The effectiveness of slider and tensioner neural mobilization techniques in the management of upper quadrant pain: a systematic review of randomized controlled trials

Key points

1. 019 of 10 carpal tunnel syndrome studies reported statistically significant pain improvement with neural mobilization
2. 02All 11 cervical radiculopathy RCTs showed pain improvement, with 7 demonstrating within-group significance and 3 between-group significance
3. 03Slider neural mobilization appears more effective for acute conditions; tensioner techniques may be better suited to chronic upper quadrant pain
4. 04Evidence for shoulder impingement syndrome, cubital tunnel syndrome, and lateral elbow tendinopathy remains insufficient due to few studies and conflicting results
5. 05Most included studies combined neural mobilization with other treatments, making it difficult to isolate the specific effect of neural mobilization alone

How it was conducted

Design

Systematic review of randomized controlled trials (PRISMA guidelines)

Databases

PubMed, Cochrane Library, EBSCOhost, no chronological restriction

Studies included

25 RCTs from 974 identified articles

Participants

1149 total across all included studies

Conditions covered

Carpal tunnel syndrome (10 studies), cervical radiculopathy (11 studies), shoulder impingement syndrome (1 study), cubital tunnel syndrome (1 study), lateral elbow tendinopathy (2 studies)

Primary outcome

Pain changes measured via VAS or NPRS; methodological quality assessed with PEDro scale

What they found

• 25 RCTs met inclusion criteria from an initial 974 articles identified
• PEDro methodological quality scores ranged from 5 to 10, with a mean score of 7.96 points
• 4 studies scored fair quality (PEDro 5); the remainder scored 6 to 10 (good to excellent)
• For carpal tunnel syndrome: 9 of 10 studies demonstrated statistically significant pain improvement; 5 showed within-group significance and 4 showed between-group significance
• For cervical radiculopathy: all 11 RCTs showed pain improvement; 7 demonstrated within-group statistical significance and 3 demonstrated between-group statistical significance
• For cubital tunnel syndrome: 1 study (Svernlov et al., 2009, N=51) found no significant between-group differences over 6 months
• For shoulder impingement syndrome: 1 study (Akhtar et al., 2020, N=80) showed lower mean pain scores at week 11 with neural mobilization added to routine physiotherapy
• For lateral elbow tendinopathy: 2 studies with within-group improvements only; no between-group comparisons were definitive
• Only 6 of the 25 studies provided follow-up beyond 6 weeks

Limitations

• Most studies combined neural mobilization with other interventions (splinting, exercise, mobilization), making it impossible to isolate the neural mobilization effect
• Heterogeneity in treatment duration (1 week to 6 months), sample sizes (15 to 103 participants), and outcome measures prevented formal meta-analysis
• Many studies lacked blinding of participants and therapists, and some did not clearly report randomization methods, increasing risk of bias
• Only English-language RCTs were included, and inconsistent terminology for both techniques and conditions may have caused relevant studies to be missed

Why it matters

For patients

Patients with carpal tunnel syndrome or cervical radiculopathy may benefit from neural mobilization exercises added to their usual care, but results for other arm and shoulder conditions are less certain.

For clinicians

Neural mobilization, particularly slider techniques for acute presentations and tensioner techniques for chronic nerve-related conditions, can be considered as an adjunct for carpal tunnel syndrome and cervical radiculopathy, though technique selection should be guided by careful clinical reasoning.

For readers

This review synthesizes 25 RCTs and finds reasonable support for neural mobilization in two common upper limb conditions, but highlights a need for larger, better-designed trials with standardized techniques and longer follow-up periods.