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. 2024 Jul 27;25(1):590.
doi: 10.1186/s12891-024-07713-6.

Mechanisms of neurodynamic treatments (MONET): a protocol for a mechanistic, randomised, single-blind controlled trial in patients with carpal tunnel syndrome

Sierra-Silvestre E  1 , Tachrount M  2 , Themistocleous Ac  1 , Stewart M  1 , Baskozos G  1 , Schmid Ab  3
Affiliations

Mechanisms of neurodynamic treatments (MONET): a protocol for a mechanistic, randomised, single-blind controlled trial in patients with carpal tunnel syndrome

Sierra-Silvestre E et al. BMC Musculoskelet Disord. .

Abstract

Background: Physiotherapeutic management is the first-line intervention for patients with entrapment neuropathies such as carpal tunnel syndrome (CTS). As part of physiotherapy, neurodynamic interventions are often used to treat people with peripheral nerve involvement, but their mechanisms of action are yet to be fully understood. The MONET (mechanisms of neurodynamic treatment) study aims to investigate the mechanisms of action of neurodynamic exercise intervention on nerve structure, and function.

Methods: This mechanistic, randomised, single-blind, controlled trial will include 78 people with electrodiagnostically confirmed mild or moderate CTS and 30 healthy participants (N = 108). Patients will be randomly assigned into (1) a 6-week progressive home-based neurodynamic exercise intervention (n = 26), (2) a steroid injection (= 26), or (3) advice (n = 26) group. The primary outcome measure is fractional anisotropy of the median nerve at the wrist using advanced magnetic resonance neuroimaging. Secondary outcome measures include neuroimaging markers at the wrist, quantitative sensory testing, electrodiagnostics, and patient reported outcome measures. Exploratory outcomes include neuroimaging markers at the cervical spine, inflammatory and axonal integrity markers in serial blood samples and biopsies of median nerve innervated skin. We will evaluate outcome measures at baseline and at the end of the 6-week intervention period. We will repeat questionnaires at 6-months. Two-way repeated measures ANCOVAs, followed by posthoc testing will be performed to identify differences in outcome measures among groups and over time.

Discussion: This study will advance our understanding of the mechanisms of action underpinning neurodynamic exercises, which will ultimately help clinicians to better target these treatments to those patients who may benefit from them. The inclusion of a positive control group (steroid injection) and a negative control group (advice) will strengthen the interpretation of our results.

Trial registration: NCT05859412, 20/4/2023.

Keywords: Carpal tunnel syndrome; Exercises; MRI; Mechanisms; Neurodynamic; Quantitative sensory testing.

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Conflict of interest statement

AS has received a rising star award grant by Ono pharmaceuticals (unrelated to this work), and lecturing fees for postgraduate lectures. GB receives fees for RNA-seq consulting by Ivy farm and for Sc RNA-seq consulting by coding.bio. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trial flow chart
Fig. 2
Fig. 2
Progressive home-based programme of nerve and tendon gliding exercises (A) Weeks 1–2, (B) weeks 3–4, and (C) weeks 5–6. The brackets surrounding two figures indicate the combination of movements for that exercise, from the start to the end point
See this image and copyright information in PMC

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