A Multimodal approach of electrotherapy versus nerve flossing technique in patients with chronic carpal tunnel syndrome: a randomized controlled trial
Main Article Content
Keywords
multimodal approach, nerve flossing technique, carpal tunnel syndrome
Abstract
Background: The median nerve becomes trapped at the level of the wrist in the condition known as carpal tunnel syndrome (CTS), which has a substantial impact on hand functions. Objectives: To assess the impact of the multimodal electrotherapy and nerve flossing technique on patients with chronic CTS on pain intensity, pinch grip power, hand function status, symptom severity, and sensory and motor distal lantenies
Design: A randomized controlled trial conducted in a single-blind technique.
Methods: In this study, 51 female cases, aged 30-45, with unilateral mild to moderate CTS in their dominant hand took part. They were divided into three groups at random. Cases in Group A (the experimental group, n = 17) underwent multimodal electrotherapy (low-level laser therapy, interferential therapy, and ultrasound) plus conventional therapy, including a splint and therapeutic exercises. Cases in Group B (the experimental group, n = 17) obtained median nerve flossing in addition to conventional therapy. Cases in Group C (the control group, n = 17) got typical rehabilitative exercises and wore a splint. Every treatment session took place three days a week for eight weeks. Measurements were taken to compare the results before and after the treatment.
Outcome measures: A visual analog pain scale was utilized to assess pain level, a baseline hydraulic pinch dynamometer was used to measure pinch power, hand function status, and symptom severity using the Boston Carpal Tunnel Questionnaire, and electromyography was used to measure the median nerve's sensory and motor distal latencies.
Results: There was no significant difference between the effects of the multimodal electrotherapy approach (group A) and the median nerve flossing technique (group B) on pain intensity level, pinch grip strength, hand function status, symptom severity, sensory, and motor distal latencies. However, these turned out to be more effective than traditional therapeutic exercises (Group C).
Conclusions: In accordance with the outcomes of the current study, patients with chronic CTS respond well to the multimodal electrotherapy method and the median nerve flossing technique.
References
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14. Soysal AN, Aslan UB. Treatment of chronic neck pain by two combined physiotherapy programs: comparison of phonophoresis and ultrasound.
Asian Biomedicine. 2013; 7(6): 821-827;doi:10.5372/1905-7415.0706.245
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19. Coppieters M.W, Hough A.D, Dilley A. Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: an in vivo study using dynamic ultrasound imaging. J Orthop Sports PhysTher.2009;39(3):164-71;doi: 10.2519/jospt.2009.2913.
20. Rayegani, S. M., Bahrami, M. H., Eliaspour, D and et al. A The effects of low intensity laser on clinical and electrophysiological parameters of carpal tunnel syndrome. Journal of lasers in medical sciences.2013; 4(4), 182.
21. Koca I, Boyaci A , Tutoglu A, Ucar M, and Kocaturk, O. Assessment of the effectiveness of interferential current therapy and TENS in the management of carpal tunnel syndrome: a randomized controlled study. Rheumatology international. 2014;34(12):1639-1645;doi: 10.1007/s00296-014-3005-3.
22. Ahmed O. F, Elkharbotly, A. M, Taha, N ,and Bekheet, A. B.Treatment of mild to moderate carpal tunnel syndrome in patients with diabetic neuropathy using low level laser therapy versus ultrasound controlled comparative study. BBA clinica.l2017 ; 20;8:43-47;doi: 10.1016/j.bbacli.2017.07.001.
23. Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM,Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998;11(3):171- 9;doi: 10.1016/s0894-1130(98)80035-5. 24. Pinar L, Enhos A, Ada S, and Güngör, N. Can We Use Nerve Gliding Exercises in Women With Carpal Tunnel Syndrome? Advances in Therapy .2005;22(5):467-475;doi: 10.1007/BF02849867.
25. Sim, S. E, Gunasagaran J, Goh, K. J, and Ahmad T. S.Short-term clinical outcome of orthosis alone vs combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome. Journal of Hand Therapy. 2019;32(4), 411 -416;doi:10.1016/j.jht.2018.01.004.
26. Ghasemi-rad, M., Nosair E and et al. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World journal of radiology. 2014;6(6):284-300; doi: 10.4329/wjr.v6.i6.284.
27. Tal- Akabi A, Rushton A, 2000. An investigation to compare the effectiveness of carpal bone mobilization and neurodynamic mobilization as methods of treatment for carpal tunnel syndrome.ManTher .2000;5(4):214-22; doi: 10.1054/math.2000.0355.
