ISRCTN - ISRCTN81771317: Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis

Plain English Summary

Lay summary under review 3

Trial website

Contact information

Type

Scientific

Primary contact

Dr Jorge Hugo Villafañe

ORCID ID

Contact details

via c. Colombo 2/9
Piossasco
10045
Italy

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

N/A

Study information

Scientific title

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

Acronym

Study hypothesis

Thumb carpometacarpal osteoarthritis (TCOA) constitutes a major cause of upper limb related-disability in Europe and the United States. In fact, 30-40% of postmenopausal women and 40-50 year-old men suffer from this condition. TCOA contributes to the largest number of osteoarthritis-related surgical procedures conducted in United States. The main cause of TCOA is the degenerative alteration of the trapeziometacarpal (TM) joint. This includes chronic deterioration of superficial surfaces of the joint and ectopic bone regeneration. These characteristics of TCOA result in increased pain at the base of the thumb.

Our primary intent in this study is to confirm that neurophysiological changes occur in response to this intervention and extend these findings to a different peripheral musculoskeletal pain condition.

Ethics approval

Local Health Authority, Collegno, Italy (Residenze Sanitarie Assistenziali Azienda Sanitaria Locale 3 (A.S.L 3), Collegno Italy) ref: 93571/c

Study design

Randomized controlled trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Hospitals

Trial type

Treatment

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet

Condition

Thumb carpometacarpal osteoarthritis

Intervention

Radial nerve mobilization (treatment group):
1. Treatment was performed in six sessions over four weeks and was applied to the dominant hand three times during a four-minute period with one-minute pauses between periods
2. The technique consisted of a sliding mobilization of the proximal-distal radial nerve
3. To begin the technique, the patient was positioned in supine and the physiotherapist was seated
4. The physiotherapist depressed the patients shoulder girdle, extended the patients elbow and then internally rotated the arm
5. The patients wrist, thumb and all the fingers were flexed. Finally ulnar deviation of the hand was added.
6. This combination of movements is hypothesized to cause stress the radial nerve
7. Once the upper extremity was positioned two movements were done as follows:
7.1. Soulder depression was applied simultaneously with elbow flexion and wrist extension
7.2. Shoulder elevation is performed with elbow extension and wrist flexion and ulnar deviation
8. These motions are alternated at a rate of approximately 2 seconds per cycle (1 second into extension and 1 second into flexion)

Placebo technique (control):
1. Participants in the placebo group attended the same number of sessions as those in the treatment group, but they received intermittent ultrasound therapy for 10 minutes with an intensity of 0 watts/cm2 to on the hypothenar area of the dominant hand
2. Gel was used as required

Co-sponsor:
Rey Juan Carlos University (Universidad Rey Juan Carlos)
Deapartment of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Alcorcón, Spain

Intervention type

Other

Phase

Not Applicable

Drug names

Primary outcome measures

1. Mechanical pain sensitivity:
1.1. Pain sensitivity was determined by measuring pressure pain threshold (PPT)
1.2. Measurements were performed with a Mechanical Pressure Algometer (Wagner Instruments, Greenwich, Connecticut, USA) with a 1cm2 rubber-tipped plunger mounted on a force transducer was used for measuring PPT
1.3. Pressure was applied at a rate of 30 kPa/s
1.4. The mean of three measurements was calculated and used for the main analysis
1.5. Previous papers have reported an intraexaminer reliability of this procedure ranging from 0.6 to 0.97, while the interexaminer reliability ranged from 0.4 to 0.98
1.6. The following points were evaluated:
1.6.1. TM joint at the bottom of the anatomical snuffbox, tubercle of the scaphoid bone and unciform apophysis of the hamate bone
1.6.2. Three measurements were made with a one-minute pause between them
1.6.3. Although pain from deep tissue is difficult to assess precisely, PPT have been found useful in assessing pain reactions in OA patients
2. Motor performance:
2.1. Pinch strength
2.1.1. The pinch strength was evaluated with a mechanical pinch gauge (Baseline, NY, USA) in the sitting position with the shoulder adducted and neutrally rotated and the elbow flexed at 90°
2.1.2. Two different measurements were taken. First we measured the tip pinch between index and thumb fingers. Then we measured tripod pinch, between index and, middle fingers and the thumb.
2.1.3. The reliability of pinch strength has been found to be high (Intra-class correlation coefficient [ICC]= 0.93) (34)
3. Measurements were taken before intervention, after 1 month, 1st Follow-up and 2 months, 2nd follow up

Secondary outcome measures

1. The Beck Depression Inventory (BDI)
1.1. Review of internal consistency for the BDI ranges from 0.73 to 0.92, with a mean of 0.86, with alpha coefficients of 0.86 and 0.81 for psychiatric and non-psychiatric populations, respectively
1.2. The BDI observed showed high discrimination of depressive symptoms (75-100%)
2. State-Trait Anxiety Inventory (STAI)
2.1. This is a self rated questionnaire divided in two parts: anxiety-trait (referring to personality aspects) and anxiety-state (referring to systemic aspects of the context)
2.2. Responses are in a 1-4 scale
2.3. Anxiety-state refers to how individuals feel at the moment and anxiety-trait to how they generally feel
2.4. Each part varies from 20 to 80 points, and the scores indicate low (0-30), medium (31-49) or high (50 or more) anxiety levels
3. Measurements were taken before intervention, after 1 month (1st follow-up) and 2 months (2nd follow up)

Overall trial start date

20/09/2010

Overall trial end date

30/05/2011

Reason abandoned

Eligibility

Participant inclusion criteria

Patients who used the dominant hand systematically such as ex-factory workers and home workers, and were diagnosed with secondary Thumb carpometacarpal osteoarthritis (TCOA) in the dominant hand by X-ray detection of stage III and IV according to the Eaton-Littler-Burton Classification.

Participant type

Patient

Age group

Adult

Gender

Both

Target number of participants

60

Participant exclusion criteria

1. Patients if they scored more than 4 on the Becks Depression Inventory and/or more than 30 on the State Trait Anxiety Inventory (STAI)
2. Patients with a medical history of carpal tunnel syndrome, arthritis, surgical interventions on trapeziometacarpal (TM) joint, or DQuervains tenosynovitis
3. Patients presenting degenerative or non-degenerative neurological conditions in which pain perception was altered

Recruitment start date

20/09/2010

Recruitment end date

30/05/2011

Locations

Countries of recruitment

Italy

Trial participating centre