Effectiveness of Tendon and Nerve Gliding Exercises in the Treatment of Patients With Mild Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial

Abstract

Background There is limited evidence regarding the efficacy of different treatment options in patients with carpal tunnel syndrome (CTS). This study aimed at assessing the effectiveness of nerve and tendon gliding exercises in the treatment of patients with mild CTS. Methods The current prospective, randomized trial with pretest-posttest design was conducted on 80 patients with mild CTS randomly assigned to 2 groups. The treatment group was instructed to perform gliding exercises in addition to the wrist splint use. The control group only used the wrist splint. All the patients were instructed to use the splint at night and during the day if required. Patients were evaluated in terms of clinical parameters (ie, grip and pinch strength). The severity of symptoms and functional status was also determined using the Boston Carpal Tunnel Syndrome Questionnaire. The subjects were followed up for 6 weeks. Results There were no significant differences in all parameters between groups. The pretest-posttest analysis showed a statistically significant improvement in subjective and objective parameters in the treatment group. However, in the control group, only a significant improvement was observed in grip strength. Wrist splint use led to a significant change in the severity of symptoms only over the second week. Conclusions Both gliding exercise and wrist splint groups showed some improvement in the severity of symptoms and functional status scores. However, the gliding exercises did not offer additional benefit compared with wrist splint alone.

A Comparison of Manual Therapy and Extracorporeal Shockwave Therapy in Patients With Carpal Tunnel Syndrome

“…In a recent, randomized controlled study of 80 patients, the study group was applied with tendon and gliding exercises together with a wrist splint, and the control group was treated with a wrist splint only. A certain amount of improvement was seen in symptom severity and the functional status scores in both groups, and it was reported that the exercises provided no extra benefit to the wrist splint treatment (8). In contrast, Hamzet et al reported that the combination of neuromobilisation techniques with exercises compare to only home exercises was more effective in improving clinical findings (26).…”

“…As part of soft tissue mobilisation, the myofascial release was applied to the anterior, mid, and posterior scalene, the pectoralis major and minor, the biceps brachii muscles, and the flexor retinaculum. For joint mobilisation, cervical tractions and mobilisation were applied to the distal and proximal radio-ulnar, radiocarpal (Figure 2), and intercarpal joints (6)(7)(8)9). While the patient was in supine position, general, and segmental traction to the cervical region was applied by the physiotherapist taking the patient's head in one hand and applying traction to all the cervical vertebrae, first as general than as segmental to each cervical segment starting from caudal to cranial.…”

“…Thus, it contributes to neural tissues regaining flexion capability and allows the re-stimulation of the normal physiological function of neural structures (7). In studies that have examined the effect of neural mobilisation techniques in addition to conservative treatment, there has been observed to be a more significant improvement in the functionality levels of the neural mobilisation group (6)(7)(8).…”

“…Physiotherapists should prefer efficient, safe, and easily appliable treatment modalities due to serious econonic losses of CTS, commonly observed disease. In the literature, CTS research studies on treatment modalities including exercise therapy alone as well as combined with nerve and tendon gliding (6)(7)(8)16), MT approaches (10)(11)(12)(13)(14)(15)(16)(17)(18), and ESWT applications (15,19,20) reported successful results. However, we did not come across a study comparing these different applications in the literature.…”