Carpal Tunnel Syndrome: How does traditional hand therapy compare with neurodynamic therapy?

Hamzeh, H., Mohammad, M., Alghwiri, A., & Hawamdeh, Z. (2021). The long-term effect of neurodynamics vs. exercise therapy on pain and function in people with carpal tunnel syndrome: A randomized parallel-group clinical trial.  Journal of Hand Therapy, 34, 521-530. 

The Skinny: 

Carpal tunnel is the most common peripheral nerve compression problem.  There is now some evidence supporting conservative management over surgical.  This makes it a reasonable, potentially cost-saving option over surgery.  There is limited information as to which conservative options are the most beneficial.  This study looked to compare two different therapy approaches, including traditional exercise therapy and neurodynamics therapy. Hand Therapy for Carpal Tunnel Syndrome Exercises included nerve glides, tendon glides, and soft tissue mobilization vs. neurodynamic therapy, which included using specific manual techniques to change the mechanical characteristic around the nerve. 

In the Weeds:

A randomized parallel-group clinical trial was completed.  Twenty patients were in the traditional group, and twenty-one patients were in the neurodynamics group.  Both groups completed a 60-minute treatment session per week and were prescribed daily exercises depending on if they were in the traditional vs. neurodynamic group.  Please see the table below from the study of explanation of neurodynamic activities.  

Bringing it Home:

Outcome measures were obtained at the 1-month follow-up and the 6 months follow-up.  Outcome measures include the Boston Carpal Tunnel Syndrome Questionnaire, QuickDash, Wrist Range of Motion, and hand Hand Grip Strength. The neurodynamics group demonstrated improvement in all outcome measures.  No patient that completed the study needed surgery after treatment.  Both treatment options lead to improved strength and function and decreased pain; however, the neurodynamics group showed better results in all outcome measures.  

Rating: 

The study would be rated 4/5.  There was no comparison between no treatment option; therefore, we do not know how patients would have done with natural recovery. Additionally, no patients in the study had severe carpal tunnel symptoms.  Also, the study size was relatively small, and it is also difficult to gauge patients’ compliance with home exercise programs.