Ultrasonographic Evaluation of the Effectiveness of Different Techniques

Clinical and Ultrasonographic Evaluation of Manual Lymphatic Drainage and Nerve Mobilization Techniques in Patients Diagnosed With Mild-Moderate Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) occurs as a result of compression of the median nerve under the transverse ligament along the carpal tunnel. The main cause of median nerve compression and carpal tunnel syndrome is increased volume in the carpal tunnel. The pressure that edema puts on the nerve must be controlled in the early period. Edema that persists beyond the inflammatory process can contribute to the fibrotic stage, delay healing, and even cause complications such as pain and stiffness. Manual lymphatic drainage (MLD) is a specialized technique that involves gentle massage techniques and follows lymphatic pathways from proximal to distal and then from distal to proximal. On the basis of this concept; Increasing circulation by stimulating the lymph system, removing biochemical residues, reducing edema and pain, and regulating sympathetic and parasympathetic system responses. It is known that MLD rapidly regulates lymphatic circulation by creating a change in interstitial fluid pressure, thus preventing even arthrofibrotic tissue that may form after a traumatic situation, reducing edema that predisposes to pain, and increasing mobility. Nerve gliding exercises are another method used in treatment. By providing a sliding movement of the tendons and median nerve in the distal-proximal direction, mobilization of the surrounding soft tissues is achieved and dynamic ischemia is terminated. The aim of this study is to determine the effectiveness of manual lymphatic drainage and nerve mobilization on clinical and ultrasonographic findings in carpal tunnel syndrome.

Study Overview

• Status: Enrolling by invitation
• Conditions: Ultrasound Evaluation of the Effect of Manual Lymph Drainage; Effect of Manual Lymph Drainage on Carpal Tunnel Syndrome
• Intervention / Treatment: Device: splint; Other: Manual lymphatic drainage; Other: Nerve gliding

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Kütahya, Turkey, 43100
    • Kutahya Health Science University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 55 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosis of mild to moderate carpal tunnel syndrome on electrodiagnostic examination
• Being between 20-55 years old
• Volunteering to participate in the treatment to be given

Exclusion Criteria:

• Have a systemic inflammatory disease
• Having any disease that may cause polyneuropathy, such as diabetes mellitus
• Cognitive impairment
• Receiving psychotherapy
• Having a pacemaker
• illiterate
• Having a disease affecting the central nervous system
• Having a hearing problem
• Any skin disease that would contraindicate manual lymphatic drainage
• Arterial or venous circulatory disorders that would contraindicate manual lymphatic drainage
• NSAID drug use

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Kontrol group	Device: splint; In splint treatment, a volar-supported splint that keeps the wrist in a neutral position will be preferred and it will be recommended to both groups to be used only at night for 4 weeks.
Experimental: MLD group	Other: Manual lymphatic drainage; Manual lymphatic drainage will be applied 5 days a week for about 15 minutes every day for 4 weeks.
Experimental: Nerve gliding group	Other: Nerve gliding; Median nerve gliding exercises as a home exercise program will be performed by the patient 5 days a week for 4 weeks. It will be performed in 6 different consecutive positions of the hand and wrist.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Ultrasonographic Evaluation	Median nerve diameter measurements and depths of the participants will be made by USG with a multifrequency (7-15 MHz) linear probe. With USG, the median CBF and its depth will be measured distally from the level of the scaphoid bone (wrist; carpal tunnel level) and the midpoint of the forearm.	20 minutes
Evaluation of symptom severity and functional status	It will be assessed with the Boston Carpal Tunnel Questionnaire (BCTQ). 1. The symptom severity scale (BCTQSS) has 11 items that evaluate pain, paresthesia, and weakness. 2. The functional status scale (BCTQ-FS) evaluates the ability to perform manual activities with 8 items. Each item evaluates the increasing severity of symptoms or difficulty with a higher score.	10 minutes

Collaborators and Investigators

• Sponsor: Selcuk University

Study record dates

Study Major Dates

• Study Start (Actual): March 12, 2024
• Primary Completion (Estimated): April 12, 2024
• Study Completion (Estimated): April 30, 2024

Study Registration Dates

• First Submitted: June 8, 2022
• First Submitted That Met QC Criteria: June 8, 2022
• First Posted (Actual): June 13, 2022

Study Record Updates

• Last Update Posted (Actual): March 15, 2024
• Last Update Submitted That Met QC Criteria: March 12, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: pain; carpal tunnel syndrome; edema; manual lymph drainage; ultrasonographic evaluation
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Wounds and Injuries; Disease; Neuromuscular Diseases; Mononeuropathies; Peripheral Nervous System Diseases; Median Neuropathy; Nerve Compression Syndromes; Cumulative Trauma Disorders; Sprains and Strains; Syndrome; Carpal Tunnel Syndrome
• Other Study ID Numbers: 2023-14/01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No