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IRCT20240724062527N1 IRCT 2024-08-27 The University of Lahore Effect of Carpal Bones Mobilization Technique with and without Neurodynamic Technique in Chronic Carpal Tunnel Syndrome Patients Effect of Carpal Bones Mobilization Technique with and without Neurodynamic Technique in Chronic Carpal Tunnel Syndrome Patients 2023-12-12 anticipated 56 Complete https://irct.ir/trial/78336 interventional Randomization: Randomized, Blinding: Single blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment, Randomization description: All the screened and willing participants will be randomly allocated to two groups (Group A and Group B) by lottery method, Blinding description: Study will be single and assessor blinded. Participants will be masked about other groups but they will know what treatment they will be receiving or what exercises they will be doing. Principal investigator would also not be masked or blinded because investigator would be applying the techniques or participants of both groups. N/A Carpal Tunnel Syndrome. Intervention 1: Experimental Group: Carpal Bone Mobilization with neurodynamic Technique Carpal Bone Mobilization Technique (CBMT) is the movement of the individual carpal bones in a posterior anterior (P-A) and an anteroposterior (A-P) direction in relation to the adjacent carpal bone, radius, ulna, or adjacent metacarpal. Participant will be positioned in supine lying in the middle of the couch with the forearm resting on the couch either pronated or supinated. The physical therapist will be stood by the participant’s involved side beyond the hand, facing the participant’s head. For P-A glide, the therapist will be positioned his hand to localize the forces on the carpal bone in such a way that the maximum breadth of the thumb tips will be placed adjacent to each other on the appropriate carpal bone or intercarpal joint; the fingers will be spread over the adjacent area of the hand for stability; and the arms and thumbs will be positioned in a P-A direction. For A-P glide, the thumbs will be contacted the palmar surface of the participant’s supinated hand against the appropriate carpal bone or intercarpal joint; the fingers will be spread over adjacent areas of the hand for stability; and the thumbs and arms will be positioned in an A-P direction . The P-A or A-P movement will be produced by pressure from the therapist’s arms being transmitted through the spring-like action of the thumbs against the appropriate carpal bone or intercarpal joint. The CBMT will be performed in 3 sets with 30 repetitions in each set, keeping a gap of one minute between the sets. (a) P-A glides (b) A-P glides over carpal bones.Tendon Gliding Exercises: Tendon gliding exercises will be carried out by the participants after applying maneuver (CMBT). The participant will be in sitting position on a chair. The exercises involved sliding the flexor tendons of the hand by moving the fingers through the following five discrete positions: straight, hook, first, table top, and straight fist positions . The exercises will be actively performed by the participants who marinated each position for 7seconds and repeated five times in each set for 3 sets, keeping one-minute rest between sets. It will be performed three times per week. (a)Straight (b) hook (c) fist (d) table top (c) straight fist .Neurodynamic Technique: This maneuver intends to yield an unrestricted gliding movement of the median nerve against the surrounding soft tissues inside the carpal tunnel.The joints will be moved in such a way that stretched the nerve proximally while releasing it distally followed by a reverse combination. For the right side, the participant will be laid supine on a plinth. The therapist will stand in stride standing (right leg in front of the left one) on the right-hand side of the plinth, facing the participant. The participant's arm will be rested on the therapist's right thigh. The therapist's left will be hand held the participant's right hand. The participant's shoulder girdle will be depressed by the therapist by pushing the right hand vertically down the plinth. The participant's shoulder will be then taken into abduction (90") and lateral rotation, the forearm was supinated and wrist, thumb, and fingers will be extended. In this position, concurrent elbow flexion and wrist extension (a) will be alternated dynamically with concurrent elbow extension and wrist flexion (b). The therapist will alter the combination of movements depending on tissue resistance. Speed and amplitude of movement will be adjusted so that it produced no pain. The NT will be performed in 2 sets of 5 minutes each with 1-minute rest between sets. It was performed three times per week for six weeks consecutively. NDT for median nerve (a) elbow flexion with wrist extension (b) elbow extension with wrist flexion. Intervention 2: Experimental Group B: Carpal Bone Mobilization without neurodynamic Technique The participants randomly allocated in Group B will be received the Carpal bone mobilization without neurodynamic technique. Before apply mobilization routine physical therapy consist of heat therapy for 15 minutes will be applied. The application of this mobilization technique or procedure will mirror the methods described earlier. Yes - There is a plan to make this available What will be shared: Demographic data and data related to final outcome will be shared by maintaining the confidentially. When: Data will be available after the publication of findings till six moths To whom: Fizza Nawaz Conditions: For research purpose Where to obtain: To the corresponding author of the study, Fizza Nawaz and can contact on +92317 8118181, fizzanawaz1122@gmail.com How to obtain: Open access and there is the traditional public data release where anyone can get access to the data. Comments:
public Fizza Nawaz
1-Km Defence Road،, near Bhuptian Chowk،, Lahore, Punjab
Lahore Pakistan 54590 +92 317 8118181 fizzanawaz1122@gmail.com The University of Lahore scientific Fizza Nawaz
1-Km Defence Road،, near Bhuptian Chowk،, Lahore, Punjab
