Effects of Neuromobilization on Stiffness of Median Nerve: Randomized Controlled Trial

The median nerve is a mixed nerve with motor and sensory functions in the upper extremity. It is observed that the median nerve slides longitudinally during upper extremity movements. However, in entrapment neuropathies (eg, Carpal Tunnel Syndrome), longitudinal displacement of the nerve is partially limited. In addition, the presence of adhesion, fibrosis, and possible scar tissue may cause difficulties for peripheral nerve adaptation in certain positions and movements. This, in turn, can result in the limitation of nerve trunk movements with respect to the surrounding tissues and a reduction in the normal shift of nerve fibers and fascicles relative to each other and to the connective tissues. Any pathology that reduces the normal stretch and slip of the medial nerve produces abnormal tension during extremity movement and the pressure on the nerve increases. This may cause symptoms such as paresthesia, weakness, and pain in the hand. With neuromobilization exercises, the tension and pressure on the median nerve are reduced and the nerve is prevented from being compressed in the carpal tunnel.

Neuromobilization is part of manual therapy and has been reported to be an effective practice for some conditions, including low back pain and carpal tunnel syndrome. The inclusion of neuromobilization in the treatment of patients with carpal tunnel syndrome, cervicobrachial pain, and lateral epicondylitis, in particular, has been associated with a reduction in the degree of pain and disability. Recently, neuromobilization techniques have started to be used in the treatment of nerve compression. These techniques consist of a series of therapeutic active and passive movements aimed at restoring the normal mechanical properties of the nerve during limb movements.

When the literature is examined, there are not many studies that objectively reveal the effects of neuromobilization techniques on nerve elasticity. Shear Wave Elastography is a method that quantitatively reveals the elasticity of tissues by measuring the speed of shear waves formed in the tissues through non-invasive high-frequency ultrasound waves. In recent studies, Shear Wave Elastography has shown promising results in demonstrating the elasticity of peripheral nerves.