Mechanisms of neurodynamic treatments (MONET)

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a relatively common condition caused by compression of the median nerve at the wrist.

Patients with carpal tunnel syndrome may undergo decompression surgery. Non-surgical treatments, such as neurodynamic exercises, are available and indicated in some patients with carpal tunnel syndrome.

Our study

Studies in animal models have shown that neurodynamic exercises can reduce inflammation and can help the nerve to regenerate. However, there is a lack of understanding about the exact mechanisms by which these exercises work.

Our study investigates the mechanisms of action of neurodynamic exercises to help clinicians identify which patients with carpal tunnel syndrome may benefit more from this treatment.

We will compare the effect of these exercises with a steroid injection (which is also a recommended treatment for carpal tunnel syndrome), or advice.

Do you have carpal tunnel syndrome?

We are looking for patients who have a diagnosis of mild or moderate CTS. We will perform a clinical assessment and electrodiagnostic studies to determine whether this is your case.

Participation involves attending two baseline appointments (~2.5 hours and ~1.5 hours) at the John Radcliffe Hospital in Oxford. We will measure how well your nerve functions using a detailed neurological examination, electrodiagnostic studies, tests of nerve function, and questionnaires. We will take blood and a small skin sample to evaluate the presence of inflammation and nerve injury. Finally, we will scan your wrist using MRI.

You will then be randomly allocated to receive one of three treatments: a home programme of neurodynamic exercises, a steroid injection or advice. After 6 weeks, you will attend another appointment (~3.5 hours) so we can repeat the same measurements and understand how the treatment helped you and your nerve function.

We will reimburse you for reasonable travel costs at the completion of the study.

If you are interested in participating, please contact us: monet@ndcn.ox.ac.uk