The effects of manual therapy on hand symptomes and median nerve tensionin in patients with carpal tunnel syndrome

Document Type : Original article

Authors

1 MSc student of sport physiotherapy, faculty of rehabilitation, Tehran University of Medical Sciences, Iran

2 Associate professor of physical therapy, Physical Medicine and Rehabilitation Research centre, Tabriz University of Medical Sciences, Iran

3 Associate professor of physical therapy, Mobility Impairment Research Center, Babol University of Medical Sciences, Iran

4 Associate professor of physical therapy, faculty of medicine, Babol University of Medical Sciences. Iran

Abstract

Background and Aims: Nerve mobilization is a relatively new approach in manual therapy whose efficacy and the most effective method of use are not clear. The aim of the present study was to investigate the effectiveness of manual therapy on severity of hand symptoms and median nerve tension in patiens with Carpal Tunnel Syndrome (CTS).
Materials and Methods: In the current RCT study, 32 patients with CTS were assigned into two groups of treatment and control. In both groups, the patients received the routine physiotherapy including the rest splint, TENS, and therapeutic ultrasound for four weeks. In addition to the routine physiotherapy, the patients in the treatment group received the manual therapy for both nerve mobilization and mechanical interface structures. The severity of hand symptoms (pain and tingling) and median nerve tension were assessed at the baseline and after four weeks using visual analogue scale and, median neurodynamic test, respectively. Paired and independent t-tests were run to compare data within and between the two groups. The significance level was set at p<0.025.
Results: There was a significant improvement in the severity of hand symptoms and median nerve tension in both groups at the end of the study compared to baseline values (p<0.025). The median nerve tension and severity of hand symptoms in the treatment group decreased significantly (P<0.025) compared to that of the control group.
Conclusion: Using manual therapy for nerve mobilization and mechanical interface structures, accompanied by physiotherapy modalities, leads to more improvement in hand sensory discomfort and median nerve tension in patients with carpal tunnel syndromes.

Keywords

Main Subjects

References

  1.  

    1. Filho AG, Nascimento BF, Amorin M, Sauaia Naua RA, Loures E, Moratelli L. Comparetive study between physical examination, electroneuromyography and ultresonography diagnosing carpal tunnel syndrome. REV BRAS ORTOP 2014; 49(5):446-451.##
    2. Chammas M, Boretto J, Burmann L, Ramos RM, Neto FC, Silva JB. Carpal tunnel syndrome-part 1 (anatomy, physiology, etiology and diagnosis). REV BRAS ORTOP 2014; 49(5):429-436.##
    3. Saint-Lary O, Rèbios A, Mediouni Z, Descatha A. Carpal tunnel syndrome:Primary Care and occupational factors. Frontiers in Medicine; 2015 2(28):1-4.##
    4. Naeser MA, Hahn KA, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study.  Arch Phys Med Rehabil 2002;83(7):978-988.##
    5. Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A. Comparison of three conservative treatment protocols in carpal tunnel syndrome.  Int J Clin Pract 2011;60(7):820-828.##
    6. Bardak AN, Alp M, erhan B, Paker N, Kaya B, Önal AE. Evaluation of the clinical effecacy of coservative treatment in the management of carpal tunnel syndrome. Adv Ther 2009;26(1):107-116.##
    7. Huisstede BM, Hoogvliet P, Randsdrop MS, Glerum S, Middelkoop M. Carpal tunnel syndrome-part 1: Effectiveness of non-surgical treatmenta: A systematic review.Arch Phys Med Rehabil 2010;91(7):981-1004.##
    8. Kostopoulos D. Treatment of carpal tunnel syndrome: a review of the non-surgical approaches with emphasis in neural mobilization.  Journal of Bodywork and Movement Therapies 2004;8:2-4.##
    9. Page MJ, ÓConnor D, Pitt V, Massy-Westropp. Exercise and mobilization intervention for carpal tunnel syndtome.Cochrance database Syst Rev 2012 Jun 13;6:CD009899. doi: 10.1002/14651858.CD009899. ##
    10. Meems M, Oudsten BD, Meems BJ, Pop V.  Effectiveness of mechanical traction as a non-surgical treatment for carpal tunne syndrome compared to care as usual: study protocol for a randomizes controlled trial. Traials 2014;15:180; http:/www.trialsjournal.com/content/15/1/180.##
    11. Butler DS. Mobilisation of the nervous system. Melbourne, Edinburgh, Tokyo, New York: Churchill Livingstone; 1991. ##
    12. Shacklock M. Clinical Neurodynamics: A new system of musculoskeletal treatment. Oxford: Elsevier; 2005.##
    13. Barral JP, Croibier A. Manual therapy for the pripheral nerves. Edinburge: Churchill Livingstone Elsevier; 2007.##
    14. Akalin E, EL Ö, Peker Ö, Senocak Ö, Tamci S, Gulbahar S, Cakmur R, ncel S. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises.  Am J Phys Med Rehabil 2002;81(2):108-113.##
    15. Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, kayhan A. Comparison of three non-surgical treatment protocols in carpal tunnel syndrome. Int J Clin Pract 2006;60(7):820-8.##
    16. Heebner ML, Roddey TS. The effects of neural mobilization in addition to standard care in persons with carpal tunnel syndrome from a community hospital. J Hand Ther 2008; 21(3):229-41.##
    17. Pinar L, Enhos A, Ada S, Gungor N. Can we use nerve gliding exercises in women with carpal tunnel syndrome?  Adv Ther 2005;22(5):467-475.##
    18. Ekstrom RA, Holden K: Examination of and intervention for a patient with chronic lateral elbow pain with signs of nerve entrapment. Phys Ther 2002,82(11): 1077–1086.##
    19. Villafañe 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. Arch Phys Med Rehabil 2012;93(3):396-40.##
    20. Kavlak Y, Uygur F. Effects of  nerve  mobilization exercise as an adjunct to the conservative treatment for patients with tarsal tunnel syndrome. J Manipulative Physiol Ther 2011;34(7):441-448.##
    21. Dwornik M, Biaoszewski D, Korabiewska I, Zbigniew Wronski Z. Principles of neuromobilization for treating musculoskeletal disease. Ortopediia Traumatologia Rehabilitacja 2007; 2(6); 111-121##
    22. Walsh MT. Upper limb neural tension testing and mobilization. Fact, fiction, and a practical approach. J Hand Ther 2005; 18(2):241-58.##
    23. Domholdt E. Rehabilitation research: principles and application. Philadelphia, Elsevier, Saunders, 2005: PP:395- 403.##
    24. Byl C, Puttlitz C, Byl N, Lotz J, Topp K. Strain in the median and ulnar nerves during upper extremity positioning.  J Hand Surg [Am] 2002;27(6):1032-1040.##
    25. Hough AD, Moore A, Jones MP. Reduced longitudinal excursion of the median nerve in carpal tunnel syndrome.  Arch Phys Med Rehabil 2007;88(5):569-576.##

     

The Scientific Journal of Rehabilitation Medicine
Volume 5, Issue 2
July and August 2016
Pages 184-192

Files

History

  • Receive Date: 27 August 2015
  • Revise Date: 02 October 2015
  • Accept Date: 16 November 2015
  • First Publish Date: 21 June 2016

Share

How to cite

Statistics