OJTR  Vol.2 No.4 , November 2014
The Effect of Longitudinal Stretching of Muscles and Nerve versus Deep Transverse Friction Massage in the Management of Patients with Carpal Tunnel Syndrome
Background and Purpose: Carpal tunnel syndrome (CTS) is a common source of hand numbness and pain. The goal of this study was to compare longitudinal stretching of muscles and nerve to deep transverse friction massage for decreasing pain and improving hand function in patients with chronic CTS. Subjects and Methods: Thirty patients, 25 to 40 years old, were included in this study and randomized into two groups: the first group (36.8 ± 0.262) followed a physical therapy program group receiving stretching of wrist and hand flexors in combination with ultrasound, strengthening exercises of wrist and hand flexors, and wrist splint, three sessions per week for 12 weeks; and the second group (35.9 ± 0.225) followed the physical therapy program of deep transverse friction massage on the carpal tunnel site at the wrist joint, with using ultrasonic therapy, strengthening exercises of wrist and hand flexors and wrist splint, three sessions per week for 12 weeks. Outcome measures were range of motion (ROM), pain using visual analog scale (VAS), and hand grip strength measured with a sphygmomanometer. Results: There was a significant difference in both groups in all outcome measures compared to baseline. Over stretching group showed significant difference at the end of study in terms of range of motion of wrist flexion, extension and strength of handgrip when compared to deep friction massage group P < 0.05. However, there is no significant difference between groups in pain. Discussion and Conclusion: This study showed that the effect of stretching exercises is more beneficial than deep transverse friction massage in the treatment of patients with CTS in decreasing the compression of the median nerve in the tunnel.

Cite this paper
Hafez, A. , Alenazi, A. , Kachanathu, S. , Alroumi, A. and Mohamed, E. (2014) The Effect of Longitudinal Stretching of Muscles and Nerve versus Deep Transverse Friction Massage in the Management of Patients with Carpal Tunnel Syndrome. Open Journal of Therapy and Rehabilitation, 2, 199-206. doi: 10.4236/ojtr.2014.24025.
[1]   Mackinnon, S.E., Novak, C.B. and Green, D.P. (2010) Compression Neuropathies. In: Green’s Operative Hand Surgery, Elsevier, Philadelphia, 977-1015.

[2]   Caetano, E. (2010) Bases Anatomicas e Funcionais das Cirurgias do Membro Superior. Medbook, Rio de Janeiro.

[3]   Aroori, S. and Spence, R.A. (2008) Carpal Tunnel Syndrome. The Ulster Medical Journal, 77, 6-17.

[4]   Okamura, A., et al. (2014) Evaluation of Patients with Carpal Tunnel Syndrome Treated by Endoscopic Technique. Acta Ortopédica Brasileira, 22, 29-33.

[5]   Atroshi, I., et al. (1999) Prevalence of Carpal Tunnel Syndrome in a General Population. JAMA, 282, 153-158. http://dx.doi.org/10.1001/jama.282.2.153

[6]   Samarakoon, L.B., et al. (2014) Anatomical Landmarks for Safer Carpal Tunnel Decompression: An Experimental Cadaveric Study. Patient Safety in Surgery, 8, 8.

[7]   Ahn, D.S. (2001) Hand Elevation: A New Test for Carpal Tunnel Syndrome. Annals of Plastic Surgery, 46, 120-124. http://dx.doi.org/10.1097/00000637-200102000-00005

[8]   Gellman, H., et al. (1986) Carpal Tunnel Syndrome. An Evaluation of the Provocative Diagnostic Tests. Journal of Bone and Joint Surgery (America Volume), 68, 735-737.

[9]   Jenkins, P.J., et al. (2012) Corticosteroid Injection for Carpal Tunnel Syndrome: A 5-Year Survivorship Analysis. Hand, 7, 151-156. http://dx.doi.org/10.1007/s11552-012-9390-8

[10]   Marshall, S., Tardif, G. and Ashworth, N. (2007) Local Corticosteroid Injection for Carpal Tunnel Syndrome. Cochrane Database of Systematic Reviews, 2, Article ID: Cd001554.

[11]   Jerosch-Herold, C., Shepstone, L., Wilson, E.C.F., Dyer, T. and Blake, J. (2014) Clinical Course, Costs and Predictive Factors for Response to Treatment in Carpal Tunnel Syndrome: The PALMS Study Protocol. BMC Musculoskeletal Disorders, 15, 35. http://dx.doi.org/10.1186/1471-2474-15-35

[12]   Gooch, C.L. and Mitten, D.J. (2005) Treatment of Carpal Tunnel Syndrome: Is There a Role for Local Corticosteroid Injection? Neurology, 64, 2006-2007.

