Nerve Mobilization Research Articles

Study on the effect, safety, prognosis quality and application value of extracorporeal shock wave based neural activity in carpal tunnel syndrome patients

BackgroundMild to moderate CTS is the most common median nerve compression disease in middle-aged and elderly women, mainly manifested by hand numbness and pain. This paper analyzes the extracorporeal shock wave of patients with mild to moderate CTS after nerve mobilization.MethodsThe clinical data of 92 patients with CTS from June 2020 to June 2022 are analyzed and randomly divided into extracorporeal shock wave group (n = 47) and routine group (n = 45). The routine group undergoes nerve mobilization, and the extracorporeal shock wave group receives extracorporeal shock wave therapy on the basis of the routine group. The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function scores, and ADL scores before and after treatment are observed. The Spearman correlation coefficient is used to analyze the correlation between upper limb function and ADL score, and the incidence of complications after treatment is analyzed.ResultsThe clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function score, ADL score and the incidence of complications in the extracorporeal shock wave group are significantly better than those in the conventional group (P < 0.05). ADL scores are negatively correlated.ConclusionExtracorporeal shock wave combined with nerve mobilization has a significant effect in the treatment of CTS patients, which can significantly improve the symptoms and pain scores of patients, and enhance the function of patients’ upper limbs. At the same time, the incidence of complications in patients is less, and it has high safety.

Effect of neural mobilisation in Bell's palsy: A randomised controlled trial.

Neural mobilisation technique is effective in spinal nerve rehabilitation. However, no study has reported the effect of facial nerve mobilisation in acute Bell's palsy. The objective of our study was to evaluate the effect of facial neural mobilisation over conventional therapy in improving facial symmetry in patients with acute Bell's palsy. A randomised controlled trial was conducted in the physical therapy department for 62 patients with acute Bell's palsy. The intervention included 10 days of drug therapy including 3 weeks of conventional therapy to the experimental and the control group. However, the experimental group received additional nerve mobilisation technique aimed at mobilising the facial nerve at the origin of external auditory meatus. All participants were assessed at baseline and after three weeks using the Sunnybrook facial grading system (SBS) and Kinovea Movement Analysis Software (KMAS). For primary outcome, analysis of covariance with baseline data as covariate showed a significant difference between groups for the post-test mean scores of SBS after 3 weeks (between-group difference, 9.2 [95% CI, 5.1-13.3], . Importantly, the effect size calculated by partial for neural mobilisation was 0.258 (small effect size). For secondary outcomes, independent sample t-test showed a significant difference between groups for the scores on KMAS after 3 weeks for zygomatic muscle (between-group difference, [95% CI, to ], ), frontalis muscle [95% CI, to ], , and orbicularis oris muscle [95% CI, to ], . Facial neural mobilisation is likely to be an effective adjunctive intervention in addition to conventional therapy in improving facial symmetry in acute Bell's palsy.

How I do it: The microsurgical clipping of the giant paraclinoid aneurysm using the retrograde suction decompression technique.

Paraclinoid aneurysms account for 5.4% of all intracranial aneurysms. Giant aneurysms are found in 49% of these cases. The 5-year cumulative rupture risk is 40%. Microsurgical treatment of paraclinoid aneurysms is a complex challenge that requires a personalized approach. Extradural anterior clinoidectomy and optic canal unroofing were performed in addition to orbitopterional craniotomy. Falciform ligament and distal dural ring transection provided the internal carotid artery and optic nerve mobilization. Retrograde suction decompression was used to soften the aneurysm. Clip reconstruction was performed using tandem angled fenestration and parallel clipping techniques. Orbitopterional approach with extradural anterior clinoidectomy combined with retrograde suction decompression technique is a safe and effective modality for treatment of giant paraclinoid aneurysms.

Surgical Strategy in Modification of the Transpetrosal Approach to Avoid Postoperative Venous Complications: A Report of 74 Consecutive Cases.

