CRPS of the upper limb is a common complication for stroke patients and it is accompanied by PAIN EDEMA JOINT STIFFNESS and can limit the functional recovery.

This syndrome is uniquely neurological where a dysfunction occurs between somatic and nociceptive afferent and sympathetic system and their regulatory efferent fibers.

Chemical function is controlled by neurotransmitters while electrical function is controlled by action potential. Any dysfunction in these will lead to this circle of pain swelling along with inflammation and joint stiffness.

The biomechanics of the neurological system has both extraneural and intraneural interfaces. A dysfunction in those will lead to a CRPS which will in return leads to a dysfunction in electrical and chemical properties of the nerve resulting in PAIN SWELLING STIIFNESS AND LIMITation in ROM.

There is no absolute treatment for CRPS, however some treatments can be used depending on the tolerance of every patient, like calcitonin, beta blockers, corticosteroids, analgesis, not forgetting the basic role of physical therapy based on evidence,

Therefore the following question arises; Will the neurodynamics and manual therapy release the intra and extra neural interfaces to increase neural results regarding the reduction of swelling and pain, as well as increasing the range of motion in hemiplegic patients suffering from CRPS in the left upper limb versus conventional physiotherapy?

To answer this question a study was conducted, over 2 years, having a Randomized Control Trial with 60 Left stroke patients aged between 60 and 80 years having CRPS since maximum of 3 months.

The sample was divided into 2 groups; an experimental one with 30 stroke patients underwent 10 neurodynamic and manual therapy sessions with therapist A. While the other, a comparative group also involved 30 stroke patients treated by 10 physical therapy sessions with therapist B. On condition that the Syndrome has occurred in less than 3 months.

Measurements were done by therapist C based on 4 variables within 25 criteria
Firstly; ROM using an electronic goniometer to assess 11 criteria
Secondly; Edema using a tape meter to assess 8 criteria

Thirdly; Pain using Visual Analogue scale to assess 4 criteria
Finally; Peripheral nervous condition using Upper Limb Tension Test to assess 4 criteria

The comparative group underwent Cryotherapy- antalgic currents

Passive mobilization along with activo-passive using contralateral hand
Passive stretching of tightened muscles and stretching for the posterior capsule of the shoulder.

On the other hand, the experimental group underwent Normalization techniques of skeletal and muscular structures in order to release any nerve entrapment due to: Neutral Side bent Left, Rotated Right ( NSLRR) Cervical Spine Dysfunction, in addition to the first rib ascension.

Neurodynamic Techniques: Firstly by Targeting the Sympathetic nervous system by pumping techniques over dorsal root ganglions and stellate ganglion.
SecondlyTargeting the spinal peripheral nervous system,
using Buttler’s technique aiming for all different nerve roots of the brachial plexus.

Gliding and sliding methods, which are used for the long nerves of the brachial plexus to liberate the nerve as it travels from the cervical root distally.

Data collection was performed before the first session and after 2 days of the last session for all the 25 criteria
Statistical results were conducted using ANOVA for quantitative and Fisher for qualitative measurements.

For the R.O.M.: 9 out of 11 gave positive significant result with p value less than 0.05; the other 2 had non significant result with a p value greater than 0.05

Concerning the Edema: 6 out of 8 criteria gave significant result with p value less than 0.05 and 2 had non significant result with p value greater than 0.05

About the pain criteria Both of them gave significant results with p value < 0.05
Upper Limb Tension Test: All 4 criteria gave a positive significant p value for the brachial plexus, median radial and ulnar nerves

Overall 21 of 25 criteria had significant results favoring the usage of the experimental approach or the neurodynamics and manual therapy techniques

4 of 25 had non significant results meaning both groups comparative and experimental had same results.

To conclude : We note that Neurodynamics and Manual Therapy released the intra and extra neural interfaces, and have an important action on decreasing symptoms of CRPS, which means that the range of motion, edema, pain and the peripheral nervous condition have been improved more than with Conventional Physiotherapy Treatment.

These results implement with no doubt that neurodynamics and manual therapy regulate the nerve’s biomechanic and allows its appropriate function on the nerve, vessel, joint and muscle level. The following pictures summarize the increased ROM and the Decreased edema

Further studies should be done to introduce these techniques in the treatment of CRPS, knowing that this is the first study conducted to target these techniques to this neurological syndrome