Movimiento y dolor
1 junio 2020

Manejo fisioterápico de dolor neuropático sin correlación anatómica nerviosa: informe de caso

Juan José Fernández-Pérez
Centro de rehabilitación neurológica FOREN, Tres Cantos, Madrid, España.
Alberto Pérez-González
Instituto de rehabilitación funcional (IRF) La Salle, Madrid, España.
Atrapamiento neuralFisioterapiaTerapia manualMovilización neural
Vol. 2 Núm. 1 (2020): Junio



El dolor neuropático periférico por atrapamiento es una patología muy descrita en la literatura desde el punto de vista anatomo-patológico. No obstante, la literatura solo nos presenta un manejo quirúrgico, con técnicas poco conservadoras y es por ello que presentamos este caso. Paciente LG, varón de 46 años que acude a consulta con 1) alodinia en la cara medial del brazo y dolor eléctrico con pinchazos hasta la muñeca (EVA 84); 2) molestias en epicóndilo lateral tras fondos en el gimnasio (EVA 30). La resonancia magnética nuclear no muestra hallazgos relevantes. Presentaba limitación de 10º en la extensión de codo y una flexión glenohumeral de 45º, con endfeel doloroso y los test neurodinámicos ULNT2b para radial y modificación para musculocutáneo positivos. Los cuestionarios Quick Dash (86,7%) y Tampa Scale of Kinesiophobia (29/44) con valores muy altos. Tratamiento conservador: se realizó una intervención de fisioterapia, combinando ejercicio cardiovascular, fuerza resistencia y control motor, combinado con terapia manual. Los síntomas neurales y el ROM se recuperaron por completo. El cuestionario Quick Dash (2,27%), TSK (16) y fuerza de prensión (de 20 a 59kg) mostraron una mejora clínicamente relevante. La fisioterapia, mediante un tratamiento que promueva el ejercicio y estrategias de afrontamiento activas son de gran utilidad en pacientes con signos/síntomas neurales.

  Cómo citar

Fernández-Pérez JJ, Pérez-González A. Manejo fisioterápico de dolor neuropático sin correlación anatómica nerviosa: informe de caso. MOVE [Internet]. 1 de junio de 2020 [citado 31 de marzo de 2023];2(1):101-18. Disponible en:


Baselgia LT, Bennett DL, Silbiger RM, Schmid AB. Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Arch Phys Med Rehabil. 2017;98(3):480–6 DOI: DOI:

Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Metaanalysis. J Orthop Sport Phys Ther. 2017;47(9):593–615 DOI: DOI:

Bennett MI, Smith BH, Torrance N, Potter J. The S -LANSS score for identifying pain of predominantly neuropathic origin: Validation for use in clinical and postal research. J Pain. 2005;6(3):149–58 DOI: DOI:

Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. Br Med J. 2006;333(7575):939–41 DOI: DOI:

Bohannon RW. Minimal clinically important difference for grip strength: a systematic review. J Phys Ther Sci. Society of Physical Therapy Science; 2019;31(1):75–8 DOI: DOI:

Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008;31(2):165–9 DOI: DOI:

Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. Elsevier; 2005;114(1–2):29–36 DOI: DOI:

Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004;108(3):248–57 DOI: DOI:

Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. Society for Neuroscience; 2015;35(17):6619–29 DOI: DOI:

Caplan N, Robson H, Robson A, Kelly M, Wilkes G. Changes in health-related quality of life (EQ-5D) dimensions associated with community-based musculoskeletal physiotherapy: a multicentre analysis. Qual Life Res. Springer International Publishing; 2018;27(9):2373–82 DOI:

Chen MJ, Fan X, Moe ST. Criterion-related validity of the Borg ratings of perceived exertion scale in healthy individuals: A meta-analysis. J Sports Sci. 2002;20(11):873–99 DOI: DOI:

Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Prim. Nature Publishing Group; 2017;3(1):17002 DOI: DOI:

Coombes BK, Bisset L, Vicenzino B. Bilateral cervical dysfunction in patients with unilateral lateral epicondylalgia without concomitant cervical or upper limb symptoms: A crosssectional case-control study. J Manipulative Physiol Ther. 2014;37(2):79–86 DOI: DOI:

