Mulligan Mobilization With Arm Movement in CTS Patients

NCT ID: NCT07042542

Last Updated: 2025-07-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-06-01
• Study Completion Date: 2025-01-10

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.

Conditions

Carpal Tunnel Syndrome

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Mulligan Spinal Mobilization with Arm Movement

Participants in this group received Mulligan spinal mobilization applied to the cervical spine at C5, C6, and C7 levels, in 3 sets of 3 repetitions per level. During mobilization, participants actively performed arm movements in a neurodynamic stretching position. The intervention was administered 3 sessions per week for 6 weeks. Additionally, all participants performed tendon gliding and hand strengthening exercises three times per week for 6 weeks, which were also prescribed as home-based programs.

Group Type: EXPERIMENTAL

Mulligan Spinal Mobilization with Arm Movement

Intervention Type: OTHER

In the neurodynamic SNAGs technique, participants sat on a chair. The therapist placed the medial border of the distal phalanx of one thumb under the facet joints of the C5, C6, and C7 levels, respectively. Then, the therapist placed the tip of the other thumb on the lateral side of the first thumb. In neurodynamic spinal mobilization combined with arm movement, the therapist provided manual contact to the affected spinous process level by supporting the medial aspect of one thumb with the index finger of the other hand. The therapist applied a transverse shift from the affected side to the unaffected side, but only in the transverse plane. While the glide was in progress, the patient was asked to perform neurodynamic movements for the median nerve, including scapular depression, shoulder abduction, elbow extension, forearm supination, and wrist and finger extension, all without crossing the pain limit for the affected side.

Tendon Gliding and Hand Strengthening Exercises

Intervention Type: BEHAVIORAL

Tendon glide exercises were performed in five consecutive positions. Each position was practiced for seven seconds, with three sets of five repetitions and one minute of rest between sets. Participants were asked to perform the exercises three times during the day. Hand muscle strengthening exercises were performed by placing a tire on the fingertips, abducting the fingers, and stretching the tire to strengthen the intrinsic muscles and fingers. Resistance could be increased by thickening the tire or adding a second one. Participants were given a grip strength exercise. The hand grip exercise strengthened the extrinsic muscles. Finger flexion and extension exercises strengthened the hand and finger muscles. Participants were asked to perform 10 repetitions of each exercise in each session and to perform the strengthening exercises three times during the day.

Conventional Neurodynamic Mobilization

Participants in this group received conventional neurodynamic mobilization techniques targeting the median nerve, applied by a therapist. The intervention was administered 3 sessions per week for 6 weeks, with 3 sets of 3 repetitions in each session. In addition, all participants performed tendon gliding exercises and hand strengthening exercises three times per week for 6 weeks. These exercises were also assigned as home-based programs.

Group Type: ACTIVE_COMPARATOR

Conventional Neurodynamic Mobilization

Intervention Type: OTHER

A neurodynamic mobilization technique involving a specific sequence of movements along the median nerve line was applied. For the right side, the procedure was performed as follows: The individual was placed supine on a stretcher. The therapist stood on the right side of the stretcher, facing the participant, with their right leg in front of their left leg. The individual's arm rested on the therapist's right thigh, and the therapist held the individual's right hand with his left hand. During the procedure, the therapist placed one hand on the individual's shoulder to depress the shoulder girdle by pressing the scapula downward. The individual's shoulder was abducted 90° and laterally rotated, and the forearm was supinated. The wrist, thumb, and fingers were extended. In this position, the therapist dynamically alternated between simultaneous elbow flexion/wrist extension and simultaneous elbow extension/wrist flexion.

Tendon Gliding and Hand Strengthening Exercises

Intervention Type: BEHAVIORAL

Tendon glide exercises were performed in five consecutive positions. Each position was practiced for seven seconds, with three sets of five repetitions and one minute of rest between sets. Participants were asked to perform the exercises three times during the day. Hand muscle strengthening exercises were performed by placing a tire on the fingertips, abducting the fingers, and stretching the tire to strengthen the intrinsic muscles and fingers. Resistance could be increased by thickening the tire or adding a second one. Participants were given a grip strength exercise. The hand grip exercise strengthened the extrinsic muscles. Finger flexion and extension exercises strengthened the hand and finger muscles. Participants were asked to perform 10 repetitions of each exercise in each session and to perform the strengthening exercises three times during the day.

Interventions

Mulligan Spinal Mobilization with Arm Movement

In the neurodynamic SNAGs technique, participants sat on a chair. The therapist placed the medial border of the distal phalanx of one thumb under the facet joints of the C5, C6, and C7 levels, respectively. Then, the therapist placed the tip of the other thumb on the lateral side of the first thumb. In neurodynamic spinal mobilization combined with arm movement, the therapist provided manual contact to the affected spinous process level by supporting the medial aspect of one thumb with the index finger of the other hand. The therapist applied a transverse shift from the affected side to the unaffected side, but only in the transverse plane. While the glide was in progress, the patient was asked to perform neurodynamic movements for the median nerve, including scapular depression, shoulder abduction, elbow extension, forearm supination, and wrist and finger extension, all without crossing the pain limit for the affected side.

Intervention Type: OTHER

Conventional Neurodynamic Mobilization

A neurodynamic mobilization technique involving a specific sequence of movements along the median nerve line was applied. For the right side, the procedure was performed as follows: The individual was placed supine on a stretcher. The therapist stood on the right side of the stretcher, facing the participant, with their right leg in front of their left leg. The individual's arm rested on the therapist's right thigh, and the therapist held the individual's right hand with his left hand. During the procedure, the therapist placed one hand on the individual's shoulder to depress the shoulder girdle by pressing the scapula downward. The individual's shoulder was abducted 90° and laterally rotated, and the forearm was supinated. The wrist, thumb, and fingers were extended. In this position, the therapist dynamically alternated between simultaneous elbow flexion/wrist extension and simultaneous elbow extension/wrist flexion.

Intervention Type: OTHER

Tendon Gliding and Hand Strengthening Exercises

Tendon glide exercises were performed in five consecutive positions. Each position was practiced for seven seconds, with three sets of five repetitions and one minute of rest between sets. Participants were asked to perform the exercises three times during the day. Hand muscle strengthening exercises were performed by placing a tire on the fingertips, abducting the fingers, and stretching the tire to strengthen the intrinsic muscles and fingers. Resistance could be increased by thickening the tire or adding a second one. Participants were given a grip strength exercise. The hand grip exercise strengthened the extrinsic muscles. Finger flexion and extension exercises strengthened the hand and finger muscles. Participants were asked to perform 10 repetitions of each exercise in each session and to perform the strengthening exercises three times during the day.

Intervention Type: BEHAVIORAL

Eligibility Criteria

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.

• Minimum Eligible Age: 20 Years
• Maximum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Beste Gebologlu

OTHER

Sponsor Role: lead

Responsible Party

Beste Gebologlu

Physiotherapist and Graduate Student Researcher

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Pınar KAYA SARIBAS, Assoc Prof

Role: PRINCIPAL_INVESTIGATOR

Istanbul Medipol University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation

Locations

Istanbul Medipol University

Istanbul, Marmara, Turkey (Türkiye)

Countries

Turkey (Türkiye)

Other Identifiers

E-10840098-772.02-3960

Identifier Type: OTHER

Identifier Source: secondary_id

KTS-MED25-BG

Identifier Type: -

Identifier Source: org_study_id