Lahore Pakistan 54590 +92 317 8118181 fizzanawaz1122@gmail.com The University of Lahore Pakistan Aged between 30-60 years Both males and females Patients with Positive Tinnel sign Patients reporting a Numeric Pain Rating Scale score between 4 and 7cm 30 years 60 years Both Patients with systemic pathology (i.e Hypothyroidism) Patients with inflammatory disorder (i.e Rheumatoid arthritis) Patients with Cervical radiculopathy Patients with any deformity in hand or wrist Patients who have undergone carpal tunnel treatment within the past 3 months Pregnancy G56.0 Carpal tunnel syndrome Treatment - Other Treatment - Other Experimental Group: Carpal Bone Mobilization with neurodynamic Technique Carpal Bone Mobilization Technique (CBMT) is the movement of the individual carpal bones in a posterior anterior (P-A) and an anteroposterior (A-P) direction in relation to the adjacent carpal bone, radius, ulna, or adjacent metacarpal. Participant will be positioned in supine lying in the middle of the couch with the forearm resting on the couch either pronated or supinated. The physical therapist will be stood by the participant’s involved side beyond the hand, facing the participant’s head. For P-A glide, the therapist will be positioned his hand to localize the forces on the carpal bone in such a way that the maximum breadth of the thumb tips will be placed adjacent to each other on the appropriate carpal bone or intercarpal joint; the fingers will be spread over the adjacent area of the hand for stability; and the arms and thumbs will be positioned in a P-A direction. For A-P glide, the thumbs will be contacted the palmar surface of the participant’s supinated hand against the appropriate carpal bone or intercarpal joint; the fingers will be spread over adjacent areas of the hand for stability; and the thumbs and arms will be positioned in an A-P direction . The P-A or A-P movement will be produced by pressure from the therapist’s arms being transmitted through the spring-like action of the thumbs against the appropriate carpal bone or intercarpal joint. The CBMT will be performed in 3 sets with 30 repetitions in each set, keeping a gap of one minute between the sets. (a) P-A glides (b) A-P glides over carpal bones.Tendon Gliding Exercises: Tendon gliding exercises will be carried out by the participants after applying maneuver (CMBT). The participant will be in sitting position on a chair. The exercises involved sliding the flexor tendons of the hand by moving the fingers through the following five discrete positions: straight, hook, first, table top, and straight fist positions . The exercises will be actively performed by the participants who marinated each position for 7seconds and repeated five times in each set for 3 sets, keeping one-minute rest between sets. It will be performed three times per week. (a)Straight (b) hook (c) fist (d) table top (c) straight fist .Neurodynamic Technique: This maneuver intends to yield an unrestricted gliding movement of the median nerve against the surrounding soft tissues inside the carpal tunnel.The joints will be moved in such a way that stretched the nerve proximally while releasing it distally followed by a reverse combination. For the right side, the participant will be laid supine on a plinth. The therapist will stand in stride standing (right leg in front of the left one) on the right-hand side of the plinth, facing the participant. The participant's arm will be rested on the therapist's right thigh. The therapist's left will be hand held the participant's right hand. The participant's shoulder girdle will be depressed by the therapist by pushing the right hand vertically down the plinth. The participant's shoulder will be then taken into abduction (90") and lateral rotation, the forearm was supinated and wrist, thumb, and fingers will be extended. In this position, concurrent elbow flexion and wrist extension (a) will be alternated dynamically with concurrent elbow extension and wrist flexion (b). The therapist will alter the combination of movements depending on tissue resistance. Speed and amplitude of movement will be adjusted so that it produced no pain. The NT will be performed in 2 sets of 5 minutes each with 1-minute rest between sets. It was performed three times per week for six weeks consecutively. NDT for median nerve (a) elbow flexion with wrist extension (b) elbow extension with wrist flexion. Experimental Group B: Carpal Bone Mobilization without neurodynamic Technique The participants randomly allocated in Group B will be received the Carpal bone mobilization without neurodynamic technique. Before apply mobilization routine physical therapy consist of heat therapy for 15 minutes will be applied. The application of this mobilization technique or procedure will mirror the methods described earlier. Pain. Timepoint: Six weeks. Method of measurement: The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0–10 integers) that best reflects the intensity of his/her pain. The common format is a horizontal bar or line. The NPRS takes <1 minute to complete Scores range from 0-10 points, with higher scores indicating greater pain intensity. The NPRS can be administered verbally (therefore also by telephone) or graphically for self-completion. Functional Status. Timepoint: Six weeks. Method of measurement: The Boston Carpal Tunnel Questionnaire (BCTQ) is a disease-specific measure of self-reported symptom severity and overall functional status. The Boston Carpal Tunnel Score is a patient-reported questionnaire that examines symptom severity and overall functional status of patients with carpal tunnel syndrome. The Symptom Severity Scale (SSS) with 11 questions is scored on a Likert scale of 1-5 and the Functional Status Scale (FSS) with 8 questions is scored from 1-5 with 1 as no difficulty and 5 as difficult. Range of motion. Timepoint: Six weeks. Method of measurement: The term 'goniometry' is derived from the Greek words 'gonia' meaning angle and 'metron' meaning measure, therefore goniometry refers to the measurement of angles, which in rehabilitation settings refers to the measurement of angles in each plane at the joints of the body. The neutral zero method (0 to 180- degree system) is the most widely used method. The range of motion of each joint should be measured in isolation, to avoid trick movement (simultaneous movement of another joint) and muscle insufficiency which may alter the reading. None Approved 2024-01-23 Research Ethics Committee of University of Lahore University of Lahore Teaching Hospital Lahore , Punjab , Pakistan Lahore Punjab Pakistan