Carpal Tunnel SyndromeNCT07042542
Mulligan Mobilization With Arm Movement in CTS Patients
A study testing Mulligan Spinal Mobilization with Arm Movement, Conventional Neurodynamic Mobilization and Tendon Gliding and Hand Strengthening Exercises in people with Carpal Tunnel Syndrome, run by Beste Gebologlu at 1 site in Turkey (Türkiye).
Trial summary
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. Read more about this study
- Who is it for?
- Ages 20 to 60 years
- Conditions the study is for
- Carpal Tunnel Syndrome
- What is being tested?
- Mulligan Spinal Mobilization with Arm Movement, Conventional Neurodynamic Mobilization and Tendon Gliding and Hand Strengthening Exercises
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 30 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Jun 2023to 10 Jan 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site
Istanbul Medipol University
Istanbul, Marmara, 34810
About this study
Official title: The Effect of the Mulligan Spinal Mobilization Technique With Arm Movement on Pain, Grip Strength, and Functionality in Individuals With Carpal Tunnel Syndrome
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).
Read the detailed description
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.
- Conditions
- Carpal Tunnel Syndrome
- Being tested
- Mulligan Spinal Mobilization with Arm Movement, Conventional Neurodynamic Mobilization, Tendon Gliding and Hand Strengthening Exercises
- Keywords
- Mulligan Spinal Mobilization with Arm Movement, Conventional Neurodynamic Mobilization, Functionality, Grip Strength, Rehabilitation, Pain, Median Nerve
- Medical subject headings
- Carpal Tunnel Syndrome, Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mulligan Spinal Mobilization with Arm MovementOther
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 MobilizationOther
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 ExercisesBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| Mulligan Spinal Mobilization with Arm Movement | Experimental | Participants in this group received Mulligan spinal mobilization applied to the cervical spine at C5, C6, and C7 levels, in 3 sets of 3 repetitions per level. During mobilization, participants actively performed arm movements in a neurodynamic stretching position. The intervention was administered 3 sessions per week for 6 weeks. Additionally, all participants performed tendon gliding and hand strengthening exercises three times per week for 6 weeks, which were also prescribed as home-based programs. Receives: Other: Mulligan Spinal Mobilization with Arm Movement; Behavioral: Tendon Gliding and Hand Strengthening Exercises |
| Conventional Neurodynamic Mobilization | Active comparator | Participants in this group received conventional neurodynamic mobilization techniques targeting the median nerve, applied by a therapist. The intervention was administered 3 sessions per week for 6 weeks, with 3 sets of 3 repetitions in each session. In addition, all participants performed tendon gliding exercises and hand strengthening exercises three times per week for 6 weeks. These exercises were also assigned as home-based programs. Receives: Other: Conventional Neurodynamic Mobilization; Behavioral: Tendon Gliding and Hand Strengthening Exercises |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain Intensity
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.
Measured: Baseline, 6th week, 12th week
Functional Status and Symptom Severity
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).
Measured: Baseline, 6th week, 12th week
Secondary outcomes (4)
Hand Grip Strength
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.
Measured: Baseline, 6th week, 12th week
Range of Motion of the Wrist
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.
Measured: Baseline, 6th week, 12th week
Sensory Function
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.
Measured: Baseline, 6th week, 12th week
Pain Quality - McGill Pain Questionnaire
Pain quality and intensity were assessed. The McGill Pain Questionnaire scores range from 0 to 78. Higher scores indicate worse pain experience.
Measured: Baseline, 6th week, 12th week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jun 2025
- Study start1 Jun 2023
- Primary completion15 Dec 2024
- Study completion10 Jan 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Carpal Tunnel SyndromeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Two-arm randomized controlled parallel design comparing Mulligan mobilization with neurodynamic mobilization in patients with carpal tunnel syndrome.
