E. Thoomes1,2, R. Ellis3,4, A. Dilley5, D. Falla1, M. Thoomes-de Graaf2
1University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, Birmingham, United Kingdom, 2Fysio-Experts, Research Department, Hazerswoude, Netherlands, 3Auckland University of Technology, Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland, New Zealand, 4Auckland University of Technology, Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Auckland, New Zealand, 5University of Sussex, Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
Background: A segmental contra-lateral cervical lateral glide (CCLG) mobilization technique is effective for patients with cervical radiculopathy (CR). The CCLG technique induces median nerve sliding in healthy individuals, but this has not been assessed in patients with CR.
Purpose: This study aimed to 1) assess longitudinal excursion of the median nerve in patients with CR and asymptomatic participants during a CCLG movement, 2) reassess nerve excursions at a 3-month follow-up in patients with CR and 3) correlate changes in nerve excursions with changes in clinical signs and symptoms.
Methods: During a computer-controlled mechanically induced CCLG, executed by the Occiflex™, longitudinal median nerve excursion was assessed at the wrist and elbow with ultrasound imaging (T0) in 20 patients with CR and 20 matched controls. Patients were re-assessed at the 3-month follow-up (T1), following conservative treatment including neurodynamic mobilization.
Results: There was a significant difference between patients and controls in the excursion of the median nerve at both the wrist and elbow at T0. There was also a significant increase in median nerve excursion at both sites between T0 and T1 in those with CR. There was a strong correlation between improvement in median nerve excursion at the elbow at T1 and improvement in pain intensity, functional limitations. Nerve excursion remained relatively unchanged in those that were not responding to the physiotherapy intervention, and all of these patients went on to have either surgery or (nerve root sleeve) injections.
Conclusion(s): Longitudinal median nerve excursion differs significantly between patients with CR and asymptomatic volunteers at baseline but this difference is no longer present after 3 months of conservative physiotherapy management.
Implications: Monitoring of the improvement in median nerve movement, using ultrasound imaging, has the potential to assist clinical decision making with regards to either continuing or suspending conservative management. Clinicians should consider including neurodynamic mobilization in the management plan of patients with CR. Taking the CCLG movement to the individual patient’s end of range has a sufficient enough effect on median nerve excursions, irrespective of the absolute range of motion.
Funding, acknowledgements: This work was unfunded
Keywords: Cervical radiculopathy, neurodynamic mobilization, median nerve excursion
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: Erasmus MC Rotterdam, The Netherlands
Committee: Medical Ethical Committee of the Erasmus MC
Ethics number: NL66281.078.18. (MEC-2018-139).
All authors, affiliations and abstracts have been published as submitted.
