Karpal Tünel Sendromlu Hastalarda Retinaculum Musculorum Flexorum’un Miyofasyal Olarak Gevşetilmesi, Median Sinir Mobilizasyonu ve Tendon Kaydırma Egzersizlerinin Kinezyo Bantlama Tekniğiyle Karşılaştırılması

Abstract

Amaç: Karpal tünel sendromu (KTS) tedavisinde, kinesio taping bantlama tekniğinin ne kadar etkin olduğunu araştırmak ve bu teknik ile retinaculum musculorum flexorum’un myofascial gevşetilmesi, n. medianus mobilizasyonu ve tendon gliding egzersizlerinin üçünün birlikte yapıldığı tedavi programının etkinliğini karşılaştırmaktır.

Materyal ve Metod: Gönüllü KTS’li 40 bayan hasta, rastgele 20 kişilik iki gruba ayrıldı ve 4 hafta tedaviye alındı. Grup 1’e haftada 5 gün retinaculum musculorum flexorum’un myofascial olarak gevşetilmesi, n. medianus mobilizasyonu ve tendon gliding egzersizleri; Grup 2’ye pazartesi-perşembe günleri haftada 2 defa kinesio taping bantlama tekniği uygulandı. Her bir hasta tedavi öncesi ve sonrası Boston Semptom Şiddeti Skalası ve Boston Fonksiyonel Kapasite Skalası ile değerlendirilip, her grubun tedavisinin kendi içinde etkinliğine ve iki grubun tedavi etkinliğinin birbiriyle karşılaştırılması yapıldı.

Bulgular: Her iki grupta da tedavi öncesi ve sonrası Boston Semptom Şiddeti Skalası ve Boston Fonksiyonel Kapasite Skalası değerleri istatistiksel olarak anlamlı şekilde azalmıştır. Egzersiz grubu ve bantlama grubu Boston Semptom Şiddeti Skalası’nda tedavi öncesi ve sonrası arasındaki fark karşılaştırıldığında istatistiksel olarak anlamlı bir fark bulunmazken, Boston Fonksiyonel Kapasite Skalası’nda iki grup arasında anlamlı bir fark tespit edildi.

Sonuç: Her iki grupta da KTS semptomları açısından olumlu etkiler sağlandığı tespit edilmiş, gruplar arasında istatistiksel olarak fark bulunmamıştır. KTS fonksiyonları açısından değerlendirildiğinde egzersiz grubu bantlama grubundan daha etkin çıkmıştır. 

Keywords

• Karpal tünel sendromu
• miyofasyal gevşetme
• n. medianus mobilizasyonu
• tendon kaydırma egzersizleri;
• kinezyo bantlama tekniği

Comparison of Kinesio Taping Technique with Myofacial Releasing of Retinaculum Musculorum Flexorum, Mobilization of the Median Nerve, and Tendon Gliding Exercises in Patients with Carpal Tunnel Syndrome

Abstract

Aim: We aimed to investigate the efficiency of the kinesiotaping technique and to compare efficacy of this technique with a treatment programme using all three types of myofacial releasing of flexor retinaculum, mobilization of the median nerve, and tendon gliding exercises in the Carpal Tunnel Sendrome (CTS).

Material and Methods: Forty volunteer female patients with CTS, divided into randomly two groups consisted of twenty patients and received treatment for 4 weeks. Group 1 was put on mobilization of the median nerve, myofascial releasing of flexor retinaculum, and tendon gliding exercises therapy for 5 days per week, while Group 2 recieved the kinesiotaping technique two times per week on Mondays and Thursdays. Every patient was evaluated within the group and compared with the other group according to Boston Symptom Severity Scale and Boston Functional Capacity Scale pretreatment and posttreatment programme to compare the efficiencies of the methods.

Results: In both groups, statisticaly significant reductions were observed according to Boston Symptom Severity Scale and Boston Functional Capacity Scale scores pretreatment and posttreatment. Although the difference between exercises and taping groups was not statistically significant according to Boston Symptom Severity Scale, a statistically significant difference was noted according to Boston Functional Capacity Scale.

Conclusion: Positive effects on CTS symptoms were observed in both groups, but statistically significant difference was not observed between groups. Excercise group was superior to taping group when we compare two groups according to improvement of hand functions.

