Neural mobilization to improve motion and reduce pain hypersensitivity in hand osteoarthritis : a preliminary study

Introduction: Pain in osteoarthritis (OA) is considered a complex integration of sensory and cognitive processes involving several abnormal cellular mechanisms at peripheral and central levels of the nervous system1. The peripherally directed therapies may modulate pain perception bilaterally. We hypothesized that these patients would show hypoalgesia of neural mobilization as compared to robotic assisted mobilization. Therefore, the purpose of this randomized controlled trial financed by “Ministero della Salute” from italy, is to examine the effects of nerves mobilization (NM) vs. robotic assisted passive mobilization of the hand on pain in sensitivity, hand function, analyze the quantitative and qualitative movement of hand in subjects with hand OA. Objective: The aim of the present preliminary study is to detail the protocol for a randomised controlled trial (RCT) of neural manual on pain in sensitivity as well as analyse the quantitative and qualitative movement of hand in subjects with hand osteoarthritis. We show some preliminary data about the group handled with NM. Methods: Fourteen patients, aged 50 to 90 years old, with a diagnosis of hand OA, have been recruited. They received bilaterally an experimental intervention: NM of radial, ulnar and median nerves, plus exercise. Treatment took place for 12 sessions over 4 weeks. Evaluation consist of administration of: VAS, Quick-DASH, evaluation of grip/pinch strenght and pressure pain threshold (PPT) by mechanical pressure algometry of 6 points: Assessment points was been at baseline and end of therapy. The outcomes of this intervention was been pain and determine the central pain processing mechanisms. Results: The analyses showed that patients with hand OA present bilaterally increased PPTs over the first CMC joint and median nerve as compared to pre-treatment (all, P<0.05). Similarly, tip pinch of the bilaterally increased did increase after treatment (P<0,05). Patients with hand OA also exhibited a hand right reduction in VAS than pre-treatment (P<0.05). A significant correlation was found between PPT over the ulnar nerve and QuickDASH (r=0.567, P=0.037). Conclusion: Treatment shows a signifier increase of PPTs over the first CMC joint and median nerve. NM decreases pain in hand with OA and increases bilaterally pinch strength after treatment.