The transpetrosal approach is a complex skull base procedure with a high risk of complications, particularly caused by injury of the venous system. It is in part related to variability of blood outflow pathways and their distinctive patterns in each individual patient. To evaluate outcomes and complications after skull base surgery with use of the petrosal approach modifications, which selection was based on the detailed preoperative assessment of venous drainage patterns. Overall, 74 patients, who underwent surgery via the transpetrosal approach at our institution between 2000 and 2017, were included in this study. In all cases, the venous drainage pattern was assessed preoperatively and categorized according to the predominant blood outflow pathway into four types as previously suggested by Hacker: (1) sphenoparietal sinus (SpPrt), (2) sphenobasal vein (SpB), (3) sphenopetrosal sinus (SpPS), and (4) cortical. The blood outflow through the bridging petrosal vein and the vein of Labbé was also taken into consideration. In patients with SpPrt- and a cortical-type venous drainage, the transpetrosal approach was used in a standard way. In patients with SpB-type venous drainage, limited extradural anterior petrosectomy was combined with intradural anterior petrosectomy after dural opening, superior petrosal sinus transection, tentorial cutting, Meckel's cave opening, and trigeminal nerve mobilization. In patients with SpPS-type venous drainage, after standard petrosectomy, dural opening, and tentorial cutting, SpPS ligation was done followed by 2-week interval before staged definitive tumor resection. Gross total, near-total, and subtotal resection of the lesion (meningioma, 48 cases; retrochiasmatic craniopharyngioma, 11 cases; brain stem cavernoma, 7 cases; other tumors, 8 cases) was achieved in 30 (40.5%), 24 (32.4%), and 20 (27.0%) patients, respectively. Postoperative complications that were possibly related to venous compromise were noted in 18 patients (24.3%), but neither one was major. Of these 18 patients, 9 were symptomatic, but all symptoms-aphasia (4 cases), seizures (2 cases), and confusion (3 cases)-fully resolved after conservative treatment. Overall, 13 patients, including 4 symptomatic, had signal changes on T2-weighted brain MRI, which were permanent only in 3 cases (all asymptomatic). Our suggested surgical strategy can be applied to any type of the venous drainage pattern. Preoperative evaluation and intraoperative preservation of the blood outflow pathways are crucial means for safe and effective application of the transpetrosal approach.

Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release.

Piriformis syndrome is also synonymous with sciatica or buttock pain. This is a condition where the muscle irritates the sciatic nerve. This nerve passes above, below, or in between the piriformis muscle piercing it. The muscle tightens or shortens, thus compressing the nerve and disturbing the impulses passing from it. The sciatic nerve is a combination of nerve roots from L4 to S3. Piriformis works as a lateral rotator and is a synergistic muscle of the flexor and abductor group. Femalesmost commonly present with piriformis syndrome than males. Many causative factors are responsible for the compression or impingement of the sciatic nerve, one of which is piriformis syndrome. Tingling, numbness, and pain are most often felt by patients when they have compression of any of the nerves. Many physiotherapy techniques have been found to be effective in managing this problem. Techniques like nerve mobilization, stretching, myofascial release, deep friction massage, and many more have been studied by authors describing their effects in the treatment of piriformis syndrome. Neural mobilization consists of two techniques, nerve glidingand nerve tensioning. Studies have found that the gliding technique produces less strain on the nerve than the tensioning technique. Piriformis stretch reduces the tightening, which has caused the impingement. Two techniques have been used for this stretch, stretching with hip flexion over 90 degrees and hip flexion under 90 degrees.This review focuses on the different advances in treating piriformis syndrome.

The effects of tibial nerve mobilization in patients with tarsal tunnel syndrome: A randomized controlled trial