Keywords

• Carpal tunnel sendrome
• myofacial releasing
• mobilization of the median nerve
• tendon gliding exercises
• kinesio taping technique

References

1. 1) Wıpperman J, Goerl K. Carpal Tunnel Syndrome: Diagnosis And Management. Am Fam Physician. University Of Kansas School Of Medicine –Wichita. 2016; 94(12): 993-9.
2. 2) Chammasa M, Boretto B, Burmann L, Ramos R, Santos Neto F, Silvac J. Carpal tunnel syndrome – Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop. 2014; 49(5): 429–36.
3. 3) Ghasemi-rad, M. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World journal of radiology. 2014; 6(6): 28.
4. 4) Doğan Akçam, F. Karpal tünel sendromunda steroid fonoforezinin klinik bulgular ve sinir iletim hızlarına olan etkisi. Uzmanlık tezi, Çukurova Üniversitesi, Adana. 2008.
5. 5) Sim S, Gunasagaran J, MS Ortho, Goh K, FRCP, Ahmad T. Short-term clinical outcome of orthosis alone vs combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome. Journal of Hand Therapy. 2018; 1-5.
6. 6) Benjamin MS, Richard NH, Robert LW, Luis-Diego Q, Bryan F, Bryan JM. Manipulative Treatment of Carpal Tunnel Syndrome: Biomechanical and Osteopathic Intervention to Increase the Length of the Transverse Carpal Ligament: Part 2. Effect of Sex Differences and Manipulative "Priming". JAOA. 2005; 105(3): 135-43.
7. 7) Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the kinesio taping method. Yayın Adı: Ken Ikai Co. Ltd. Tokyo, Japan. 2013.
8. 8) Mansiz Kaplan B, Akyuz G, Kokar S, Yagci I. Comparison of the effectiveness of orthotic intervention, kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study. J Hand Ther. 2018; 1130(17): 30127-8.