28. El-Gendy, M., Lasheen, Y., and Rezkalla, W. Multimodal approach of electrotherapy versus myofascial release in patients with chronic mechanical neck pain: a randomized controlled trial. Physiotherapy Quarterly.2019;27(4), 6-12; doi:10.5114/pq.2019.87735
29. Roberts H C, DenisonH J, and et al.A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age and ageing.2011;40 (4), 423-429;doi: 10.1093/ageing/afr051.
30. Wadida, H., et al. Adaptation to Arabic Language, Validity and Reliability Test of Boston Carpal Tunnel Questionnaire in Carpal Tunnel Syndrome Patients. The Medical Journal of Cairo University, 2019, 87.December: 4405-4411..
31. Levine D, Simmons B, and Koris M. A elf-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg. 1993;75: 1585-1592; doi: 10.2106/00004623-199311000-00002.
32. Jablecki C K, Andary M, Floeter M K, and et al . Practice parameter: electrodiagnostic studies in carpal tunnel syndrome report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2002;58(11): 1589-1592; doi: 10.1212/wnl.58.11.1589.
33. Chang W, Jiang J, Yeh C, and Tsai C. Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the trans- verse carpal
ligament. Photomed Laser Surg .2008;26 (6):551-7; doi: 10.1089/pho.2007.2234.
34. Falkiner S, and Myers S . When exactly can carpal tunnel syndrome be considered work‐related. ANZ Journal of Surgery.2002;72(3), 204-209; doi: 10.1046/j.1445-2197.2002.02347.
35. Kocjan, J. Efficacy of neural mobilization and mid-carpal mobilization in the treatment of carpal tunnel syndrome= Skuteczność neuromobilizacji oraz mobilizacji stawu śródnadgarstkowego w leczeniu zespołu kanału nadgarstka. Journal Of Education, Health And Sport. 2016;6(6): 31-38. ;doi:10.5281/zenodo.54547
36. Chen, Shuai, et al. Effectiveness of therapeutic ultrasound for the treatment of carpal tunnel syndrome (the USTINCTS trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial. BMJ open.2022;12(4): e057541; doi: 10.1136/bmjopen-2021-057541.
37. Bakhtiary AH, Rashidy-Pour A.(2004). Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother .2004;50(3):147-51;doi: 10.1016/s0004-9514(14)60152-5.
38. TalebiG A, Saadat P, Javadian Y, and Taghipour M. Comparison of two manual therapy techniques in patients with carpal tunnel syndrome: A randomized clinical trial. Caspian Journal of Internal Medicine.2020;11(2):163-170; doi: 10.22088/cjim.11.2.163..
39. Horng, Yi-Shiung, et al. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial. American journal of physical medicine & rehabilitation. 2011;9(.6) : 435-442;doi: 10.1097/PHM.0b013e318214eaaf.
40. Dincer, Umit, et al.The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies. Photomedicine and laser surgery.2009; 27(1): 119-125;doi: 10.1089/pho.2008.2211.
41. Pattapong, Nitsara, et al. Effectiveness of Multiwave Locked System Laser therapy in treatment of Carpal Tunnel Syndrome Patients. Naresuan University Journal: Science and Technology. 2016; 24(1): 24-35.
42. Gobichandran, P. The Effect of Ultrasound Versus Nerve and Tendon Gliding Exercise on Pain and Functions in Patients with Carpal Tunnel Syndrome–A Comparative study. Diss. KMCH College of Physiotherapy, Coimbatore, 2013. .
43. Ballestero-Pérez, Ruth, et al. Effectiveness of nerve gliding exercises on carpal tunnel syndrome: a systematic review. Journal of manipulative and physiological therapeutics .2017; 40(1): 50-59; doi: 10.1016/j.jmpt.2016.10.004.
44. Brininger, Teresa L, et al.Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Archives of physical medicine and rehabilitation .2007;88(11): 1429-1435; doi: 10.1016/j.apmr.2007.07.019.
2. Kleopa, K. A.Carpal tunnel syndrome, Annals of internal medicine. 2015 1;163(5):ITC1; doi: 10.7326/AITC201509010.
3. Martins RS, Siqueira MG.Conservative therapeutic management of carpal tunnel syndrome.ArqNeuropsiquiatr. 2017;75(11):819-824;doi: 10.1590/0004 282X20170152.
4. LeBlanc KE, Cestia W. Carpal tunnel syndrome. Am Fam Physician.2011; 83 (8): 952-958.
5. Kozak A, Schedlbauer G, Wirth T, Euler U,Westermann C, Nienhaus A.Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a metaanalysis of current research. BMC MusculoskeletDisord. 2015; 1;16:231;doi: 10.1186/s12891-015-0685-0.
6. Spinner RJ, Bachman JW, Amadio PC.The many faces of carpal tunnel syndrome. Mayo ClinProc1989;64(7):829-36;doi: 10.1016/s0025-6196(12)61756-x.
