paired-t test. On comparing the pre-test and post-tests within Group A & Group B on the Numerical Pain Rating Scale (NPRS), wrist flexion and extension Range of Motion (ROM) show a significant difference in mean values at P ≤ 0.001. There was a significant difference in the mean values of NPRS (6.33 to 3.40), wrist flexion (54.00 to 72.66), and wrist extension (55.66 to 72.80) in subjects from Group A who underwent contrast bath and nerve gliding exercises, compared to the significant difference in the mean values of NPRS (6.26 to 4.46), wrist flexion (53.66 to 63.00), and wrist extension (56.00 to 61.66) in subjects from Group B, which served as the control group.

Effectiveness of Sciatic Nerve Gliding with Hip Abductor Muscle Strengthening in Software Professionals Suffering from Piriformis Syndrome

Background: Piriformis syndrome is a neuromuscular disorder where the sciatic nerve is compressed or irritated by the inflammation of piriformis muscle representing pain, tingling and numbness in the buttock region and in the course of sciatic nerve. Piriformis syndrome can be painful, but it is very rarely alarming and needs surgical interventions. It can be managed effectively by conservative means such as NSAIDS, analgesics and physiotherapy interventions like stretching, electro therapeutic modalities, myofascial release, thermo therapies, etc. The purpose of this study is to compare the effect of sciatic nerve gliding exercise with hip abductor strengthening exercises versus piriformis stretching exercises in software professionals who are sitting for prolong hours in office and diagnosed with piriformis syndrome. Materials & Methods: 30 patients with piriformis syndrome, reporting at the OPD of Physiotherapy Department were evaluated according to the inclusion and exclusion criteria and were divided into Group A (experimental) N=15, Group B (control) N=15 randomly. Their baseline data with respect to age, sex, pain in VAS, hip internal rotation range by goniometer, and disability evaluation by MODQ were taken on day 1 of the treatment and day 15 of the treatment. Data analysis was done by Mann Whitney ‘u’ test for subjective data and unpaired ‘t’ test for objective data analysis with 95%confidence interval. Results: The patients treated with sciatic nerve sliding exercise and abductor strengthening (Group A) showed statistically significant decrease in pain (p=0.00), increase in range of motion for hip internal rotation (p=0.00) and decrease in disability level according to MODQ (p=0.00) after 15 days of interventions as compared to Group B who were treated by piriformis stretching exercises. Conclusion: This study has shown significant improvement in the experimental group (group A) in respect to pain relief, hip internal rotation range of motion, and .......

Successful evaluation of a new image-based parameter for the diagnosis of carpal tunnel syndrome: ultrasound assessment of longitudinal median nerve gliding in patients, healthy volunteers, and cadavers.

Reduced longitudinal median nerve gliding is a new promising diagnostic feature in carpal tunnel syndrome (CTS). However, the complexity of existing ultrasound analysis protocols undermines the application in routine clinical practice. To provide a simple method for assessing longitudinal gliding with ultrasound, without the need for post-hoc image analysis. 1) Retrospective cohort study, validation by external blinded reviewers; 2) proof of concept in body donors. 1) Outpatient clinic; 2) anatomy department. The population included 48 patients with idiopathic CTS diagnosed by electrodiagnostic testing and ultrasound, as well as 15 healthy controls. Twelve, non-frozen, non-embalmed body donors were enrolled. Longitudinal gliding of the median nerve in the carpal tunnel was visualized in all patients with idiopathic CTS and healthy controls. All ultrasound videos were pseudonymized, equipped with a scale, and randomized. Videos were analyzed by four independent radiologists, all blinded to clinical characteristics. The endpoint was gliding rated as millimeters. Validity of the technique was tested by using speckle tracking software, and in body donors, directly measuring nerve excursion in situ, simultaneously to ultrasound. Gliding differed significantly between controls and patients with CTS, decreasing with incremental CTS severity. A cut-off value of 3.5 mm to identify patients with CTS, yielded 93.8% sensitivity and 93.3% specificity. Intraclass correlation coefficient among senior author and raters was 0.798 (95% CI 0.513 to 0.900, P<0.001), indicating good reliability. Speckle tracking and especially direct validation in body donors correlated well with ultrasound findings. First, longitudinal median nerve gliding can reliably be assessed using this simple technique without the need for complicated procedures. Second, a decrease in gliding was found with progressive severity of CTS. Reproducibility for measured distances is good among raters. An easy to apply sonography parameter would bolster the diagnostic ability of specialists in physical medicine and rehabilitation in daily routine.