Costello M, Puentedura E “Louie” J, Cleland J, Ciccone CD. The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial. J Man Manip Ther. Taylor & Francis; 2016;24(3):128–40 DOI: DOI:

Costigan M, Scholz J, Woolf CJ. Neuropathic Pain: A Maladaptive Response of the Nervous System to Damage. Annu Rev Neurosci. Annual Reviews; 2009;32(1):1–32 DOI: DOI:

Covill LG, Petersen SM. Upper extremity neurodynamic tests: Range of motion asymmetry may not indicate impairment. Physiother Theory Pract. 2012;28(7):535–41 DOI: DOI:

Dabholkar AS, Kalbande VM, Yardi S. Neural Tissue Mobilisation Using ULTT2b and Radial Head Mobilisation v/s Exercise Programme in Lateral Epicondylitis. Indian J Physiother Occup Ther Int J. A. Sharma; 2006;7(4):247–52.

Davis DS, Anderson IB, Carson MG, Elkins CL, Stuckey LB. Upper Limb Neural Tension and Seated Slump Tests: The False Positive Rate among Healthy Young Adults without Cervical or Lumbar Symptoms. J Man Manip Ther. Taylor & Francis; 2008;16(3):136–41 DOI: DOI:

Domkundwar S, Autkar G, Khadilkar S V, Virarkar M. Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies. J Ultrasound. Springer; 2017;20(2):111–22 DOI: DOI:

Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD. The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. J Pain. Churchill Livingstone Inc.; 2016;17(9):T70–92 DOI: DOI:

Ekstrom RA, Holden K. Examination of and Intervention for a Patient With Chronic Lateral Elbow Pain With Signs of Nerve Entrapment. Phys Ther. Oxford University Press (OUP); 2002;82(11):1077–86 DOI: DOI:

Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice ASC, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis. Lancet Neurol. Lancet Publishing Group; 2015;14(2):162–73 DOI:

Foster C, Porcari JP, Anderson J, Paulson M, Smaczny D, Webber H, Doberstein ST, Udermann B. The talk test as a marker of exercise training intensity. J Cardiopulm Rehabil Prev. 2008;28(1):24–30 DOI: DOI:

García Campayo J, Rodero B, Alda M, Sobradiel N, Montero J, Moreno S. Validation of the Spanish version of the Pain Catastrophizing Scale in fibromyalgia. Med Clin (Barc). 2008;131(13):487–92. DOI:

Godoy Izquierdo D, Godoy García JF, López-Chicheri García I, Martínez Delgado A, Gutiérrez Jiménez S, Vázquez Vázquez L. Psychometric properties of the Escala de Autoeficacia para el Afrontamiento del Estrés (EAEAE). Psicothema. 2008;20(1):155– 65.

Van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: A systematic review of epidemiological studies. Vol. 155, Pain. Elsevier B.V.; 2014. p. 654–62 DOI: DOI:

Hervás MT, Navarro Collado MJ, Peiró S, Rodrigo Pérez JL, López Matéu P, Martínez Tello I. Versión Española del cuestionario DASH. Adaptación transcultural, fiabilidad, validez y sensibilidad a los cambios. Med Clin (Barc). Ediciones Doyma, S.L.; 2006;127(12):441–7 DOI: DOI:

Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BMA. Does effectiveness of exercise therapy and mobilization techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Vol. 47, British Journal of Sports Medicine. 2013. p. 1112–9 DOI: DOI:

Jensen TS, Finnerup NB. Allodynia and hyperalgesia in neuropathic pain: Clinical manifestations and mechanisms. Lancet Neurol. 2014;13(9):924–35 DOI:

Kim MJ, Park KS, Seo AR, Lee S Il, Ha YC, Yoo J Il. Determining functional activity profiles in patients with upper extremity disorders: Is there effect modification by hand-grip strength? Clin Interv Aging. Dove Medical Press Ltd.; 2018;13(1):2351–8 DOI: DOI:

Lee M, Gandevia SC, Carroll TJ. Unilateral strength training increases voluntary activation of the opposite untrained limb. Clin Neurophysiol. 2009;120(4):802–8 DOI: DOI:

López-de-Uralde-Villanueva I, Gil-Martínez A, CandelasFernández P, de Andrés-Ares J, Beltrán-Alacreu H, La Touche R. Validity and reliability of the Spanish-language version of the selfadministered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. Neurologia. 2018;33(8):505–14 DOI: DOI:

