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  1. Paolo Pedersini1,
  2. Stefano Negrini1,2,
  3. Raquel Cantero-Tellez3,
  4. Josue Fernandez-Carnero4,
  5. Mark D. Bishop5,
  6. Jorge Hugo Villafañe1
  1. 1Fondazione Don Carlo Gnocchi, Milan, Italy
  2. 2Universita degli Studi di Brescia, Brescia, Italy
  3. 3Universidad de Málaga, Málaga, Spain
  4. 4Universidad Rey Juan Carlos, Madrid, Spain
  5. 5University of Florida, Florida, United States of America


Background Recent studies suggest that osteoarthritis (OA) is a mixed pain state and that in some patients’ central nervous system factors can play an important role.

Objectives In this study, we showed some preliminary dataon the effectiveness of neural manual mobilization vs robotic assisted mobilization, on reduce pain sensitivity in subjects with dominant hand OA.

Methods A pilot randomized controlled trial was conducted. 50 patients (50 to 90 years old) with a diagnosis of dominant hand OA were randomized into two groups of 25 participants. The experimental group received an intervention of neurodynamic mobilization of median, radial and ulnar nerves plus exercise, the control one received a robotic assisted passive mobilization treatment (Gloreha Workstation, Idrogenet srl, Brescia, Italy) plus exercise. Both groups received 12 treatment sessions over 4 weeks. Pressure pain thresholds (PPTs) were assessed bilaterally over the Radial, Median and Ulnar nerves, first Carpometacarpal (CMC) joint, Hamate bone and in the C5-C6 zygapophyseal joint. Intensity of pain (Visual analogue scale, VAS), Quick-DASH scale, grip and pinch strength were also measured bilaterally. Patients were assessed at beginning, at the end of therapy and after a period of 1 and 3 months.

Results In comparison with pre-treatment values, the experimental treatment increased the PPTs in the first CMC joint, radial and median nerves (P < 0.05) and this effect was maintained until the 2nd Follow up session in the dominant hand. No significant changes in PPT at the hamate bone and ulnar nerve during treatment were found. No significant interaction for pain intensity (VAS) of hand while executing a grip strength, over the last 24 hours and over the last week also was found. Similarly, grip and pinch of the dominant hand did not increase after treatment.

Conclusion Neurodynamic mobilization by sliding technique decreases pain in the hand joints in patients with hand OA, suggesting alternative therapies to surgery or to the use of analgesic. This research suggests alternative therapies to surgery or the use of analgesic therapy.

References [1] Kroon FPB, Carmona L, Schoones JW, Kloppenburg M. Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis. RMD open 2018; 4(2): e000734.

[2] Villafane JH, Valdes K, Pedersini P, Berjano P. Osteoarthritis: a call for research on central pain mechanism and personalized prevention strategies. Clinical rheumatology2018.

[3] Villafane JH, Bishop MD, Fernandez-de-Las-Penas C, Langford D. Radial nerve mobilisation had bilateral sensory effects in people with thumb carpometacarpal osteoarthritis: a randomised trial. Journal of physiotherapy2013; 59(1): 25-30.

[4] Villafane JH, Silva GB, Bishop MD, Fernandez-Carnero J. Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. Archives of physical medicine and rehabilitation2012; 93(3): 396-403.

[5] Villafane JH, Cleland JA, Fernandez-de-Las-Penas C. The effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. The Journal of orthopaedic and sports physical therapy2013; 43(4): 204-13.

Acknowledgement This study was supported by a grant from the Ministry of Health, Italy, 2016 (project code: GR-2013-02358472).

Disclosure of Interests None declared

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