Exclusion criteria were other neuromuscular pathology in the hand (eg, De Quervain’s tenosynovitis, trigger finger), surgical interventions on the carpometacarpal joint, a Beck Depression Inventory score of more than 4 (Wang et al 2005), a State
Trait Anxiety Inventory score of 30 or more (Antunes et al 2005), or any neurological condition in which pain perception was altered (Wajon and Ada 2005). Both interventions were applied by an experienced physiotherapist with a 4-year post-graduate certificate in manual therapy and 11 years of experience in the management of musculoskeletal pain disorders. The experimental group received a neurodynamic nerve slider technique targeted to the radial nerve over the symptomatic hand for 6 sessions over 4 weeks. The technique was applied with the patient positioned in Libraries supine and the physiotherapist seated. The technique involved alternating the following two movements: shoulder HKI-272 order depression applied simultaneously with elbow flexion and wrist extension; and shoulder elevation simultaneously with elbow Selleck CX-5461 extension, wrist flexion, and ulnar deviation. These movements were alternated at a rate of approximately 2 seconds per cycle (1 second into extension and 1 second into flexion). This technique is intended to produce a sliding movement of neural structures in relation to their adjacent
tissues. Speed and amplitude of movement were adjusted such that no pain was produced. At each session, the technique was applied 3 times for 3 min separated by 1-min rest periods. Participants in the control group received a sham dose of intermittent ultrasound therapy to the thumb region for 10 minutes for 6 sessions over 4 weeks. Further detail of each intervention is available in the primary report of this trial (Villafañe et al 2012a). Pressure pain threshold is a quantitative sensory test of
tissue sensitivity and it is defined as the minimal amount of pressure that produces pain, measured via a pressure algometer (Ylinen 2007). Pressure pain thresholds near to the pathological site are thought to represent the degree of peripheral nociception, whereas pressure pain thresholds distant to the pathology are a marker of central nervous system hyper-excitability (Kamper et al 2011). The validity much and reproducibility of algometry has been described, with higher pressure pain thresholds indicating lower pain sensitivity (Fischer 1987). Pressure pain threshold was measured contralaterally over the lateral epicondyle, thumb carpometacarpal joint at the anatomical snuffbox, the tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone. The pressure applied was increased by approximately 0.1 kg/cm2 each second until the onset of pain. Three measurements were obtained from each point and the mean was used for statistical analysis. A 1-min rest period was allowed between each measurement.