In tarsal tunnel syndrome (TTS), the nerve mobilization, one of the conservative treatment methods, aims to relieve abnormal nerve tension with appropriate movements of the nerve tissue. The aim of this study was to investigate the effect of tibial nerve mobilization in addition to home exercise on the tibial nerve area in patients diagnosed with TTS. The study included 40 participants, including 20 cases in the intervention group (IG) and 20 cases in the control group (CG). IG received tibial nerve mobilization and a home exercise program for and foot-ankle joint. Participants in the control group had only a home exercise program for the foot-ankle joint. Primary outcome measures were tibial nerve diameter and Tinel's sign measurements. Secondary outcome measures were pain intensity, neuropathic pain status (NPQ) and foot functional index (FFI). The positive Tinel's sign incidence was lower in favour of IG (Odds ratio:0.11 95% CI: 0.03 to 0.46). Between-group comparisons revealed a significant difference in pain intensity (Mean difference: 1.45; 95% CI: 0.69 to 2.20), NPQ (Mean difference: 0.70; 95% CI: 0.36 to 1.03), pain subscale (Mean difference: 10.0; 95% CI: 4.33 to 15.66) and total score of FFI (Mean difference: 20.60; 95% CI: 0.53 to 40.66) in favour of IG. There was no reported adverse events. This study showed that the addition of tibial nerve mobilization to home exercise program might improve symptoms, especially pain and functionality in patients with TTS. Further studies with large sample sizes are need to support these results.

Elongated, finger-like ophthalmic segment aneurysms: Implications for selection of treatment modality

BackgroundMicrosurgical treatment of ophthalmic segment aneurysms often requires anterior clinoidectomy and optic nerve mobilization prior to successful clipping. ObjectiveWe hypothesize that ophthalmic segment aneurysms that are elongated and finger-like grow unconstrained, lateral to the optic nerve. We note that this avoids the need for clinoid resection and optic nerve mobilization. MethodsThree cases with up-pointing aneurysms were reviewed. Patient and aneurysm characteristics were collected. ResultsThe first two patients with elongated ophthalmic segment aneurysms were found to have aneurysms growing lateral to the optic nerve. This allowed for straightforward treatment via microsurgical clipping without anterior clinoidectomy or division of the falciform ligament. The third patient presented with distortion of the optic chiasm superiorly and medially by a giant ventral ICA aneurysm. A concomitant ophthalmic aneurysm in this patient exhibited elongated morphology, with a high-resolution MRI demonstrating the patient’s optic nerve was located inferior and medial to the ophthalmic artery aneurysm dome. This supports our hypothesis that an overriding optic nerve normally impedes vertical growth of ophthalmic segment aneurysms. ConclusionsOphthalmic segment aneurysms may acquire a round morphology when their growth is constrained superiorly by the optic nerve. Elongated ophthalmic segment aneurysms may be the result of growth lateral to the optic nerve. For these aneurysms, an anterior clinoidectomy is not required, and microsurgical clipping represents a straightforward treatment option.

Pengaruh Lower Limb Tension Test Terhadap Penurunan Nyeri Terhadap Nyeri Punggung Bawah di RSUD KRMT Wongsonegoro

Background: Lower back pain (NPB) Ischialgia is a pinched ischialgia nerve in the lower back area which causes the buttocks, thighs, lower legs and even feet to become tingling, painful, and sometimes causing weakness. Nerve mobilization is a manipulation technique by moving and stretching nerve tissue to increase axonal transportation so that it can improve nerve conduction. Nerve mobilization can reduce the pressure in the nerves so that there is an increase in blood flow to the nerves, which can have a regenerative and healing effect on injured nerves (Butler, 1991). Nerve mobilization is often used as a form of diagnosis and treatment for musculoskeletal conditions with nerve involvement (Butler, 1991). Nerve mobilization in the Lower Limb Tension Test (LLTT) is carried out at the branches of the Brachial plexus such as the radial nerve, median nerve and ulnar nerve. But here the author only discusses LLTT in the ishiadic nerve, namely LLTT 1 which is related to lower back pain.&#x0D; The aim is to determine physiotherapy management and the effect of Ultrasoundtherapy therapy and nerve mobilization using the LLTT 1 method in cases of lower back pain on reducing pain and increasing the functional ability of the hand. Two group pre test and post test method. RESEARCH PLACE: Physiotherapy clinic, RSU Sidoarjo. TIME: Measuring instrument: Visual Analouge Scale (VAS). Results: treatment using the Mann-Whtney test. With confidence interval (CI) (95%) The results of the study revealed that there was a significant difference in pain in group 1 (p = 0.00) and group 2 (p = 0.00). But there was no significant difference between the two groups in pain improvement (p = 0.152), so there was no better treatment between the two groups. Conclusion: It is concluded that ULTT is useful in treating CTS patients to reduce pain in two groups. The targeted outcomes are publications in national journals indexed by Sinta and HAKI. The TKT target for implementing this gamelan accompaniment exercise is level 2.