Giving nerve and tendon gliding exercises to reduce pain in carpal tunnel syndrome

Background: Physical activity in blacksmith workers, which involves repetitive use of hand and wrist muscles, grasping tools, and forging iron, can cause symptoms of carpal tunnel syndrome (CTS), including pain that affects functional activities. This study aimed to determine whether giving Nerve Tendon Gliding Exercise can reduce pain in patients with CTS. Methods: This study used a randomized control trial design. The intervention group received the nerve gliding and tendon gliding exercises, while the control group received the nerve gliding exercise only. Sampling in this study was conducted using non-probability sampling techniques with a purposive sampling model, a sampling technique with specific considerations. The sample of this study involved respondents aged between 25 and 40 years. Furthermore, the data obtained were analyzed using the Wilcoxon and Mann-Whitney tests. Results: Analysis of the results of the effect test using the Wilcoxon Test the results p &lt;0.05 that shows an influence on the treatment group given nerve and gliding exercise with the control group given nerve gliding exercise to reduce pain. Furthermore, the analysis using the Mann-Whitney test obtained the results of the Z value = -2.757 with a p-value of 0.006 &lt;0.05, which means it shows a significant difference in influence. Conclusion: Giving Nerve Tendon Gliding Exercise shows a significant difference in the effect on the treatment group given nerve gliding exercise with the addition of tendon gliding exercise and the control group given nerve gliding exercise to reduce pain.

Additional contribution of phonophoresis and low-level laser therapy to exercise in the treatment of carpal tunnel syndrome: A clinical, electrophysiological, and ultrasonographic evaluation.

Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression syndrome. This study aims to evaluate the additive contribution of phonophoresis and low-level laser therapy (LLLT) to tendon and nerve gliding exercises electrophysiologically, ultrasonographically, and clinically in the treatment of moderate CTS. The sample consisted of 45 patients with moderate CTS, randomized into three groups. Group 1 received phonophoresis and exercise, Group 2 received LLLT and exercise, and Group 3 received exercise alone. Participants were evaluated electrophysiologically, clinically, and ultrasonographically before treatment and at the 6th and 12th weeks after the treatment. An improvement was observed in clinical parameters (Boston Functional Status Scale, Boston Symptom Severity Scale, visual analog scale at rest, and visual analog scale during activity) for all groups at the 6th and 12th weeks after the treatment (p<0.05). An improvement was also noted in the ultrasonographic parameter (cross-sectional area) for all groups at the 12th week after the treatment (p=0.017). Phonophoresis and LLLT do not provide additional effects to exercise therapy. Exercise therapy alone may positively contribute to ultrasonographic and clinical outcomes in the treatment of moderate CTS.

Case Report on the Outcome of the Scheduled Exercise and Manual Physiotherapy on A Male Patient with Failed Neck Surgery Syndrome

Pain and discomfort after spinal surgery are known as "Failed Back Surgery Syndrome (FBSS)" and "Failed Neck Surgery Syndrome (FNSS)," respectively. Understanding what triggers FBSS/FNSS is essential for treating it. Outcomes can be affected by preoperative symptoms, patient expectations, and previous surgeries. Imaging techniques including X-rays, CT scans, and MRIs help doctors diagnose physical problems. After surgical attempts have failed, conservative treatment is often suggested. A 34-year-old Indian man after cervical surgery had neuropathic neck discomfort. Scheduled exercise and manual physiotherapy completed the treatment. Manual therapy addressed scar tissue adhesions and nerve mobility, while exercise improved neck strength, flexibility, and stability. Twelve weeks of three-times-a-week treatment. Manual physiotherapy uses soft tissue mobilisation, myofascial release, joint mobilisation, and nerve gliding to alleviate neck pain and restore function. The patient's neck pain, mobility, and neuropathic symptoms improved over twelve weeks after the intervention. The intervention also improved the group's flexibility, mobility, and pain management, as seen by a greater range of motion, decreased discomfort, and higher pressure pain threshold. Balance increased as well. NDI scores showed little improvement after the intervention. Moreover, the intervention improved physical performance, pain management, and balance, however further research could address neck impairment elements not addressed by the intervention (Table 1). A 34-year-old Indian guy with a history of cervical surgery was cured of chronic neuropathic neck pain after 12 weeks of exercise and manual physiotherapy. Manual treatment targeted scar tissue and nerve movement, while exercise relieved neck pain and mobility. Keywords: Failed Back Surgery Syndrome (FBSS)”, Cervical Surgery, Neuropathic Symptoms, Neck Pain

