Investigation the effects of painless mobilization technique in carpal tunnel syndrome

Peripheral nerve impingement neuropathies are the most common mononeuropathies encountered in clinical practice. Carpal Tunnel Syndrome (CTS) occurs as a result of compression of the median nerve as it passes through the carpal tunnel, a narrow osteofibrous canal. CTS is the most common entrapment neuropathy of the upper extremity, affecting approximately 3% of the general population. Massage and mobilization techniques are used in the treatment of CTS due to their analgesic effects. The painless mobilization with movement technique (MWM, developed by Brian Mulligan) is a manual therapy method applies to correct the limitation of movement in the joint and to relieve pain and functional disorders. Many studies have shown that MWM technique provides faster and momentary painless joint movement compared to other physical therapy modalities. The patient group with CTS has a large place in the general population and long treatment processes cause both labour loss and economic loss. In the literature review, there is no study examining the effects of MWM in patients with CTS. Therefore, this study aimed to examine the effectiveness of MWM technique in cases with CTS. In this study, 45 CTS patients with age range 18-65 who applied to Kırşehir Ahi Evran University Training and Research Hospital were examined. The individuals included in the study were divided into two groups according to the paired randomization method. These groups were control and intervention groups. Traditional physiotherapy methods were applied to the control group, traditional physiotherapy and MWM techniques were applied to the intervention group. Traditional physiotherapy methods were included; Transcutaneous Electrical Nerve Stimulation (TENS), Ultrasound (US), tendon-nerve gliding exercises, night splint, stretching and strengthening exercises. For the evaluation of patients; Visual Analogue Scale (VAS), wrist goniometric measurements, grip strength measurement, pinch strength measurement, edema measurement, Electromyography (EMG), Nelson Hand Reaction Test, Upper Limb Disorders Arm Shoulder and Hand Problems Questionnaire (DASH), Boston Carpal The Tunnel Injury Questionnaire and Michigan Hand Result Questionnaire (MHRQ) was used. As a result of the statistical evaluation, improvement was observed in both groups in all parameters measured, except the Nelson Hand Reaction Test. In terms of group x measurement interaction, statistical significance was found in favor of the intervention group in the parameters of activity pain, DASH and MESA 1-5 modules (p<0,05). In terms of group x measurement interaction, no statistical significance was found in favor of the control group in all parameters (p>0,05). As a result, the effect of MWM technique on pain, quality of life and functionality in patients with CTS was found to be more successful than traditional physiotherapy methods. Therefore, it is thought that including the MWM technique in the treatment program in patients with CTS will strengthen the treatment processes, especially in direct relation with the rapid reduction of pain, and decrease the loss of work force by increasing the functionality and quality of life in patients. Keywords: Carpal tunnel syndrome, Mobilization with movement, Manuel therapy