- Masking
- None (open label)
- Enrolment
- 30 participants (actual)
Sponsor and investigators
- Lead sponsor
- Beste Gebologlu
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Beste Gebologlu, Medipol University
- Investigators
- Pınar KAYA SARIBAS, Assoc Prof, Principal investigator, Istanbul Medipol University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07042542
- Sponsor's protocol ID
- KTS-MED25-BG
- Other IDs
- E-10840098-772.02-3960
- Status last verified
- Jun 2025
- First submitted
- 20 Jun 2025
- Last updated
- 2 Jul 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: This is a non-commercial academic thesis study and there is no plan to share individual participant data (IPD) with other researchers.
Study at a glance
From the registry record, last updated by the sponsor on 2 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of the Mulligan Spinal Mobilization Technique With Arm Movement on Pain, Grip Strength, and Functionality in Individuals With Carpal Tunnel Syndrome
- ClinicalTrials.gov ID
- NCT07042542
- Acronym / sponsor ID
- KTS-MED25-BG
- Conditions
- Carpal Tunnel Syndrome
- Keywords
- Mulligan Spinal Mobilization with Arm Movement, Conventional Neurodynamic Mobilization, Functionality, Grip Strength, Rehabilitation, Pain, Median Nerve
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 30 participants (actual)
- Lead sponsor
- Beste GebologluUniversity, hospital or other
- Study start
- 1 Jun 2023 (actual)
- Primary completion
- 15 Dec 2024 (actual)
- Study completion
- 10 Jan 2025 (actual)
- First posted
- 29 Jun 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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).
Detailed description
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Two-arm randomized controlled parallel design comparing Mulligan mobilization with neurodynamic mobilization in patients with carpal tunnel syndrome.
| Arm | Type | Receives |
|---|---|---|
| Mulligan Spinal Mobilization with Arm Movement | Experimental | Other: Mulligan Spinal Mobilization with Arm Movement, Behavioral: Tendon Gliding and Hand Strengthening ExercisesParticipants in this group received Mulligan spinal mobilization applied to the cervical spine at C5, C6, and C7 levels, in 3 sets of 3 repetitions per level. During mobilization, participants actively performed arm movements in a neurodynamic stretching position. The intervention was administered 3 sessions per week for 6 weeks. Additionally, all participants performed tendon gliding and hand strengthening exercises three times per week for 6 weeks, which were also prescribed as home-based programs. |
| Conventional Neurodynamic Mobilization | Active comparator | Other: Conventional Neurodynamic Mobilization, Behavioral: Tendon Gliding and Hand Strengthening ExercisesParticipants in this group received conventional neurodynamic mobilization techniques targeting the median nerve, applied by a therapist. The intervention was administered 3 sessions per week for 6 weeks, with 3 sets of 3 repetitions in each session. In addition, all participants performed tendon gliding exercises and hand strengthening exercises three times per week for 6 weeks. These exercises were also assigned as home-based programs. |
Who may qualify
- Ages
- 20 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- 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.
Key exclusion criteria (8 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mulligan Spinal Mobilization with Arm MovementIn 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. | Other | Mulligan Spinal Mobilization with Arm Movement |
| Conventional Neurodynamic MobilizationA 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. | Other | Conventional Neurodynamic Mobilization |
| Tendon Gliding and Hand Strengthening ExercisesTendon 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. | Behavioural | Conventional Neurodynamic Mobilization, Mulligan Spinal Mobilization with Arm Movement |
Primary outcome
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.
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).
4 secondary outcomes
Hand Grip Strength
Time frame: Baseline, 6th week, 12th week
Range of Motion of the Wrist
Time frame: Baseline, 6th week, 12th week
Sensory Function
Time frame: Baseline, 6th week, 12th week
Pain Quality - McGill Pain Questionnaire
Time frame: Baseline, 6th week, 12th week
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Jul 2025.
- Individual participant dataSharing planned: No. This is a non-commercial academic thesis study and there is no plan to share individual participant data (IPD) with other researchers.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Pınar KAYA SARIBAS, Assoc Prof principal investigator
Istanbul Medipol University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mulligan Spinal Mobilization with Arm Movement, Conventional Neurodynamic Mobilization and Tendon Gliding and Hand Strengthening Exercises in people with Carpal Tunnel Syndrome, run by Beste Gebologlu at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 2 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain Intensity (time frame: Baseline, 6th week, 12th week). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jul 2025.