The long-term effect of neurodynamics vs exercise therapy on pain and function in people with carpal tunnel syndrome: a randomized parallel-group clinical trial

Key points

1. 01Neurodynamics therapy (4 sessions combining manual nerve mobilization and home exercise) outperformed supervised exercise therapy on functional disability scores at 6 months
2. 02Between-group difference in QuickDASH general disability favoured neurodynamics by 12.6 points at 6 months (P = .04)
3. 03Between-group pain difference favoured neurodynamics at 1 month (worst pain -1.93, P = .014) but was not significant at 6 months
4. 04Grip strength improved significantly in the neurodynamics group at 1 and 6 months, though the between-group difference was not statistically significant
5. 050 of 41 participants required median nerve decompression surgery at 1 year after treatment

How it was conducted

Design

Parallel-group randomized clinical trial with blinded outcome assessment

Participants

41 adults (52 hands) with clinically and electrophysiologically confirmed carpal tunnel syndrome; majority female (90%), mean age 48.2 years

Intervention

Neurodynamics group (NDT): 4 weekly 60-minute sessions of median nerve manual therapy plus supervised home neurodynamic exercises

Control

Exercise group (EXT): 4 sessions of tendon gliding, wrist strengthening, stretching, and active range-of-motion exercises plus daily home exercise pamphlet

Follow-up

Outcomes measured at baseline, 1 month (treatment completion), 6 months post-treatment, and surgery at 1 year

Primary outcome

Boston Carpal Tunnel Questionnaire - Symptom Severity Scale (SSS) and Functional Status Scale (FSS)

What they found

• NDT group SSS improved by mean 1.36 (95% CI 0.9 to 1.8) at 1 month and 1.55 (95% CI 0.9 to 2.2) at 6 months; EXT group improved by 0.65 (95% CI 0.4 to 1.0) and 0.79 (95% CI 0.5 to 1.1) respectively
• Between-group FSS difference at 6 months: -0.49 (95% CI -1.0 to -0.01), P = .04, favouring NDT
• Between-group QuickDASH general disability difference at 6 months: -12.60 (95% CI -24.5 to -0.7), P = .04, favouring NDT
• NDT worst pain improved by 4.76 (95% CI 2.7 to 6.8) at 1 month and 5.00 (95% CI 2.6 to 7.4) at 6 months; between-group difference at 1 month: -1.93 (95% CI -3.5 to -0.4), P = .014
• NDT mean pain between-group difference at 1 month: -1.75 (95% CI -2.9 to -0.6), P = .005
• NDT grip strength improved by mean 11.00 lb (95% CI -20.8 to -1.2) at 1 month and 14.26 lb (95% CI -22.7 to -5.8) at 6 months; between-group differences were not significant (P = .46 at 1 month, P = .28 at 6 months)
• QuickDASH improvement at 6 months: NDT 44.41 points (95% CI 27.0 to 61.8), EXT 30.06 points (95% CI 19.0 to 41.1), both exceeding the 15.91-point minimum clinically important difference
• 0 out of 41 participants required decompression surgery at 1 year

Limitations

• No true no-treatment control group, so natural recovery and placebo effects cannot be separated from treatment effects
• Loss to follow-up was 16% in EXT and 23% in NDT, reducing the analyzed sample to 41 of 51 randomized participants
• 6-month follow-up was the longest controlled time point; a 1-year or longer controlled follow-up would be more appropriate for assessing long-term durability
• Participants were not stratified by CTS severity, limiting conclusions about which patient subgroups benefit most

Why it matters

For patients

People with mild-to-moderate carpal tunnel syndrome can expect meaningful pain relief and functional improvement from either physiotherapy approach, with neurodynamics offering greater functional gains, and both avoiding the need for surgery at 1 year.

For clinicians

Neurodynamics therapy combining manual nerve mobilization with structured home exercise should be considered as a first-line conservative approach for CTS, given its superior functional outcomes at 6 months over standard exercise therapy in just 4 treatment sessions.

For readers

This trial supports conservative physiotherapy, particularly neurodynamics, as an effective and surgery-sparing strategy for CTS, though the absence of a no-treatment control and modest sample size limit the strength of conclusions.