Effects of Sciatic Nerve Mobilization on Pain, Disability and Range in Patients with Lumbar Radicular Pain

Background: Lumbar radicular pain is one of the leading causes of musculoskeletal disability. Variety of conventional treatment options are available. Aim: To find the effectiveness of sciatic nerve mobilization on disability and range of straight leg raise in patients with lumbar radicular pain. Study Design: Randomized control trail. Methodology: In this single blinded randomized control trial eighty patients were randomly divided in two groups. The experimental group received sciatic nerve mobilization along with routine physical therapy treatment whereas control group only received routine treatment in form of moist hot pack and back exercises. Outcomes were pain, disability and straight leg raise range measured through numeric pain rating scale, Modified Oswestry disability index MODI and inclinometer. The outcomes were assessed at baseline and at 4th and at 6th weeks of the treatment. Data was analyzed by SPSS software, version 20 as qualitative variables were expressed as mean ± SD. Paired sample t-test was applied. Results: Between groups analysis showed a significant difference in mean in both groups. Within group analysis was done using paired sample t test showed significant improvement (p &lt;0.05) occurred in all variables in terms of pain, disability and straight leg raise range but sciatic nerve group had better improvement in terms of pain and disability as compared to conventional group. Conclusion: We concluded that sciatic nerve mobilization was an effective treatment for pain and disability in patients with lumbar radicular pain. Keywords: Lumbar Radicular Pain, Lumbar Radiculopathy, Sciatic Nerve Mobilization and Sciatic Nerve Neurodynamics.

Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial.

Purpose Cervical radiculopathy is disorder of cervical spinal nerve root affecting large number of population. Previously many studies are conducted to design suitable protocol for management of this disorder, but they lack in quality. The purpose of this study was to compare the effects of neural mobilization and cervical isometrics on health-related quality of life and deep flexors endurance in cervical radiculopathy. Methods A double-blinded randomized clinical trial was conducted at Mayo Hospital, Lahore, Pakistan. Eighty-eight patients within the age range of 35-50 years were included in the study after taking their consent. In the experimental group (n = 44), median nerve mobilization was applied along with cervical isometric exercises. The control group (n = 44) performed cervical isometric exercises alone. Muscle endurance was measured by craniocervical flexion test and quality of life on 36 items short form health survey SF-36 scale. Measurements were taken at baseline, at 2nd week, and at 4th week. For missing data, intention-to-treat analysis was used. Results Within-group comparison with Friedman test showed a significant difference between pre, mid, and posttreatment scores on craniocervical flexion test and in all domains of SF 36 in both groups. While between-group comparison with Mann–Whitney U test showed all variables were similar at baseline but after 4 weeks there was a statistically significant improvement in craniocervical flexion test scores and all domains of SF 36 in the experimental group. But domain of pain showed mean rank of 49.43 after 4 weeks in the experimental group and 39.57 in the control group with p = 0.065 and d = 0.579, while for all the other 7 domains values were p < .05 and d > 0.25. Conclusion Neural mobilization combined with cervical isometrics shows significant effects in improving quality of life and deep flexors endurance in patients with cervical radiculopathy than cervical isometrics alone.

Comparing Effectiveness of Median Nerve Mobilization with and without Transverse Carpal Ligament Stretching in Patients with Carpal Tunnel Syndrome

Carpal tunnel is the narrow space which is present between smaller bones of hand and an important ligament of hand which is called transverse carpal ligament. Compression of median nerve occurs commonly at wrist which results in Carpal Tunnel Syndrome (CTS). Objective: To compare effectiveness of median nerve mobilization with and without transverse carpal ligament stretching in patients with carpal tunnel syndrome. Methods: In this study, 34 patients were randomly assigned into one of two groups, each with 17 individuals. For two weeks, group B received a combination therapy strategy of Neurodynamics and transverse carpal ligament stretching, while group A only received neurodynamics. After two weeks, there was an improvement in functioning and pain. The DASH questioner and VAS were filled at baseline. The current RCT was conducted at the Akhtar Saeed Trust Hospital in Lahore. SPSS was used to conduct the analysis. Results: In the present study of 34 patients independent sample t test was applied as the mean difference was less in group B, which used a combination treatment method of transverse carpal ligament stretching and neurodynamics, compared to group A, which used only neurodynamics. The p value is less than 0.05, indicating that the results were significant. In comparison to group A, results of group B in which combined treatment approach was applied found to be more substantial and superior. Conclusions: Group B, which included both neurodynamics and transverse carpal ligament stretching, was shown to be more effective than group A, which solely used neurodynamics.

