Effect of massage, passive neural mobilization and transcutaneous electrical nerve stimulation on magnetic resonance diffusion tensor imaging (MR-DTI) of the tibial nerve in a patient with type 2 diabetes mellitus induced neuropathy: a case report

ABSTRACT

Background

MR-DTI parameters namely fractional anisotropy (FA) and apparent diffusion coefficient values (ADC) of diffusion imaging demonstrate the directional preference and speed of diffusion of water molecules. The purpose of this case report is to explore the effect of massage, passive neural mobilization and transcutaneous electrical nerve stimulation on MR-DTI of the tibial nerve in a patient with type 2 diabetes mellitus having chronic distal symmetrical sensorimotor neuropathy.

Case Description

A 63-year-old male with type 2 diabetes mellitus diagnosed with chronic symmetrical sensorimotor diabetic peripheral neuropathy on the basis of medical examination and electrophysiological testing. Altered mechanosensitivity of the tibial nerve was confirmed through neurodynamic testing. MR-DTI revealed severe damage of the tibial nerve as shown by chaotic diffusion of water molecules and damaged microstructural integrity.

Intervention

A total six sessions over 3 weeks including nerve massage in a longitudinal and transverse direction; passive neural mobilization consisting of sliders and tensioners of the tibial nerve; and followed by 15 minutes of continuous transcutaneous electrical nerve stimulation directed along the nerve course.

Outcome

FA and ADC values, pain, neuropathy quality of life and range of motion data were collected pre and post intervention. Analysis revealed clinical improvement in all the outcome measures.

Conclusion

This case report identified improvement in radiological MR-DTI outcomes following rehabilitation in a patient with diabetic peripheral neuropathy.

KEYWORDS:

• Diabetic neuropathies
• diffusion tensor magnetic resonance imaging
• transcutaneous electrical nerve stimulation
• type 2 diabetes mellitus

Acknowledgments

The authors express their sincere thanks to Mr. Pramod Dubey, CT/MRI Technologist, Maharishi Markandeshwar Super-Specialty Hospital, Affiliated to Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University) , Mullana – 133207, Haryana, India for his assistance in data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the Maharishi Markandeshwar (Deemed to be University), Mullana [MM (DU)/PhD/20170001].