Effect of Self Neural Mobilization in Low Back Pain with Radiculopathy on Pain, ROM and Functional Disability - An Interventional Study

BACKGROUND: Leg pain extending below the knee into the foot and toes is lumbar radiculopathy, often accompanied by sensory, reflex or motor neurological problems along the lumbosacral nerves or nerve roots. Neural tissue mobilization techniques involve assessing and relieving neural tension through movements, restoring the nervous system's capacity to handle daily forces. These manual methods aid movement within neural structures and have been found, in research on both humans and animals, to reduce edema, enhance fluid dispersion, alleviate pain sensitivity, and reverse heightened immune responses resulting from nerve injuries. Nerve gliding exercises aim to improve nerve mobility and reduce irritation. They involve stretching and releasing a nerve in a controlled manner to potentially reduce swelling and alleviate symptoms. These exercises should be performed with caution and under the guidance of a healthcare professional. OBJECTIVES: To study the effect of self-neural mobilization on pain by NPRS. To study the effect of self-neural mobilization in ROM by Goniometry. To study the effect of self-neural mobilization on functional disability by ODI. METHODOLOGY: 36 patients were screened according to inclusion and exclusion criteria and divided into two groups; each consist of 18 patients. Group A received nerve mobilization and conventional treatment and Group B received conventional treatment. Post outcome measures such as NPRS, ODI and SLR ROM were taken after 6 weeks of treatment. RESULTS: After six-week data analysis was done suggest both group’s p value is &lt; 0.05 but interventional group has significant better improvement compared to control group. CONCLUSION: From the current study it has been concluded that nerve mobilization technique is effective in reducing pain, reduce functional disability and improves SLR ROM. Keywords: Low back pain, Radiculopathy, Nerve mobilization

The effect of nerve gliding on clinical outcome in batik workers of Yogyakarta with carpal tunnel syndrome

Background: The carpal tunnel syndrome (CTS), if left untreated, handicaps the manual workers and incurs heavy financial loss to them due to loss of their productivity and the cost on treatment. The nerve gliding exercises can speed up the rehabilitation process in these patients and improve their function. We aimed to observe the clinical efficacy of nerve gliding in reducing pain enhancing productivity in batik workers.&#x0D; Methodology: This study is a quasi-experimental and the subject were batik workers in Yogyakarta, Indonesia. Subjects who met the criteria were divided into Group I (n = 18) received nerve gliding with mecobalamin 3x500 μg and Group II (n = 17) as controls received 3x500 μg mecobalamin only. The pain relief was observed in the form of Visual Analog Scale (VAS) score and Boston Carpal Tunnel Questionnaire (BTCQ) score consisting of BTCQ symptom severity scale and functional status scale (FSS).&#x0D; Result: In paired t-test we found significant decrease in VAS scores in Group II on week 2 and 3. From the Wilcoxon test we found significanly decreased VAS scores on week I, 2 and 3 in Group I. From the Wilcoxon test we found significanly reduced BTCQ scores on week 3 in Group II, and significanly reduced BTCQ scores in Group I at week I, 2, and 3. The decrease in VAS and BTCQ was significantly higher in the Group I than Group II. Based on the multivariate analysis of model I, the nerve gliding gave significant effect on VAS (P = 0.001) and BTCQ (P = 0,000) scores.&#x0D; Conclusion: There is significant clinical improvement by using nerve gliding and mecobalamin for 3 weeks to batik workers in Yogyakarta.&#x0D; Abbreviations: BTCQ - Boston Carpal Tunnel Questionnaire; CTS - Carpal Tunnel Syndrome; FSS - Functional Status Scale; NSAIDS - Nonsteroidal Anti-Inflammatory Drugs; PO – Per Orum; ROM - Range of Motion; VAS - Visual Analog Scale&#x0D; Key words: Carpal Tunnel Syndrome; Clinical Outcome; Nerve Gliding; Safe Working Environment; Human&#x0D; Citation: Srie Setyaningrum CT, Hidayati HB, Astuti, Ayu Puspamaniar V, Indrihapsari EF. The effect of nerve gliding on clinical outcome in batik workers in Yogyakarta with carpal tunnel syndrome. Anaesth. pain intensive care 2023;27(5):579−584.&#x0D; DOI: 10.35975/apic.v27i5.2319&#x0D; Received: November 23, 2021; Reviewed: January 07, 2022 ; Accepted: January 08, 2022 -----