Effectiveness of Obturator Nerve Mobilization for Knee Joint Pain in Young Females

Background: Medial knee pain is reported due to adductor tightness in young females. Nerve supply of adductors of thigh is obturator nerve. Compression of obturator nerve is one of the reasons to generate medial knee pain. Objectives: To evaluate the effect of obturator nerve mobilization for treating medial knee joint pain in young females. Material and Methodology: A quantitative, randomized clinical trial was conducted comprising of sample of 30 patients. Patients were allocated into control group and treatment group randomly by using lottery method. Hot pack and adductor release was given as baseline treatment in both groups. Treatment group received obturator nerve release in addition. Visual analogue scale, Q angle and lower extremity functional scale was used as outcome measures. Results: Data was analyzed by SPSS V.20. Independent sample t-test was used for inter-group analysis, paired sample t-test and repeated measurement ANOVA test was used for intra-group analysis. Significant decrease in medial knee joint pain, Q-angle and lower extremity functional score was reported in treatment group with p value &lt;0.05. Association of BMI with pain and Q angle was found non-significant with p value &gt;0.05. Conclusion: Obturator nerve neurodyanamics showed significant improvement in treating medial knee joint pain in young females. No association was found of BMI with pain and Q angle. Keywords: Young adult, female, Obturator nerve, Nerve compression syndromes, Neurodynamics

Efficacy of Hip Abductors Strengthening as Compared to Piriformis Muscle Stretching in Improving Lower Extremity Function in Patients with Piriformis Syndrome

Objective: The study's goal was to determine the effects of hip abductors strengthening and piriformis stretching on pain, hip abductors strength, and lower extremity functional status in piriformis syndrome patients. Methodology: A total of 60 patients were diagnosed with piriformis syndrome and referred to the Physiotherapy department from the NILD Assessment Clinic. Then, using simple random sampling, 60 patients were divided into two groups: Group-A (Hip abductor and Sciatic nerve mobilisation) and Group-B (no hip abductor and sciatic nerve mobilisation) (Sciatic nerve mobilisation and piriformis stretching). Each subject's demographic data was collected prior to the intervention. Data on pain severity, muscle strength (hip extensor and abductor), and lower extremity functional scale score were collected before and after treatment. Both groups continued to take their medications according to the evaluation clinic's recommendations. Results: Patient’s average age was 57.18 ± 2.64 years. Out of 60 patients 19 belongs to age 35-45 year, 13 belongs to 45-55 year and 28 belongs to age group of 55-65 year. This table explains that mean difference of NPRS and Hip Abductor strength between two groups showed p-value 0.082 and 0.100 respectively statistically non-significant result, whereas, Hip Abductor strength and LEFS showed p-value 0.001 statistically significant difference between two groups. Conclusion: According to the findings piriformis syndrome can be treated without the use of stretching, electrophysical agents, or soft tissue mobilization. Considering that piriformis insertion is on greater trochanter. The excessive hip adduction and internal rotation shown during functional movement testing were exerting tension on this muscle, resulting in sciatic nerve compression. However only Group A improved in terms of hip abductor strength. Group A demonstrated considerable improvement in strength of hip abductor and lower extremity functional scale when compared to Group B. Keywords: Piriformis syndrome, Sciatica,

Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome.

Background Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

Contralateral vs. Ipsilateral Approach to Superior Hypophyseal Artery Aneurysms: An Anatomical Study and Morphometric Analysis.