7. Katz, J. N, Simmons, B. P. Carpal tunnel syndrome: clinical practice. N Engl J Med2002; 346 )23(: 1807-12;doi: 10.1056/NEJMcp013018.
8. Kohara N. Clinical and electrophysiological findings in carpal tunnel syndrome. Brain Nerve.2007;59(11):1229-38.
9. Chan L, Turner J A, Comstock B A and et al. The relationship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome. Archives of physical medicine and rehabilitation .2007;88(1):19-24;doi: 10.1016/j.apmr.2006.10.013.
10. Mallik A, Weir AI. Nerve conduction studies: essentials and pitfalls in practice. J J Neurol Neurosurg Psychiatry .2005, 76.suppl 2: ii23 ii31;doi:10.1136/jnnp.2005.069138.
11. Viera AJ.. Management of carpal tunnel syndrome. Am Fam Physician.2003; 68 (2): 265- 272.
12. Maddali BS, Signorini M, Bassetti M, Del Rosso A, Orlandi M, De Scisciolo G. A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study. RheumatolInt. 2013; 33: 1233–1241; doi: 10.1007/s00296-012-2507-0.
13. Huisstede BM, Hoogvliet P, Randsdorp MS, and et al. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatment systematic review. Arch Phys Med Rehabil 2010;91(7):981-1004;doi: 10.1016/j.apmr.2010.03.022.
14. Soysal AN, Aslan UB. Treatment of chronic neck pain by two combined physiotherapy programs: comparison of phonophoresis and ultrasound.
Asian Biomedicine. 2013; 7(6): 821-827;doi:10.5372/1905-7415.0706.245
15. Shacklock M. Clinical neurodynamics: a new system of musculoskeletal treatment: Elsevier Health Sciences. 2nd ed. New York:Butterworth-Heinemann;2005; 251.
16. Ellis RF, Hing WA. Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. J Man Manip Ther. 2008;16(1):8-22;doi: 10.1179/106698108790818594.
17. Coppieters MW, Butler DS. Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008;13(3):213-21; doi: 10.1016/j.math.2006.12.008.
18. Michelle LH, Toni SR, 2008. The effects of neural mobilization in addition to standard care in persons with carpal tunnel syndrome from a community hospital. J Hand Therapy.2008;21(3):229- 241;doi: 10.1197/j.jht.2007.12.001.
19. Coppieters M.W, Hough A.D, Dilley A. Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: an in vivo study using dynamic ultrasound imaging. J Orthop Sports PhysTher.2009;39(3):164-71;doi: 10.2519/jospt.2009.2913.
20. Rayegani, S. M., Bahrami, M. H., Eliaspour, D and et al. A The effects of low intensity laser on clinical and electrophysiological parameters of carpal tunnel syndrome. Journal of lasers in medical sciences.2013; 4(4), 182.
21. Koca I, Boyaci A , Tutoglu A, Ucar M, and Kocaturk, O. Assessment of the effectiveness of interferential current therapy and TENS in the management of carpal tunnel syndrome: a randomized controlled study. Rheumatology international. 2014;34(12):1639-1645;doi: 10.1007/s00296-014-3005-3.
22. Ahmed O. F, Elkharbotly, A. M, Taha, N ,and Bekheet, A. B.Treatment of mild to moderate carpal tunnel syndrome in patients with diabetic neuropathy using low level laser therapy versus ultrasound controlled comparative study. BBA clinica.l2017 ; 20;8:43-47;doi: 10.1016/j.bbacli.2017.07.001.
23. Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM,Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998;11(3):171- 9;doi: 10.1016/s0894-1130(98)80035-5. 24. Pinar L, Enhos A, Ada S, and Güngör, N. Can We Use Nerve Gliding Exercises in Women With Carpal Tunnel Syndrome? Advances in Therapy .2005;22(5):467-475;doi: 10.1007/BF02849867.
25. Sim, S. E, Gunasagaran J, Goh, K. J, and Ahmad T. S.Short-term clinical outcome of orthosis alone vs combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome. Journal of Hand Therapy. 2019;32(4), 411 -416;doi:10.1016/j.jht.2018.01.004.
26. Ghasemi-rad, M., Nosair E and et al. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World journal of radiology. 2014;6(6):284-300; doi: 10.4329/wjr.v6.i6.284.
27. Tal- Akabi A, Rushton A, 2000. An investigation to compare the effectiveness of carpal bone mobilization and neurodynamic mobilization as methods of treatment for carpal tunnel syndrome.ManTher .2000;5(4):214-22; doi: 10.1054/math.2000.0355.
