Loading...
Author Verified
RCT
ACE Report #4497

Thumb carpometacarpal osteoarthritis: Radial nerve mobilization as a possible treatment


Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A

Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial

Arch Phys Med Rehabil. 2012 Mar;93(3):396-403. doi: 10.1016/j.apmr.2011.08.045. Epub 2012 Jan 2

Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here

Synopsis

60 patients with dominant-hand thumb carpometacarpal osteoarthritis (OA) were randomized into two groups to measure the effects of either radial nerve mobilization treatment or a nontherapeutic placebo treatment on pain sensitivity and pinch strength. At 2 months follow-up, patients who underwent radial nerve mobilization experienced a decrease in pain sensitivity in the trapeziometacarpal joint and an increase in tip and tripod pinch strength.

Publication Funding Details +
Funding:
Not Reported
Conflicts:
None disclosed

Risk of Bias

7.5/10

Reporting Criteria

19/20

Fragility Index

N/A

Was the allocation sequence adequately generated?

Was allocation adequately concealed?

Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?

Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?

Blinding Patients: Was knowledge of the allocated interventions adequately prevented?

Was loss to follow-up (missing outcome data) infrequent?

Are reports of the study free of suggestion of selective outcome reporting?

Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?

Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?

Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.

4/4

Randomization

4/4

Outcome Measurements

4/4

Inclusion / Exclusion

4/4

Therapy Description

3/4

Statistics

Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

Thumb carpometacarpal OA affects many people, especially women, in Europe and the United States. The cause of this upper limb-related disability is a result of the modification of the trapeziometacarpal joint. Consequently, those with the condition have difficulty with pinch and grip strength and experience much pain. Thumb carpometacarpal OA may be treated by undergoing surgery, but it only results in partial improvement. Neurodynamic techniques have been suggested as additional treatments on top of surgery in managing pain and improving pinch strength, but not many studies have tested the outcomes of applying such methods. Hence, this study aimed to test the efficacy of the neurodynamic technique, radial nerve mobilization, in treating thumb carpometacarpal OA.

What was the principal research question?

Did radial nerve mobilization treatment for dominant-hand thumb carpometacarpal OA decrease pain sensitivity in the thumb and increase pinch strength, when measured over a 2 month period?

Study Characteristics -
Population:
60 right-hand dominant patients, who had stage III or IV secondary thumb carpometacarpal OA in the dominant hand, approved radiographically by the Eaton-Littler-Burton Classification (Age range: 70-90).
Intervention:
Radial Nerve Mobilization Group: Patients underwent 6 sessions of radial nerve mobilization treatment on their right hand over a 4 week period. During each session, the treatment, which involved a sliding mobilization of the proximal-distal radial nerve, was applied 3 times over a 4 minute period (Mean age: 80.87 +/- 2.93) (n=30).
Comparison:
Placebo Group: Patients underwent 6 sessions of a placebo technique on their right hand over a 4 week period. During each session, the placebo technique, which involved the patient receiving inactive and nontherapeutic doses of pulsed ultrasound, was applied 3 times over a 4 minute period (Mean age: 81.73 +/- 2.93) (n=30).
Outcomes:
The outcomes measured were pressure pain threshold (PPT) of the trapeziometacarpal joint, scaphoid and hamate bones, as an indicator of mechanical pain sensitivity (measured using a mechanical pressure algometer with pressure applied at a rate of 30kPa/s) and tip and tripod pinch strength, as indicators of motor performance (measured using a mechanical pinch gauge when elbow was flexed at 90 degrees).
Methods:
RCT: prospective; multi center; double blinded.
Time:
PPT and pinch strength were measured prior to and 5 minutes, 1, and 2 months following to treatment.

What were the important findings?

  • PP-There was a significant improvement in PPT of the trapeziometacarpal joint between all assessments for the Radial Nerve Mobilization group (p<0.001), but not for the placebo group.
  • There were significant improvements in PPT of the scaphoid and hamate bones between the first and second months of assessments for both groups, but no significant difference between groups (p=0.06).
  • There was a significant difference in tip and tripod pinch strength between pre-treatment and post-treatment assessments for the Radial Nerve Mobilization group (p=0.04).
  • There were no significant differences in tip and tripod pinch strength during assessments at 1 and 2 months following treatment between the Radial Nerve Mobilization group and the placebo group (p>0.05).T and pinch strength were measured prior to and 5 minutes, 1, and 2 months following to treatment.

What should I remember most?

The results displayed that radial nerve mobilization treatment of dominant-hand thumb carpometacarpal OA was effective in increasing mechanical pain sensitivity in the trapeziometacarpal joint and increasing tip and tripod pinch strength.

How will this affect the care of my patients?

Radial nerve mobilization was successful when focussing on its effects on neurophysiological function of patients. However, it is uncertain whether improvements would be observed if pain or disability scales for the hand were used instead. Future studies should incorporate these scales to measure outcomes and a larger sample size should be included.

CME Image

Continuing Medical Education Credits

You could be earning 0.5 CME credits for each report you read.

LEARN MORE

Please Login or Join to leave comments.