IntroductionSurgical clipping of superior hypophyseal artery (SHA) aneurysms is a challenging task for neurosurgeons due to their close anatomical relationships. The development of endovascular techniques and the difficulty in surgery have led to a decrease in the number of surgical procedures and thus the experience of neurosurgeons in this region. In this study, we aimed to reveal the microsurgical anatomy of the ipsilateral and contralateral approaches to SHA aneurysms and define their limitations via morphometric analyses of radiological anatomy, three-dimensional (3D) modeling, and surgical illustrations.MethodFive fixed and injected cadaver heads underwent dissections. In order to make morphometric measurements, 75 cranial MRI scans were reviewed. Cranial scans were rendered with a module and used to produce 3D models of different anatomical structures. In addition, a medical illustration was drawn that shows different sizes of aneurysms and surgical clipping approaches.ResultsFor the contralateral approach, pterional craniotomy and sylvian dissection were performed. The contralateral SHA was reached from the prechiasmatic area. The dissected SHA was approached with an aneurysm clip, and maneuverability was evaluated. For the ipsilateral approach, pterional craniotomy and sylvian dissection were performed. The ipsilateral SHA was reached by mobilizing the left optic nerve with left optic nerve unroofing and left anterior clinoidectomy. MRI measurements showed that the area of the prechiasm was 90.4 ± 36.6 mm2 (prefixed: 46.9 ± 10.4 mm2, normofixed: 84.8 ± 15.7 mm2, postfixed: 137.2 ± 19.5 mm2, p < 0.001), the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale was 10.0 ± 3.5 mm (prefixed: 5.7 ± 0.8 mm, normofixed: 9.6 ± 1.6 mm, postfixed:14.4 ± 1.6 mm, p < 0.001), and optic nerves’ interneural angle was 65.2° ± 10.0° (prefixed: 77.1° ± 7.3, normofixed: 63.6° ± 7.7°, postfixed: 57.7° ± 5.7°, p: 0.010).ConclusionAnatomic dissections along with 3D virtual model simulations and illustrations demonstrated that the contralateral approach would potentially allow for proximal control and neck control/clipping in smaller SHA aneurysm with relatively minimal retraction of the contralateral optic nerve in the setting of pre- or normofixed chiasm, and ipsilateral approach requires anterior clinodectomy and optic unroofing with considerable optic nerve mobilization to control proximal ICA and clip the aneurysm neck effectively.

Treatment Preferences of Physical Therapists in Management of Carpal Tunnel Syndrome: A Cross Sectional Survey

Background: Carpal tunnel syndrome affects one out of ten people throughout their lives, and repetitive work related conditions affecting wrist and hand are the most common cause of prolonged absenteeism from work and limited functional ability. Multiple physical therapy interventions have been used by physical therapists for reducing pain severity, increasing range of motion and decreasing functional limitations in carpal tunnel syndrome.Methods: A cross-sectional survey was conducted among 196 physical therapists in Karachi, Pakistan. Demographic data of physical therapists was obtained, as well as information regarding carpal tunnel syndrome and its intervention techniques used.Conclusion: There existed variability among the treatment preferences of physical therapists regarding the management of carpal tunnel syndrome. A majority of respondents (72.4%) used nerve mobilization techniques, and therapeutic ultrasound was given by 66.3%. The least common intervention used was myofascial release (28.1%). Different approaches had been given in combination as well, which showed that physical therapists are also aware about the recent approaches and their effects for the management of CTS.

COMPARISON BETWEEN EFFECTS OF PASSIVE VERSUS SELF-MOBILIZATION OF SCIATIC NERVE IN PIRIFORMIS SYNDROME FOR RELIEVING PAIN AND IMPROVING HIP OUTCOMES