[13]   Huisstede, B.M., Randsdorp, M.S., Henk Coert, J., Glerum, S., van Middelkoop, M. and Koes, B.W. (2010) Carpal Tunnel Syndrome. Part II: Effectiveness of Surgical Treatments—A Systematic Review. Archives of Physical Medicine and Rehabilitation, 91, 1005-1024.

[14]   Ucar, B.Y., Demirtas, A., Bulut, M., Azboy, I. and Uçar, D. (2012) Carpal Tunnel Decompression: Two Different Mini-Incision Techniques. European Review for Medical and Pharmacological Sciences, 16, 533-538.

[15]   Acioly, M.A., Maior, P.S., Telles, C. and de Aguiar, G.B. (2013) Bilateral Mini-Open Decompression in the Treatment of Carpal Tunnel Syndrome Caused by Persistent Median Artery: Case Report. Journal of Neurological Surgery. Part A, Central European Neurosurgery, 74, e124-e127.

[16]   Verdugo, R.J., et al. (2008) Surgical versus Non-Surgical Treatment for Carpal Tunnel Syndrome. Cochrane Database Syst Rev, 4, p. Cd001552.

[17]   MacDonald, R.I., Lichtman, D.M., Hanlon, J.J. and Wilson, J.N. (1978) Complications of Surgical Release for Carpal Tunnel Syndrome. Journal of Hand Surgery, 3, 70-76.

[18]   Bland, J.D. (2007) Treatment of Carpal Tunnel Syndrome. Muscle & Nerve, 36, 167-171.

[19]   Bakhtiary, A.H. and Rashidy-Pour, A. (2004) Ultrasound and Laser Therapy in the Treatment of Carpal Tunnel Syndrome. Australian Journal of Physiotherapy, 50, 147-151.

[20]   Burke, F.D., Ellis, J., McKenna, H. and Bradley, M.J. (2003) Primary Care Management of Carpal Tunnel Syndrome. Postgraduate Medical Journal, 79, 433-437. http://dx.doi.org/10.1136/pmj.79.934.433

[21]   Dakowicz, A. and Latosiewicz, R. (2005) The Value of Iontophoresis Combined with Ultrasound in Patients with the Carpal Tunnel Syndrome. Roczniki Akademii Medycznej w Bialymstoku, 50, 196-198.

[22]   Hayward, A.C., Bradley, M.J. and Burke, F.D. (2002) Primary Care Referral Protocol for Carpal Tunnel Syndrome. Postgraduate Medical Journal, 78, 149-152. http://dx.doi.org/10.1136/pmj.78.917.149

[23]   Toge, Y., Nishimura, Y., Basford, J.R., Nogawa, T., Yamanaka, M., Nakamura, T., Yoshida, M., Nagano, A. and Tajima, F. (2013) Comparison of the Effects of Flexion and Extension of the Thumb and Fingers on the Position and Cross-Sectional Area of the Median Nerve. PLoS ONE, 8, e83565.

[24]   Gelberman, R.H., Hergenroeder, P.T., Hargens, A.R., Lundborg, G.N. and Akeson, W.H. (1981) The Carpal Tunnel Syndrome. A Study of Carpal Canal Pressures. Journal of Bone and Joint Surgery. American Volume, 63, 380-383.

[25]   Lam, N. and Thurston, A. (1998) Association of Obesity, Gender, Age and Occupation with Carpal Tunnel Syndrome. Australian and New Zealand Journal of Surgery, 68, 190-193. http://dx.doi.org/10.1111/j.1445-2197.1998.tb04743.x

[26]   Rempel, D., Manojlovic, R., Levinsohn, D.G., Bloom, T. and Gordon, L. (1994) The Effect of Wearing a Flexible Wrist Splint on Carpal Tunnel Pressure during Repetitive Hand Activity. Journal of Hand Surgery, 19, 106-110. http://dx.doi.org/10.1016/0363-5023(94)90231-3

[27]   Gerritsen, A.A., de Vet, H.C.W., Scholten, R.J.P.M., Bertelsmann, F.W., de Krom, M.C.T.F.M. and Bouter, L.M. (2002) Splinting vs Surgery in the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial. JAMA, 288, 1245-1251.

[28]   Gajdosik, R.L. and Bohannon, R.W. (1987) Clinical Measurement of Range of Motion. Review of Goniometry Emphasizing Reliability and Validity. Physical Therapy, 67, 1867-1872.

[29]   Boonstra, A.M., Schiphorst Preuper, H.R., Reneman, M., Posthumus, J.B. and Stewart, R.E. (2008) Reliability and Validity of the Visual Analogue Scale for Disability in Patients with Chronic Musculoskeletal Pain. International Journal of Rehabilitation Research, 31, 165-169.

[30]   Lusardi, M.M. and Bohannon, R.W. (1991) Hand Grip Strength: Comparability of Measurements Obtained with a Jamar Dynamometer and a Modified Sphygmomanometer. Journal of Hand Therapy, 4, 117-122. http://dx.doi.org/10.1016/S0894-1130(12)80226-2

[31]   Medicine ACoS (2006) ACSM’s Guidelines for Exercise Testing and Prescription. 7th Edition, Lippincott Williams Wilkins, Baltimore.

[32]   Groves, E.J. and Rider, B.A. (1989) A Comparison of Treatment Approaches Used after Carpal Tunnel Release Surgery. American Journal of Occupational Therapy, 43, 398-402.

[33]   Povlsen, B., Bashir, M. and Wong, F. (2014) Long-Term Result and Patient Reported Outcome of Wrist Splint Treatment for Carpal Tunnel Syndrome. Journal of Plastic Surgery and Hand Surgery, 48, 175-178. http://dx.doi.org/10.3109/2000656X.2013.837392

[34]   Akalin, E., El, Ö., Peker, Ö., Senocak, Ö., Tamci, S., Gülbahar, S., çakmur, R. and Öncel, S. (2002) Treatment of Carpal Tunnel Syndrome with Nerve and Tendon Gliding Exercises. American Journal of Physical Medicine & Rehabilitation, 81, 108-113.

[35]   Greening, J., Smart, S., Leary, R., Hall-Craggs, M., O’Hggins, P. and Lynn, B. (1999) Reduced Movement of Median Nerve in Carpal Tunnel during Wrist Flexion in Patients with Non-Specific Arm Pain. Lancet, 354, 217-218. http://dx.doi.org/10.1016/S0140-6736(99)02958-X

[36]   Rozmaryn, L.M., Dovelle, S., Rothman, E.R., Gorman, K., Olvey, K.M. and Bartko, J.J. (1998) Nerve and Tendon Gliding Exercises and the Conservative Management of Carpal Tunnel Syndrome. Journal of Hand Therapy, 11, 171-179. http://dx.doi.org/10.1016/S0894-1130(98)80035-5

[37]   Wilgis, E.F. and Murphy, R. (1986) The Significance of Longitudinal Excursion in Peripheral Nerves. Hand Clinics, 2, 761-766.

[38]   Oztas, O., Turan, B., Bora, I. and Karakaya, M.K. (1998) Ultrasound Therapy Effect in Carpal Tunnel Syndrome. Archives of Physical Medicine and Rehabilitation, 79, 1540-1544. http://dx.doi.org/10.1016/S0003-9993(98)90416-6

[39]   Pinar, L., Enhos, A., Ada, S. and Güngör, N. (2005) Can We Use Nerve Gliding Exercises in Women with Carpal Tunnel Syndrome? Advances in Therapy, 22, 467-475.

[40]   Cobb, T.K., Dalley, B.K., Posteraro, R.H. and Lewis, R.C. (1993) Anatomy of the Flexor Retinaculum. Journal of Hand Surgery, 18, 91-99. http://dx.doi.org/10.1016/0363-5023(93)90251-W

[41]   Chamberlain, G.J. (1982) Cyriax’s Friction Massage: A Review. Journal of Orthopaedic & Sports Physical Therapy, 4, 16-22. http://dx.doi.org/10.2519/jospt.1982.4.1.16

[42]   Piravej, K. and Boonhong, J. (2004) Effect of Ultrasound Thermotherapy in Mild to Moderate Carpal Tunnel Syndrome. Journal of the Medical Association of Thailand, 87, S100-S1006.

[43]   Lee, D., van Holsbeeck, M.T., Janevski, P.K., Ganos, D.L., Ditmars, D.M. and Darian, V.B. (1999) Diagnosis of Carpal Tunnel Syndrome. Ultrasound versus Electromyography. Radiologic Clinics of North America, 37, 859-872. http://dx.doi.org/10.1016/S0033-8389(05)70132-9