Effect of Adding Kinesiotaping to Median Nerve Gliding Exercise Toward Hand Performance of Patients with Carpal Tunnel Syndrome by Using Michigan Hand Outcomes Questionnaire

Background: CTS occurs due to local compression of the median nerve with manifestations of neuropathy, mostly in the productive population. Many conservative treatments have been observed to reduce the degree of pain and quality of life in CTS patients. Kinesiotaping is a new therapy that has been widely used for various musculoskeletal conditions and is known for reducing median nerve compression. Aim: To determine the effect of adding kinesiotaping to median nerve gliding exercise on hand function in CTS patients by using the Michigan Hand Outcomes Questionnaire. Methods: This research was an experimental randomized pre-and post-test group design. A sample of 24 patients from the Medical Rehabilitation Outpatient in RSUP Dr. Kariadi were divided into two groups randomly. The intervention group (n=12, dropout 1) got kinesiotaping application and median nerve gliding exercise. The control group (n=12, dropout 1) did the median nerve gliding exercise only. Hand performance has been evaluated before and at the end of the 4th week of treatment by using the Michigan Hand Outcomes Questionnaire. Result: There were significant improvements in the intervention group’s right-hand function (p&lt;0,001), activities of daily living (ADLs) or the ability of the right hand to do certain tasks (p&lt;0,001), work performance (p&lt;0,001), pain (p=0,024), and satisfaction (p&lt;0,001), as compared to the control group. Meanwhile, the intervention and the control group did not show significant differences in left-hand function score (p=0.884), left-hand ability score (p=0.884), and aesthetics score (p=1,000). Conclusion: There was a positive effect on improving hand performance in CTS patients by adding kinesiotaping to median nerve gliding exercises.

Median nerve versus flexor tendons: visualization of median nerve level changes in the proximal carpal tunnel during wrist movement with dynamic high-resolution ultrasound.

The purpose of this prospective ultrasound study was to document dorso-palmar (vertical) displacement of the median nerve in relation to the superficial flexor tendons at the level of the carpal tunnel. Furthermore, the gliding patterns of the median nerve were characterized. The presence of vertical gliding was intended to serve as an additional bio-kinematic parameter of median nerve movement, and will be referred to as a 'level change'. In this study, a total of 32 healthy young individuals underwent dynamic high-resolution ultrasound examinations of both wrists. The neutral position, and maximum flexion and extension of the wrist had to be reached in active and passive movement. The gliding patterns were determined in relation to the superficial flexor tendons. When no vertical nerve gliding was observed, it was characterized as 'no level change'. The presence of a level change prevailed in the healthy young cohort and was observed in 84% (27/32) of individuals during wrist flexion. The following gliding pattern was distinctively the most common: gliding of the entire nerve in between the flexor tendons in active but not in passive movement of the right and left wrists (13/27; 48%). The extent of vertical displacement was found to be associated with the gliding pattern (Kruskal-Wallis test). Movement in the carpal tunnel allows the median nerve to adapt to biomechanical stress. Dynamic ultrasound can demonstrate median nerve level changes in response to wrist movements. Furthermore, a typical gliding pattern was characterized. The presence of level change and gliding patterns were proposed as additional movement parameters during wrist flexion in healthy individuals.

