Author Names
Mohamed, F. I., Hassan, A. A., Abdel-Magied, R. A., & Wageh, R. N.
Reviewer Name
Juan Carlos Chavez Casiano
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Median nerve mobilization is a manual therapy intervention used for treating CTS. Aim The aim of the present study was to investigate the effectiveness of median nerve mobilization in relieving manifestations of CTS when compared with conventional medical treatment. Patients and methods A total of 28 CTS patients were divided into two groups: patients in group I (n = 18) underwent median nerve mobilization, and those in group II (n = 10) underwent conventional medical treatment. Median nerve mobilization consisted of 18 treatments (three/week for 6 weeks). Patients were assessed for hand sensitivity, paresthesia, strength, pain, night awakening, thenar eminence atrophy, and were subjected to Phalen’s test, Tinel’s sign, Boston Carpal Tunnel Questionnaire’s Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), and sensory and motor conduction studies for median nerve at baseline and at 6 weeks after treatment. Results At baseline versus at 6 weeks, pain, sensation, paresthesia, tingling, Tinel’s signs, and Phalen’s test outcomes were significantly improved in both groups; wrist flexion and extension improved only in group I. The difference between group I and group II after 6 weeks was significant as regards tingling, pain, wrist flexion, and extension. BCTQ-SSS and BCTQ-FSS scores improved after 6 weeks compared with baseline in patients in group I, whereas in group II the improvement was observed in BCTQ-FSS; the difference between the groups was significant. Sensory nerve conduction velocity, sensory distal latency, sensory amplitude, distal motor latency, and motor amplitude were significantly improved after 6 weeks in group I. In addition, there was a change in the grade of CTS, whereas in group II there was improvement only in sensory nerve conduction velocity; the difference between the groups was not significant. Conclusion CTS improves after median nerve mobilization, which is better than conventional medical treatment. It provides support for the use of manual therapy in conservative management of CTS with satisfactory results.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Cannot Determine, Not Reported, or Not Applicable
- Were study participants and providers blinded to treatment group assignment?
- Cannot Determine, Not Reported, or Not Applicable
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Cannot Determine, Not Reported, or Not Applicable
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Cannot Determine, Not Reported, or Not Applicable
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Cannot Determine, Not Reported, or Not Applicable
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Cannot Determine, Not Reported, or Not Applicable
Key Finding #1
Patients who underwent median nerve mobilization treated had a significant improvement in symptoms of carpal tunnel syndrome when compared to the conventional medical treatment.
Key Finding #2
Sensory nerve conduction velocity, sensory distal latency, sensory amplitude, distal motor latency, and motor amplitude improved significantly in patients who received median nerve mobilization compared to medical treatment.
Key Finding #3
Comparted to the conventional medical treatemnt group the patients that received the median nercer mobalilization were the onlys one to show an improvement in wrist flextion and extension.
Please provide your summary of the paper
This study compared the effects of median nerve mobilization versus conventual medical treatment on patients with carpal tunnel syndrome. This study took a total of 28 patients and split them into two groups; group 1 patients were treated with neurodynamic mobilization technique (median nerve mobilization) and group 2 patients underwent conventional medical treatment (NSAIDs, diclofenac 150 mg/day for 2 weeks and 1500 μg vitamin B12 per day for 6 weeks). All patients were assessed using the Boston Carpal Tunnel Questionnaire, Functional Status Scale, hand sensitivity, paresthesia, strength, pain, night awakening, thenar eminence atrophy, Phalen’s test, and Tinel’s sign. The results showed a significant improvement in patients who received median nerve mobilization when compared to conventual medical treatment.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study supports the use of Manuel therapy treatment with patients that have carpal tunnel syndrome. As a future clinician I want to be someone that uses evidence based practice in my clinic, so finding more articles that support my treatment style or not are necessary to do so. Along with the conventional medical treatment, manual therapy can help the patient see dramatic results.