Marcolino AM, das Neves LMS, Oliveira BG, Alexandre AA, Corsatto G, Barbosa RI, de Cássia Registro Fonseca M. Multimodal approach to rehabilitation of the patients with lateral epicondylosis: a case series. Springerplus. SpringerOpen; 2016;5(1):34–45 DOI:

Mathers JJ. Differential diagnosis of a patient referred to physical therapy with neck pain: A case study of a patient with an atypical presentation of angina. Vol. 20, Journal of Manual and Manipulative Therapy. Taylor & Francis; 2012. p. 214–8 DOI: DOI:

Mehta P, Claydon LS, Hendrick P, Cook C, Baxter DG. Pain and Physical Functioning in Neuropathic Pain: A Systematic Review of Psychometric Properties of Various Outcome Measures. Pain Pract. 2016;16(4):495–508 DOI: DOI:

Nacul LC, Mudie K, Kingdon CC, Clark TG, Lacerda EM. Hand grip strength as a clinical biomarker for ME/CFS and disease severity. Front Neurol. Frontiers Media S.A.; 2018;9(2):13–24 DOI: DOI:

Olaussen M, Holmedal O, Lindbaek M, Brage S, Solvang H. Treating lateral epicondylitis with corticosteroid injections or nonelectrotherapeutical physiotherapy: A systematic review. BMJ Open. BMJ Publishing Group; 2013;3(10) DOI: DOI:

Olaussen M, Holmedal Ø, Mdala I, Brage S, Lindbæk M. Corticosteroid or placebo injection combined with deep transverse friction massage, Mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: A randomised, controlled trial. BMC Musculoskelet Disord. BioMed Central Ltd.; 2015;16(1):65–74 DOI:

Olsen MF, Bjerre E, Hansen MD, Hilden J, Landler NE, Tendal B, Hróbjartsson A. Pain relief that matters to patients: Systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Med. BioMed Central Ltd.; 2017;15(1) DOI:

Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clin Rehabil. SAGE Publications Ltd; 2014;28(9):862–72 DOI: DOI:

Reyhan AC, Sindel D, Dereli EE. The effects of Mulligan’s mobilization with movement technique in patients with lateral epicondylitis. J Back Musculoskelet Rehabil. IOS Press; 2020;33(1):99–107 DOI: DOI:

Saposnik G, Redelmeier D, Ruff CC, Tobler PN. Cognitive biases associated with medical decisions: a systematic review. BMC Med Inform Decis Mak. BioMed Central Ltd.; 2016;16(1):1– 14 DOI: DOI:

Schmid AB, Brunner F, Luomajoki H, Held U, Bachmann LM, Künzer S, Coppieters MW. Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskelet Disord. BioMed Central; 2009;10(1):11 DOI: DOI:

Schreiber KL, Campbell C, Martel MO, Greenbaum S, Wasan AD, Borsook D, Jamison RN, Edwards RR. Distraction analgesia in chronic pain patients the impact of catastrophizing. Anesthesiology. Lippincott Williams and Wilkins; 2014;121(6):1292–301 DOI: DOI:

Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentricconcentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. J Hand Ther. Hanley and Belfus Inc.; 2017;30(1):13–9 DOI: DOI:

Stasinopoulos D, Stasinopoulos I, Pantelis M, Stasinopoulou K. Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy. Br J Sports Med. 2010;44(8):579–83 DOI: DOI:

Svens B, Lee H. Intra- and inter-instrument reliability of GripStrength Measurements: GripTrackTM and Jamar® hand dynamometers. Br J Hand Ther. SAGE Publications; 2005;10(2):47–55 DOI: DOI:

Wainner RS, Allison SC. Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy The treatment-based classification system: revision and update View project APEP trial View project. Spine (Phila Pa 1976). 2003;28(1):52–62 DOI:

Wardrop D. Ockham’s Razor: sharpen or re-sheathe? J R Soc Med. Royal Society of Medicine Press; 2008;101(2):50–1 DOI: DOI:

Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Rehabilitation of the Overhead Athlete’s Elbow. Sports Health. SAGE Publications; 2012;4(5):404–14 DOI: DOI: