Short-Term Neurodynamic Mobilizations May Improve Hand Osteoarthritis Pain Hypersensitivity

Among patients with hand osteoarthritis (OA), neurodynamic mobilizations decrease pain hypersensitivity, but this effect is not maintained at 3-month follow-up, according to study results published in Arthritis Care & Research.

In this randomized controlled trial (ClinicalTrials.gov Identifier: NCT02701335), investigators randomly assigned patients (mean age, 71±11 years) diagnosed with dominant hand OA (n=72) into 2 groups to receive 12 sessions over a 4-week time frame, consisting of either neurodynamic mobilization of the median, radial, and ulnar nerves  or robotic-assisted passive physiologic movement treatment. Patients in both groups also received additional standardized exercises. Researchers used pain intensity, pressure pain thresholds (PPTs), and strength measurements as outcome measures.

Patients who received neurodynamic mobilization had significantly higher PPTs than those who received passive physiologic movement treatment at 3 sites, including the ipsilateral thumb carpometacarpal joint (0.7 kg/cm²; 95% CI, 0.6-0.8 kg/cm² vs 0.2 kg/cm²; 95% CI, 0.1-0.4 kg/cm²), median nerve (0.7 kg/cm²; 95% CI, 0.6-0.7 kg/cm² vs 0.1 kg/cm²; 95% CI, 0.2-0.4 kg/cm²), and radial nerve (0.5 kg/cm²; 95% CI, 0.3-0.6 kg/cm² vs 0.2 kg/cm²; 95% CI, 0.1-0.4 kg/cm²). Patients also showed a significant reduction in pain immediately after the intervention. At the 3-month follow-up, these differences were no longer statistically significant.

This study was limited by having only 1 testing measure to determine the presence of pain sensitivity. Multiple testing measures to adequately assess pain processing alterations in hand OA, and a longer follow-up, would be useful in further studies. Performing bilateral tests to examine the effect of neurodynamic mobilization on nerve conduction velocity might have provided insight into any changes in the central and peripheral neural functioning. The hand stability exercises received by both groups may have presented a confounding variable if the combination of treatments was more important for outcomes than the treatments without exercise. Researchers did not assess all outcome domains recommended in the Osteoarthritis Research Society International/Outcome Measures in Rheumatology core sets for outcome measurement in hand OA trials. Therefore, they could not comment on the effect of observed changes in the proxy measures of sensitization in these areas.

Researchers demonstrated that neurodynamic mobilizations and exercise decrease hypersensitivity to a greater extent than passive movement combined with exercise immediately after intervention in patients with OA.

“We are unable to calculate the effect of the neurodynamic mobilization without the influence of the exercise program,” the researchers wrote. “These results were not maintained at the 3-month follow-up. Therefore, future studies should continue to examine the effects in neural mobilization in [patients] with hand OA to determine if any true benefits exist.”

Reference

Pedersini P, Valdes K, Cantero-Tellez R, Cleland JA, Bishop MD, Villafañe JH. The effects of neurodynamic mobilizations on pain hypersensitivity in patients with hand osteoarthritis compared to robotic assisted mobilization: A randomized clinical trial [published online November 1, 2019]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24103