28. El-Gendy, M., Lasheen, Y., and Rezkalla, W. Multimodal approach of electrotherapy versus myofascial release in patients with chronic mechanical neck pain: a randomized controlled trial. Physiotherapy Quarterly.2019;27(4), 6-12; doi:10.5114/pq.2019.87735
29. Roberts H C, DenisonH J, and et al.A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age and ageing.2011;40 (4), 423-429;doi: 10.1093/ageing/afr051.
30. Wadida, H., et al. Adaptation to Arabic Language, Validity and Reliability Test of Boston Carpal Tunnel Questionnaire in Carpal Tunnel Syndrome Patients. The Medical Journal of Cairo University, 2019, 87.December: 4405-4411..
31. Levine D, Simmons B, and Koris M. A elf-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg. 1993;75: 1585-1592; doi: 10.2106/00004623-199311000-00002.
32. Jablecki C K, Andary M, Floeter M K, and et al . Practice parameter: electrodiagnostic studies in carpal tunnel syndrome report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2002;58(11): 1589-1592; doi: 10.1212/wnl.58.11.1589.
33. Chang W, Jiang J, Yeh C, and Tsai C. Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the trans- verse carpal
ligament. Photomed Laser Surg .2008;26 (6):551-7; doi: 10.1089/pho.2007.2234.
34. Falkiner S, and Myers S . When exactly can carpal tunnel syndrome be considered work‐related. ANZ Journal of Surgery.2002;72(3), 204-209; doi: 10.1046/j.1445-2197.2002.02347.
35. Kocjan, J. Efficacy of neural mobilization and mid-carpal mobilization in the treatment of carpal tunnel syndrome= Skuteczność neuromobilizacji oraz mobilizacji stawu śródnadgarstkowego w leczeniu zespołu kanału nadgarstka. Journal Of Education, Health And Sport. 2016;6(6): 31-38. ;doi:10.5281/zenodo.54547
36. Chen, Shuai, et al. Effectiveness of therapeutic ultrasound for the treatment of carpal tunnel syndrome (the USTINCTS trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial. BMJ open.2022;12(4): e057541; doi: 10.1136/bmjopen-2021-057541.
37. Bakhtiary AH, Rashidy-Pour A.(2004). Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother .2004;50(3):147-51;doi: 10.1016/s0004-9514(14)60152-5.
38. TalebiG A, Saadat P, Javadian Y, and Taghipour M. Comparison of two manual therapy techniques in patients with carpal tunnel syndrome: A randomized clinical trial. Caspian Journal of Internal Medicine.2020;11(2):163-170; doi: 10.22088/cjim.11.2.163..
39. Horng, Yi-Shiung, et al. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial. American journal of physical medicine & rehabilitation. 2011;9(.6) : 435-442;doi: 10.1097/PHM.0b013e318214eaaf.
40. Dincer, Umit, et al.The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies. Photomedicine and laser surgery.2009; 27(1): 119-125;doi: 10.1089/pho.2008.2211.
41. Pattapong, Nitsara, et al. Effectiveness of Multiwave Locked System Laser therapy in treatment of Carpal Tunnel Syndrome Patients. Naresuan University Journal: Science and Technology. 2016; 24(1): 24-35.
42. Gobichandran, P. The Effect of Ultrasound Versus Nerve and Tendon Gliding Exercise on Pain and Functions in Patients with Carpal Tunnel Syndrome–A Comparative study. Diss. KMCH College of Physiotherapy, Coimbatore, 2013. .
43. Ballestero-Pérez, Ruth, et al. Effectiveness of nerve gliding exercises on carpal tunnel syndrome: a systematic review. Journal of manipulative and physiological therapeutics .2017; 40(1): 50-59; doi: 10.1016/j.jmpt.2016.10.004.
44. Brininger, Teresa L, et al.Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Archives of physical medicine and rehabilitation .2007;88(11): 1429-1435; doi: 10.1016/j.apmr.2007.07.019.
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Apr 15, 2023
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Fatma Seddik Amin, Heba Ahmed Abd El_Azeem Haridy, Ebtesam Mohamed Fahmy, & Yasser Ramzy Lasheen. (2023). A Multimodal approach of electrotherapy versus nerve flossing technique in patients with chronic carpal tunnel syndrome: a randomized controlled trial. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 322-334. https://doi.org/10.47750/jptcp.2023.30.07.039
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How to Cite
Fatma Seddik Amin, Heba Ahmed Abd El_Azeem Haridy, Ebtesam Mohamed Fahmy, & Yasser Ramzy Lasheen. (2023). A Multimodal approach of electrotherapy versus nerve flossing technique in patients with chronic carpal tunnel syndrome: a randomized controlled trial. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 322-334. https://doi.org/10.47750/jptcp.2023.30.07.039