Background: Piriformis syndrome is disorder which is neuromuscular, caused by sciatic nerve compression and lead to compromised Hip functions. This problem, as well as the management for the restoration of hip functions need to addressed. Objective: To determine the effectiveness of passive mobilization versus self-mobilization in managing pain and improving quality of life in patients with Piriformis syndrome. Methodology: A quasi-experimental study was conducted at Imran Idrees Hospital Sialkot from April to October 2019. The simple random sampling was used to collect n=30 subjects with pain in the gluteal region from more than 2 months, both genders in age of 30-50 years were included. The Passive Sciatic Mobilization was given in one group, while other group was only taught the self-mobilization of the sciatic nerve along with home planThe Visual analogue scale and hip outcomes were measured at baseline, 2nd, 3rd, and 4th week using International Hip Outcome Tool (IHOT) Repeated measurement ANOVA for within-group and independent-sample t-test between groups were used. The level of significance was set at 95% (p&lt;0.05).Results: The mean age of participants in self-mobilization was 41.20 +5.79 and passive mobilization was 42.87 +4.82. Out of 30 participants, 17(56.66%) were male and 13(43.33%) were females participants. The mean of pain at baseline in experimental group was 4.86± 1.30 and reduced to 2.06 ± 1.09 after 4 weeks of passive mobilization and Hip functions at baseline was 131.73 ± 22.59 and improved to 232.00 ± 19.39. Between the groups comparison of pain and hip functions showing that both techniques were effective in reduction of pain and improving Hip functions but passive mobilization group has was dominant over the self-mobilization p value P =0.00 Conclusion: The current study concluded that passive mobilization of sciatic nerve was effective in the management of piriformis syndrome compared to the self-mobilization for improving pain and hip functions. Key words: Hip Functioning Pain, Nerve Mobilization, Piriformis Syndrome, Passive Mobilization,Sciatic Nerve, Self-stretching

The effect of median nerve mobilization on two point discrimination.

[Purpose] Two-point discrimination (TPD) is expressed as the minimum distance at which two mechanical stimuli applied simultaneously to the skin can be perceived as two separate points. The aim of this study was to investigate the effect of median nerve mobilization on TPD in healthy adults. [Participants and Methods] This study included 120 healthy adults. Participants were randomized according to their gender into the Neural Mobilization Group (NMG) and Control Group (CG). Demographic data of the participants (gender, age, height, weight, BMI, smoking) were recorded and TPD measurement was performed with baseline aesthesiometer on the palm with distal phalanges of the thumb, index and middle finger on the right-left hand. After the baseline TPD test, participants in the NMG performed Median Nerve Mobilization for 14 days. Measurements were taken before and after training. [Results] A statistically significant difference was found in all other measurements in both groups, except for the right and left palm TPD measurements in the control group. [Conclusion] It is thought that it would be beneficial to investigate the healing effects of the neural mobilization applications, which include all parts of the nerve line in disease conditions.

The Effects of Tibial Nerve Mobilization in Patients with Tarsal Tunnel Syndrome: A Randomized Controlled Trial

The Effects of Tibial Nerve Mobilization in Patients with Tarsal Tunnel Syndrome: A Randomized Controlled Trial

Safe thyroidectomy for thyroid and parathyroid diseases

To offer the ways for safe thyroidectomy aimed at prevention of damage of recurrent laryngeal nerve in patients with thyroid and parathyroid diseases. We analyzed postoperative outcomes after thyroidectomy in 342 patients aged 20-80 years. Topography of recurrent laryngeal nerves was studied on 20 laryngeal-tracheal complexes of deceased patients. Technique of visualization of various segments of recurrent laryngeal nerve was worked out. Thyroidectomy was performed in 342 patients with thyroid and parathyroid diseases. Thyroidectomy was performed in accordance with recommendations described by F.W. Lahey, W.B. Hoover (1938) and H. Malcolm, M.D. Wheeler (1998). Location of recurrent laryngeal nerve varied in patients with nodular, retrosternal goiter and parathyroid gland adenoma. Comparison of intraoperative and morphological data on recurrent laryngeal nerve visualization showed possible risks of its damage during manipulations on thyroid gland, esophagus and trachea. Our study confirmed the need for visualization and mobilization of recurrent laryngeal nerve in all procedures on thyroid and parathyroid glands. Introduction of the described technique of thyroidectomy and training sessions for recurrent laryngeal nerve mobilization on laryngeal-tracheal complexes reduced postoperative incidence of phonation disorders from 21.6% to 0.98%. Thyroidectomy may be a safe procedure if surgeons are familiar with the details of surgical technique and prevent damage to adjacent structures.