Comparison of the effects of median nerve mobilization, manual therapy techniques and extracorporeal shock wave therapy in individuals with carpal tunnel syndrome

The aim of this study was to investigate the effects of different physiotherapy methods on pain, muscle strength, range of motion (ROM), symptom severity, functionality levels, and quality of life (SF-36) in patients with carpal tunnel syndrome (CTS) and to evaluate their superiority over each other. A total of 75 patients, 69 women (92%) and 6 men (8%) with aged 25-60 years were included in our study. The patients were randomly divided into three groups according to their registry to the system. The home program was applied to the first group (n=25). That program included median nerve mobilization and exercises 3 days a week for total of 4 weeks. The second group (n=25) received Manual Therapy (MT) treatment- soft tissue and joint mobilization, in addition to the home program, of a total of 12 sessions of 3 days a week for 4 weeks. Third group (n=25) received a total of 12 sessions of Extracorporeal Shock Wave Therapy (ESWT) for 3 days and 4 weeks, in addition to the home program. Subjects' subjective pain severity was assessed by Visual Pain Scale (VAS), muscle strength with manual muscle test, and normal joint range of motion (ROM) was evaluated with goniometer. In addition, symptom severity and functionality levels were assessed by Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and Cochin Hand Function Questionnaire (CHFS), and quality of life was assessed by SF-36. The evaluation of the participants were performed before the treatment and after 4 weeks of treatment. As a result of the evaluations, there was a significant decrease in resting and activity pain in the MT and ESWT groups (p<0.05), but there was no difference between the groups (p>0.05). However; it was observed that the pain values of both groups decreased significantly compared to the home program group (p<0.05). In all three treatment groups, sensory, hand and wrist range of motion, muscle strength and functionality levels were significantly increased after the treatment (p<0.05). The decrease in symptom severity and increase in functionality levels of the patients was found to be significant in the MT and ESWT groups compared to the home exercise group (p<0.05), while the difference between the MT and ESWT groups was not significant (p>0.05). It was concluded that the MT and ESWT treatment modalities combined with the home program on pain, muscle strength, range of motion, functionality levels and quality of life were not superior to each other among patients with CTS after 4 weeks. Key Words: Carpal Tunnel Syndrome, Exercise, Manual Therapy, Extracorporeal Shock Wave Therapy.