Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of carpal tunnel: a cadaveric study.

(Boudier-Revéret et al., 2017)

Aims: To evaluate the effect of neurodynamics mobilization (NDM) on an artificially induced œdema in the median nerve at the level of the carpal tunnel in unembalmed cadavers and to assess whether NDM tensioning techniques (TT) and NDM sliding techniques (SLT) induce similar effects on intraneural fluid dispersion.

Methods: Seven cadavers. Transverse carpal ligament and forearm fascia incised. Blue dye injected under the median epineurium. Dye spread measured with digital calliper at baseline, after spread stabilized 5 min of tensioner/glider. Sutures opened to measure spread. First one technique, then sutures tightened and then the other technique performed for 5 min (if started with slider, then tensioner and the other way around). Both limbs.

Results: Tensioners and sliders provided significant increase of longitudinal spread (compared to when the spread was stabilized). Not significant difference between sliders and tensioners related to the amount/length of spread. Most spread after first session.

Not any significant difference between limbs.

Limitations: Cadaveric study so limited when generalising to live subjects / The dissection to allow the fluid to be injected alters the carpal tunnel anatomy and carpal tunnel pressure may have reduced / The injection does not precisely replicate physiological oedema / No control group.

In practice: Both ND techniques seem to help spread of œdema intraneural.

Boudier-Revéret, M., Gilbert, K. K., Allégue, D. R., Moussadyk, M., Brismée, J. M., Sizer, P. S., … Sobczak, S. (2017). Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study. Musculoskeletal Science and Practice, 31, 45–51. https://doi.org/10.1016/j.msksp.2017.07.004

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