Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome-an MRI study to reveal therapeutic mechanisms

Annina B. Schmid, James M. Elliott, Mark W. Strudwick, Mary Little, Michel W. Coppieters*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Splinting and nerve and tendon gliding exercises are commonly used to treat carpal tunnel syndrome (CTS). It has been postulated that both modalities reduce intraneural edema. To test this hypothesis, 20 patients with mild to moderate CTS were randomly allocated to either night splinting or a home program of nerve and tendon gliding exercises. Magnetic resonance images of the wrist were taken at baseline, immediately after 10min of splinting or exercise, and following 1 week of intervention. Primary outcome measures were signal intensity of the median nerve at the wrist as a measure of intraneural edema and palmar bowing of the carpal ligament. Secondary outcome measures were changes in symptom severity and function. Following 1 week of intervention, but not immediately after 10min, signal intensity of the median nerve was reduced by ∼11% at the radioulnar level for both interventions (p=0.03). This was accompanied by a mild improvement in symptoms and function (p<0.004). A similar reduction in signal intensity is not observed in patients who only receive advice to remain active. No changes in signal intensity were identified further distally (p>0.28). Ligament bowing remained unchanged (p>0.08). Intraneural edema reduction is a likely therapeutic mechanism of splinting and exercise.

Original languageEnglish (US)
Pages (from-to)1343-1350
Number of pages8
JournalJournal of Orthopaedic Research
Volume30
Issue number8
DOIs
StatePublished - Aug 2012

Keywords

  • MRI
  • carpal tunnel syndrome
  • nerve and tendon gliding exercises
  • neurodynamics
  • splinting

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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