Neurodynamic Techniques in the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

Carpal tunnel syndrome (CTS) is a condition that affects the main nerves in the wrist area that causes numbness, tingling, and weakness in the hand and arm. CTS affects 5% of the general population and results in pain in the wrist due to repetitive use, most commonly affecting women and office workers. Conservative management of CTS includes neurodynamic modulation to promote median nerve gliding during upper limb movements to maintain normal function. However, evidence for the benefits of neurodynamic modulation found disparities, and hence, the effectiveness of neurodynamic modulation remains unclear. This study aimed to systematically review the current evidence from randomized controlled trials (RCTs) to establish the effectiveness of neurodynamic techniques as a non-surgical treatment option for CTS. Using the PRISMA guidelines, two authors searched four electronic databases, and studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included outcomes from the Boston carpal tunnel syndrome questionnaire, while secondary outcomes included nerve conduction velocity, pain, and grip strength. Quality assessment was completed using the Cochrane RoB2 form, and a meta-analysis was performed to assess heterogeneity. Twelve RCTs met our inclusion/exclusion criteria with assessments on 1003 participants in the treatment and control arms. High heterogeneity and some risks of bias were observed between studies, but the results of the meta-analysis showed a significant reduction in our primary outcome, the Boston carpal tunnel syndrome questionnaire-symptom severity scale (mean difference = -1.20, 95% CI [-1.72, -0.67], p < 0.00001) and the Boston carpal tunnel syndrome questionnaire-functional severity scale (mean difference = -1.06, 95% CI [-1.53, -0.60], p < 0.00001). Secondary outcomes such as sensory and motor conduction velocity increased significantly, while motor latency was significantly reduced, all positively favoring neurodynamic techniques. Pain was also significantly reduced, but grip strength was not significantly different. Our systematic review demonstrates significant benefits of neurodynamic modulation techniques to treat CTS and specifically that it reduces symptom severity, pain, and motor latency, while at the same time improving nerve conduction velocities. Hence, our study demonstrates a clear benefit of neurodynamic techniques to improve recovery CTS.

PENATALAKSANAAN FISIOTERAPI PADA KASUS CARPAL TUNNEL SYNDROME DI KLINIK FISIOTERAPI SURABAYA: CASE REPORT

Background: Carpal Tunnel Syndrome is a neuropathic pressure on the median nerve in the carpal tunnel at the wrist, precisely under the flexor retinaculum. Sensory and motor disturbances occur in the palm, phalanges I, II, III and medial phalange IV. Objective: To know the implementation of physiotherapy to reduce pain, tingling and numbness in cases of Left Carpal Tunnel Syndrome with Ultrasound, TENS and Nerve Gliding Exercise modalities. Methods: The study used the Case Report method conducted at the Surabaya Physiotherapy Clinic in a 55-year-old female patient diagnosed with Carpal Tunnel Syndrome Sinistra physiotherapy with complaints of pain in the left wrist that radiated to the 3rd and 4th fingers. The patient was given intervention in the form of Ultrasound, TENS, and Nerve Gliding Exercise which is carried out 1 week 2 times. Results: Physiotherapy modalities in the form of Ultrasound, TENS, and Nerve Gliding Exercise are able to reduce pain, numbness and numbness, increase joint scope and can restore functional activity. Conclusion: Based on this study using Case Reports, it shows that physiotherapy management using the Ultrasound, TENS, and Nerve Gliding Exercise methods in cases of Carpal Tunnel Syndrome Sinistra as a whole resulted in an increase.

