Mulligan Mobilization With Arm Movement in CTS Patients

Not Applicable

Completed

• Conditions: Carpal Tunnel Syndrome

• Registration Number: NCT07042542
• Lead Sponsor: Beste Gebologlu

Brief Summary

The aim of this study was to investigate the effect of the Mulligan Spinal Mobilization with Arm Movement technique on pain, grip strength and functionality in individuals with carpal tunnel syndrome and to compare it with the conventional neurodynamic mobilization technique. The study aims to answer the following questions:

Is the Mulligan spinal mobilization technique with arm movement superior to the conventional neurodynamic mobilization technique in terms of pain, grip strength, and functionality in individuals with carpal tunnel syndrome? Does the Mulligan spinal mobilization technique with arm movement outperform the conventional neurodynamic mobilization technique in terms of pain, grip strength, and functionality in individuals with carpal tunnel syndrome? The evaluation process took place in three stages for both groups: Baseline (pre-test), 6 weeks after the start of the study (post-test), and 12 weeks after the start of the study (follow-up test).

Detailed Description

Thirty participants completed the randomized controlled trial and were divided into two groups as the study group (Mulligan group) and the control group (conventional neurodynamic mobilization). Both groups received tendon gliding exercises (TGE) and strengthening exercises for the intrinsic and extrinsic muscles of the hand during the treatment period. The treatment period lasted six weeks, and after the end of the treatment, the individuals were followed up with a home program until the 12th week. Evaluations were performed three times at baseline, 6 and 12 weeks and included measures of pain (VAS, McGill), functionality (DASH, FDS, FDS), grip strength (Jamar hand dynamometer), range of motion and sensation (Semmes-Weinstein monofilament test). The control group received Mulligan's neurodynamic spinal mobilisation technique at the C5-C6-C7 levels with arm movement for six weeks. This involved three sessions per week, each comprising three sets of three repetitions, with each repetition lasting an average of one minute. The total duration of each session was approximately ten minutes.

The control group received the same technique without the Mulligan approach for six weeks, three days a week, three sets of three repetitions, with each repetition lasting an average of one minute. After the treatment period, both groups performed a standard exercise programme consisting of tendon gliding and hand strengthening exercises, which were also recommended to patients at the end of each session. These exercises were continued throughout the follow-up period after treatment.

The study was completed between June 2023 and January 2025 with ethical approval from Istanbul Medipol University.

Study Timeline

• Study Start: 2023-06-01
• Primary Completion: 2024-12-15
• Study Completion: 2025-01-10
• Status Verified: 2025-06
• Study First Submitted: 2025-06-20
• Study First Submitted QC: 2025-06-20
• Study First Posted: 2025-06-29
• Last Update Submitted: 2025-06-29
• Last Update Posted: 2025-07-02

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

• Having a diagnosis of mild to moderate carpal tunnel syndrome (CTS).
• Being between 20 and 60 years of age.
• Having symptoms of paresthesia, pain, and numbness in areas of the hand related to the median nerve lasting more than six weeks.
• A positive Tinel, Phalen, or carpal compression test during wrist examination.

Exclusion Criteria

• Pregnancy.
• The patient has a contraindication to exercise.
• Additional neurological, rheumatological, and orthopedic conditions.
• A positive Spurling test.
• Patients who have undergone surgery in the wrist or neck region.
• Presence of a tumor or pathology in the cervical region.
• Patients who have received physical therapy for the wrist or neck in the last six months.
• The patient has mental health issues.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Functional Status and Symptom Severity	Baseline, 6th week, 12th week	Functional status and symptom severity were evaluated using the Boston Carpal Tunnel Questionnaire, including the Functional Status Scale (FSS) and Symptom Severity Scale (SSS). Each scale ranges from 1 to 5. Higher scores indicate greater disability (FSS) or more severe symptoms (SSS).
Pain Intensity	Baseline, 6th week, 12th week	Pain intensity was assessed using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst pain), at rest and during activity with higher scores indicating worse pain.

Secondary Outcome Measures

Name	Time	Method
Sensory Function	Baseline, 6th week, 12th week	Sensory function was evaluated using the Semmes-Weinstein monofilament test on the median nerve-innervated area. Filaments of varying thickness were used to determine sensory threshold. Lower values indicate greater sensitivity, while higher filament values indicate decreased sensory function.
Hand Grip Strength	Baseline, 6th week, 12th week	Hand grip strength was measured using a dynamometer in kilograms to assess functional improvement. There is no fixed scoring range; higher values indicate greater muscle strength and improved function.
Range of Motion of the Wrist	Baseline, 6th week, 12th week	Wrist range of motion was measured in degrees using a goniometer, including supination, pronation, radial deviation, ulnar deviation, flexion, and extension. There is no fixed scale; higher degrees represent greater joint mobility.
Pain Quality - McGill Pain Questionnaire	Baseline, 6th week, 12th week	Pain quality and intensity were assessed. The McGill Pain Questionnaire scores range from 0 to 78. Higher scores indicate worse pain experience.

Trial Locations

Locations (1)

Istanbul Medipol University; 🇹🇷 Istanbul, Marmara, Turkey