9. 9) Geler Külcü D, Bursali C, Aktaş İ, Bozkurt Alp S, Ünlü Özkan F. Akpinar P. Kinesiotaping as an alternative treatment method for carpal tunnel syndrome. Turk J Med Sci. 2016; 46(4): 1042-9.
10. 10) Güner A, Altan L1, Kasapoğlu Aksoy M. The effectiveness of the low-power laser and kinesiotaping in the treatment of carpal tunnel syndrome, a pilot study. Rheumatol Int. 2018; 38(5): 895-904.
11. 11) Yıldırım P, Dilek B, Şahin E, Gülbahar S, Kızıl R. Ultrasonographic and clinical evaluation of additional contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of carpal tunnel syndrome. Turk J Med Sci. 2018; 48(5): 925-32.
12. 12) Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75: 1585-92.
13. 13) Mattioli S, Baldasseroni A, Curti S, Cooke RMT, Mandes A, Zanardi F et all. Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy. Occup Environ Med. 2009; 66(5): 299–304.
14. 14) Arslan Y, Bülbül İ, Öcek L, Şener U, Zorlu Y. Effect of hand volume and other anthropometric measurements on carpal tunnel syndrome. Neurological Sciences. 2017; 38 (4): 605–10.
15. 15) Dec P, Zyluk A. Bilateral carpal tunnel syndrome - A review. Neurol Neurochir Pol. 2018; 52(1): 79-83.
16. 16) Ghasemi-rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E et all. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World journal of radiology, 2014; 6(6): 284-300.
17. 17) Özgenel G, Bayraktar A, Özbek S, Akın S, Kahveci R. Karpal Tünel Sendromu: 92 Olgunun Geriye Dönük Değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2010; 36 (3): 95-98.
18. 18) MacDermid JC, Wessel J. Clinical diagnozis of carpal tunnel syndrome: Asystematic Review. Journal of Hand Therapy. 2004; 17(2): 309-19.
19. 19) Heybeli N, Özerdemoğlu DA, Aksoy OG, Mumcu EF. Karpal tünel sendromu: Cerrahi tedavi izleminde fonksiyonel ve semptomatik skorlama. Functional scoring used fort he assesment of outcome in carpal tunnel release. Acta Traumatol Turc. 2001; 35 147-51.
20. 20) Ren Y, Wang X, Wei Z, Fan B, Lin W, Zhou X et all. Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome A systematic review and meta-analysis. Medicine (Baltimore). 2017; 96(16) : 6778.
21. 21) Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res 2011; 6: 17.
22. 22) Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Pareja JA, Alonso-Blanco C. The effectiveness of manual therapy versus surgery on self-reported function, cervical range of motion, and pinch grip force in carpal tunnel syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2017; 47(3): 151-61.
23. 23) Adams R, White B, Beckett C. The Effects of Massage Therapy on Pain Management in the Acute Care Setting. Int J Ther Massage Bodywork. 2010; 3(1): 4–11.
24. 24) Sucher BM. Palpatory diagnosis and manipulative management of carpal tunnel syndrome. J Am Osteopath Assoc, 1994; 94: 647- 63.
25. 25) Siu G, Jaffe D, Rafique M, Weinik MM. Osteopathic Manipulative Medicine for Carpal Tunnel Syndrome Review. JAOA. 2012; 112(3): 127- 39.
26. 26) Adam L, Schreiber DO, Benjamin M. Sucher DO, Levon N, Nazarian MD. Two Novel Nonsurgical Treatments of Carpal Tunnel Syndrome. Physical Medicine and Rehabilitation Clinics of North America. 2014; 25 (2): 249-64.
27. 27) Jennifer M, Medina M, Yancosek E. Neural Gliding Techniques for the treatment of carpal tunnel syndrome:a systematic review. Journal of Sport Rehabilitation. 2008; 17: 324-41.
28. 28) Hough AD, Moore AP, Jones MP. Reduced longitudinal excursion of the median nerve in carpal tunnel syndrome. Arch. Phys. Med. Rehabil. 2007; 88: 569-76.
29. 29) Ettema AM, Zhao C, Amadio PC, O’ByrneMM KN. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel sendrome: a pilot study. Clin Anat. 2007; 20: 292-9.
30. 30) Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic reviewof nonsurgical management. Ann. Fam. Med. 2004; 2: 267-73.
31. 31) Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, Macdermid JD. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review. J. Hand. Ther. 2004; 17: 210-28.
32. 32) O’conner D, Marshall S, Massy-westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003; CD003219.
33. 33) Ballestero-Pérez R, Plaza-Manzano G, Urraca-Gesto A, Romo-Romo F, Atín-Arratibel ML, Pecos-Martín D et all. N. Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review. J Manipulative Physiol Ther. 2017; 40(1): 50-9.
34. 34) Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey K, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998; 11(3): 171-9.
35. 35) Akalin E, El Ö, Peker Ö, Şenocak Ö, Tamci Ş, Gülbahar S, Çakmur R et all. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. American Journal of Physical Medicine and Rehabilitation. 2002; 81(2): 108-13.
36. 36) Sang-Dol Kim RN. Efficacy of tendon and nerve gliding exercises for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Phys Ther Sci. 2015; 27(8): 2645–8.
37. 37) Paksoy Karateke H. Karpal Tünel Sendromu Hastalarında Kinezyolojik Bantlama Ve Steroid İyontoforezi Yöntemlerinin Klinik, Elektrofizyolojik Ve Sonografik Olarak Karşılaştırılması. Doktora tezi. Mustafa Kemal Üniversitesi. Hatay. 2016.
38. 38) Aktürk S, Büyükavcı R, Aslan Ö, Ersoy Y. Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study. Clin Rheumatol. 2018; 37(9): 2465-9.
39. 39) Eroğlu M. Karpal tünel sendromunda kinezyolojik bantlama ve splint etkisinin karşılaştırılması. Tıpta Uzmanlık. Adnan Menderes Üniversitesi, Aydın. 2016.
40. 40) Mansız Kaplan B. Karpal tünel sendromu olan hastalarda splint, kinezyolojik bantlama ve parafin tedavilerinin etkinliğinin karşılaştırılması. Tıpta Uzmanlık. Marmara Üniversitesi, İstanbul. 2014.
41. 41) Güner A. Karpal tünel sendromu tedavisinde düşük enerjili lazer ve kinezyo bantlama tekniğinin etkinliği. Tıpta Uzmanlık. Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Bursa. 2017.