Investigating how neurodynamic treatments affect carpal tunnel syndrome

Mechanisms of Neurodynamic Treatments (MONET)

This study is testing how certain exercises and treatments can help people with mild to moderate carpal tunnel syndrome feel better and improve their nerve function.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 108 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of Oxford (Academic / other)
• Locations: 1 site (Oxford, Oxfordshire)
• Trial ID: NCT05859412 on ClinicalTrials.gov

What this trial studies

This study aims to explore the mechanisms of action of neurodynamic treatments for patients with mild to moderate carpal tunnel syndrome. It will involve a 6-week intervention period where participants will undergo specific physiotherapeutic exercises, steroid injections, and receive advice. The study will assess nerve function and structure through various measures, including follow-up questionnaires at 6 months. The goal is to better understand how these treatments work, which could help tailor therapies to those who would benefit most.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older diagnosed with mild to moderate carpal tunnel syndrome.

Not a fit: Patients who have already undergone surgery for carpal tunnel syndrome will not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to more effective non-surgical treatments for carpal tunnel syndrome, potentially reducing the need for surgery.

How similar studies have performed: Previous studies have shown that neurodynamic exercises can reduce the need for surgery in carpal tunnel syndrome, indicating potential success for this approach.

Eligibility criteria

Inclusion Criteria

Patients:

1. Patients who have a diagnosis of mild to moderate carpal tunnel syndrome based on a clinical assessment and confirmed with nerve conduction studies.
2. Male or Female, aged 18 years or above.
3. Patient is willing and able to give informed consent for participation in the study.

Healthy participants:

1. Male or female aged 18 years or above.
2. Participant is willing and able to give informed consent for participation in the study.
3. No history of hand or arm symptoms
4. No history of neck pain in the past 3 months
5. No systemic medical condition
6. No strong anticoagulant medication or altered coagulation (e.g., hemophilia) preventing skin biopsies
7. Severe anxiety or depression
8. Participants are required to be age- \& sex-matched to patient participants
9. No contraindications for magnetic resonance scanning at 3T
10. Sufficient command of the English language

Exclusion Criteria

Patients:

1. Patients who already had surgery for their carpal tunnel syndrome (CTS) or are planning to undergo surgery in the next 6 weeks (patients with unilateral surgery who have unoperated CTS on the other hand are eligible to participate)
2. Patients who had a steroid injection for their CTS in the 6 months prior to the study enrolment or who had already more than 1 steroid injection into the study wrist.
3. Patients who have a diagnosis of severe carpal tunnel syndrome based on a clinical assessment and confirmed with electrodiagnostic testing
4. Electrodiagnostic testing revealing abnormalities other than CTS
5. Any other upper limb or neck problem for which they have sought treatment in the past 3 months
6. History of significant trauma to the upper limb or neck
7. Diabetes
8. Hypothyroidism
9. Severe anxiety or depression
10. Patient who is pregnant, lactating, or planning pregnancy during the study.
11. Patients on strong anticoagulant medication or altered coagulation preventing skin biopsies.
12. Contraindications for magnetic resonance imaging (assessed with MRI safety screening questionnaire).
13. Contraindications for steroid injections
14. Insufficient command of the English language

Where this trial is running

Oxford, Oxfordshire

• Nuffield Department of Clinical Neurosciences, University of Oxford — Oxford, Oxfordshire, United Kingdom (Recruiting)

Study contacts

• Principal investigator: Eva Sierra-Silvestre, PhD — University of Oxford
• Study coordinator: Annina Schmid, PhD

Conditions Carpal Tunnel Syndrome; Neurodynamic Treatment; Nerve Mobilisation; Diffusion MRI; Physiotherapy; Mechanistic Trial