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Completed

NCT Number: NCT07042542

Mulligan Mobilization With Arm Movement in CTS Patients

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).

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Key information

Conditions

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

Age range

20 year–60 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Istanbul Medipol University

Istanbul, Marmara, 34810, Turkey (Türkiye)

About this study

Thirty participants completed the randomized controlled trial and were divided into two groups as the study group (Mulligan group) and the control group (conventional neurodynamic mobilization). Both groups received tendon gliding exercises (TGE) and strengthening exercises for the intrinsic and extrinsic muscles of the hand during the treatment period. The treatment period lasted six weeks, and after the end of the treatment, the individuals were followed up with a home program until the 12th week. Evaluations were performed three times at baseline, 6 and 12 weeks and included measures of pain (VAS, McGill), functionality (DASH, FDS, FDS), grip strength (Jamar hand dynamometer), range of motion and sensation (Semmes-Weinstein monofilament test). The control group received Mulligan's neurodynamic spinal mobilisation technique at the C5-C6-C7 levels with arm movement for six weeks. This involved three sessions per week, each comprising three sets of three repetitions, with each repetition lasting an average of one minute. The total duration of each session was approximately ten minutes.

The control group received the same technique without the Mulligan approach for six weeks, three days a week, three sets of three repetitions, with each repetition lasting an average of one minute. After the treatment period, both groups performed a standard exercise programme consisting of tendon gliding and hand strengthening exercises, which were also recommended to patients at the end of each session. These exercises were continued throughout the follow-up period after treatment.

The study was completed between June 2023 and January 2025 with ethical approval from Istanbul Medipol University.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • 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.

Exclusion criteria

  • 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.

Treatment and study plan

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.

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.

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.

Primary outcomes

  1. Pain Intensity

    Time frame: Baseline, 6th week, 12th week

    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.

  2. Functional Status and Symptom Severity

    Time frame: Baseline, 6th week, 12th week

    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).

Secondary outcomes

  1. Hand Grip Strength

    Time frame: Baseline, 6th week, 12th week

    Hand grip strength was measured using a dynamometer in kilograms to assess functional improvement. There is no fixed scoring range; higher values indicate greater muscle strength and improved function.

  2. Range of Motion of the Wrist

    Time frame: Baseline, 6th week, 12th week

    Wrist range of motion was measured in degrees using a goniometer, including supination, pronation, radial deviation, ulnar deviation, flexion, and extension. There is no fixed scale; higher degrees represent greater joint mobility.

  3. Sensory Function

    Time frame: Baseline, 6th week, 12th week

    Sensory function was evaluated using the Semmes-Weinstein monofilament test on the median nerve-innervated area. Filaments of varying thickness were used to determine sensory threshold. Lower values indicate greater sensitivity, while higher filament values indicate decreased sensory function.

  4. Pain Quality - McGill Pain Questionnaire

    Time frame: Baseline, 6th week, 12th week

    Pain quality and intensity were assessed. The McGill Pain Questionnaire scores range from 0 to 78. Higher scores indicate worse pain experience.

Sponsors and collaborators

Lead sponsor

Beste Gebologlu

Other

Registry information

Official study title

The Effect of the Mulligan Spinal Mobilization Technique With Arm Movement on Pain, Grip Strength, and Functionality in Individuals With Carpal Tunnel Syndrome

Important dates

Study start
2023
Primary completion
2024
Study completion
2025
First posted
Jun 29, 2025
Registry last updated
Jul 2, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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