Mulligan Mobilization With Arm Movement in CTS Patients

NCT07042542 | Completed

• 2 other identifiers: KTS-MED25-BGE-10840098-772.02-3960
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

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).

Conditions

Carpal Tunnel Syndrome

Keywords

Mulligan Spinal Mobilization with Arm Movement; Conventional Neurodynamic Mobilization; Functionality; Grip Strength; Rehabilitation; Pain; Median Nerve

Outcome Measures

Primary Outcomes (2)

• Pain Intensity

  Pain intensity was assessed using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst pain), at rest and during activity with higher scores indicating worse pain.

  Baseline, 6th week, 12th week

• Functional Status and Symptom Severity

  Functional status and symptom severity were evaluated using the Boston Carpal Tunnel Questionnaire, including the Functional Status Scale (FSS) and Symptom Severity Scale (SSS). Each scale ranges from 1 to 5. Higher scores indicate greater disability (FSS) or more severe symptoms (SSS).

  Baseline, 6th week, 12th week

Secondary Outcomes (4)

• Hand Grip Strength

  Baseline, 6th week, 12th week

• Range of Motion of the Wrist

  Baseline, 6th week, 12th week

• Sensory Function

  Baseline, 6th week, 12th week

• Pain Quality - McGill Pain Questionnaire

  Baseline, 6th week, 12th week

Study Arms (2)

Mulligan Spinal Mobilization with Arm Movement

EXPERIMENTAL

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.

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

Conventional Neurodynamic Mobilization

ACTIVE COMPARATOR

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.

Other: Conventional Neurodynamic Mobilization; Behavioral: Tendon Gliding and Hand Strengthening Exercises

Interventions

Mulligan Spinal Mobilization with Arm Movement 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.

Mulligan Spinal Mobilization with Arm Movement

Conventional Neurodynamic Mobilization 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.

Conventional Neurodynamic Mobilization

Tendon Gliding and Hand Strengthening Exercises 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; Mulligan Spinal Mobilization with Arm Movement

Eligibility Criteria

• Age: 20 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Beste Gebologlu: lead

Study Sites (1)

Istanbul Medipol University

Istanbul, Marmara, 34810, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Carpal Tunnel Syndrome; Pain

Condition Hierarchy (Ancestors)

Median Neuropathy; Mononeuropathies; Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Nerve Compression Syndromes; Cumulative Trauma Disorders; Sprains and Strains; Wounds and Injuries; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Pınar KAYA SARIBAS, Assoc Prof

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

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Physiotherapist and Graduate Student Researcher

Model Details: Two-arm randomized controlled parallel design comparing Mulligan mobilization with neurodynamic mobilization in patients with carpal tunnel syndrome.

Study Record Dates

• First Submitted: June 20, 2025
• First Posted: June 29, 2025
• Study Start: June 1, 2023
• Primary Completion: December 15, 2024
• Study Completion: January 10, 2025
• Last Updated: July 2, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)