Mulligan Mobilization With Arm Movement in CTS Patients

Beste Gebologlu

Status: Completed

Conditions: Carpal Tunnel Syndrome

Treatments: Behavioral: Tendon Gliding and Hand Strengthening Exercises; Other: Conventional Neurodynamic Mobilization; Other: Mulligan Spinal Mobilization with Arm Movement

Study type: Interventional

Funder types: Other

Identifiers

NCT07042542

E-10840098-772.02-3960 (Other Identifier)

KTS-MED25-BG

Details and patient eligibility

About

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).

Full 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.

Enrollment: 30 patients

Sex: All

Ages: 20 to 60 years old

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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30 participants in 2 patient groups

Mulligan Spinal Mobilization with Arm Movement

Experimental group

Description:

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.

Treatment:

Other: Mulligan Spinal Mobilization with Arm Movement

Behavioral: Tendon Gliding and Hand Strengthening Exercises

Conventional Neurodynamic Mobilization

Active Comparator group

Description:

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.

Treatment:

Other: Conventional Neurodynamic Mobilization

Behavioral: Tendon Gliding and Hand Strengthening Exercises