Background Neurodynamics, is a newly area of physiotherapy that emphasise the role of nerve mobilisation for the treatment and prevention of nerve. To date, neurodynamic therapies are done empirically, without any evidence of imaging. The aim of this study was determine the optimal range of abduction of the upper limb in which the lateral flexion of the head causes the most sliding of the median nerve at the distal part of the arm.
Methods Twenty five healthy volunteers ranging from 18 to 32 years old were studied. Measurements were taken in different degrees of abduction of the glenohumeral joint (neutral, 30°, 60°, and 90°). At each point, active and passive flexion of the head was applied and measurements were taken at the wrist, forearm, and elbow. Another physiotherapist stabilised the patient shoulder. The movement was applied until arriving at grade III resistance (Maitland). The ultrasound scanner that is used is a Toshiba Xario with a 704 s linear probe (18 MHZ). The program used to quantify the nerve movement was Kinovea (0.8.15) using a frame-by-frame technique. The data obtained was statistically evaluated through a T-student with SPSS program (version 16.0. IBM Corporation).
Results The sliding of the median nerve is maximised at 30° of abduction in the wrist, and at 60° in the forearm and elbow. At 0° and 90° we found a significant statistical reduction of the sliding of the median nerve in all of the analysed locations. We observed that when the point of measurement is closer to the joint that is moving, in this case the neck, the nerve has more mobility in the elbow, forearm and wrist. We didn’t find significant statistical differences in the sliding of the median nerve under active or passive mobilisation of the head.
Conclusions The present study demonstrates that the active and passive inclination of the head causes a sliding of the median nerve at the level of the wrist, forearm, and elbow. We’ve observed a significant increase of the amount of sliding at 30° and 60°. We have also seen that there is a greater amount of sliding in the elbow and forearm in relation to the wrist. Understanding the behaviour in vivo of the median nerve during neurodynamic tests can improve its implementation in real patients. We propose that a future study apply this study to patients with pathologies, Carpal Tunnel Syndrome for example, in order to compare the differences in the movement of the median nerve.
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