99. Investigating the Impact of Sex Hormones on Post-surgical Nerve Gliding

99. Investigating the Impact of Sex Hormones on Post-surgical Nerve Gliding

Hamstrings fascicle length and physical performance changes after a single bout of dynamic stretching or neurodynamic gliding in healthy young and older adults

IntroductionThe physiological and structural alterations have been less reported in response to dynamic stretching (DS) or neurodynamic nerve gliding (NG). Accordingly, this study investigated the changes in fascicle lengths (FL), popliteal artery velocity, and physical fitness in response to a single bout of DS or NG. MethodsThe study included 15 healthy young adults (20.9 ± 0.7 yrs) and 15 older adults (66.6 ± 4.2 yrs) who randomly performed three different interventions (DS, NG, and rest control) for 10 min and 3 days apart. The biceps femoris and semitendinosus FL, popliteal artery velocity, sit and reach (S&R), straight leg raise (SLR), and fast walking speed were measured before and immediately after the intervention. ResultsAfter NG intervention, S&R was largely greater by 2 cm (1.2, 2.8 cm) and 3.4 cm (2.1, 4.7 cm) with largely increased SLR angles of 4.9° (3.7°, 6.1°) and 4.6° (3.0°, 6.2°) with all p < 0.001 for the older adults and young groups, respectively. A similar magnitude improvement in the S&R and SLR testing was also seen for both groups after DS (p < 0.05). Moreover, no changes were seen in FL, popliteal artery velocity, fast gait speed, and age effect following all three intervention occasions. ConclusionStretching with DS or NG immediately increased flexibility, which appeared to be largely due to changes in stretch tolerance rather than an increase in fascicle length. Furthermore, age dependency in response to stretching exercise was not seen in the present study.

Effectiveness of Ultrasound Plus Nerve Gliding Exercise with and without Low-level Laser Therapy in Patients with Moderate Carpal Tunnel Syndrome

Introduction: Although carpal tunnel syndrome (CTS) is an incident entrapment neuropathy disorder, there has been inadequate evidence about the effect evaluation of adding low-level laser therapy to ultrasound (US) plus median nerve glide exercises in these patients. Hence, this research investigated the trace of US plus median nerve glide exercises with and without low-level laser therapy (LLLT). Materials and Methods: Thirty-six patients with moderate CTS in two groups of intervention were assessed. One group received 10 sessions of adding LLLT to median nerve glide exercises plus US and the other group received median nerve glide exercises plus US without LLLT. Outcome measures were hand grip strength (HGS), visual analogue scale (VAS), Boston questionnaire (BQ), and cross-sectional area (CSA) of the median nerve. Results: Baseline analysis revealed similarities between the two groups in all parameters. Statistical analysis indicated significant improvement of HGS, VAS, BQ, and CSA of the median nerve in two groups of intervention. Conclusion: In patients with CTS, US and median nerve glide exercises with and without LLLT significantly improved without the superiority of adding LLLT to mentioned treatment.

The Use of Amniotic membrane in Carpal Tunnel Syndrom, a Cadaver Study

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome worldwide. Even after surgery in 2-25% of patients symptoms persist. Most commonly the carpal tunnel was not completely released. In the other cases perineural scarring is causing recurrent compression of the nerve. The literature states different treatment options including “nerve wraps,” made out of autologous veins or synthetic materials, to protect the nerve from scarring. The human amniotic membrane (HAM) has been proven to express anti-inflammatory and anti-fibrotic properties, without causing a immune reaction. In a rat model it has been shown that nerve gliding could be improved by the application of HAM after introducing a fibrotic scar. The application of HAM in CTS and it´s possible influence on nerve gliding has been examined. Materials and Methods: Fourteen (7 female, 7 male) fresh body donors were dissected. The carpal tunnel was released and a nerve wrap out of HAM was sutured around the median nerve with continuous stitches (7-0). The position of the HAM was measured and the skin was closed (3-0) Next the arm was moved according to a protocol, creating a largest possible movement of the nerve. The position was again evaluated. This was done after 25, 50, 100, 150, 200, 250 movement cycles. Results: The HAM on the median nerve did not change its position significantly between the timepoints. From the beginning to the end of the movements it contracted and reduced its size to about 92% of its starting length. The evaluation of the gliding properties is still in progress. Conclusion: The HAM showed to stay in place and only minor contract on both ends in the carpal tunnel. The application of HAM in the carpal tunnel worked well without any complications and can be seen as feasible treatment method for recurrent carpal tunnel syndrome.