Effectiveness of Mirror Therapy in Patients With Carpal Tunnel Syndrome
Condition: Carpal Tunnel Syndrome
MeSH terms: Carpal Tunnel Syndrome; Syndrome
Study type: Interventional

Summary: 
      Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy. CTS presents with
      motor and sensory disturbances, including pain, paraesthesia, and numbness in the fingers and
      hand. Therefore, CTS has a great impact on the activities of daily living.

      There are non-surgical treatments that can be effective in people who experience mild or
      moderate symptoms derived from CTS. Among them, flexor tendon and median nerve sliding
      exercises may offer an improvement in pain severity and symptoms, strength, wrist joint
      range, functionality, and quality of life for people with CTS. However, there are few studies
      on the effectiveness of treatments focused on the mechanisms of neuroplasticity through
      techniques aimed at rehabilitating different deficits.

      Mirror therapy (MT) may be beneficial in musculoskeletal injuries that occur with pain and
      reduced functionality of a body segment. For example, in people with acute stroke,
      orthopaedic hand injuries or complex regional pain syndrome type 1. However, its effect has
      not been studied in patients with CTS in mild or moderate stages.

      Thus, the objective of this study is to analyze the effectiveness of MT with conventional CTS
      exercises in symptoms of median nerve compression, pain, mobility, strength and motor
      functionality in patients with CTS.
    

Detailed description: 
      Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy. CTS presents with
      motor and sensory disturbances, including pain, paresthesia, and numbness in the fingers and
      hand. In addition, since complex movements and tactile sensation of the hand are essential to
      perform everyday tasks, STC has a great impact on the activities of daily living.

      Previuos studies have shown that CTS is not merely a local compression of the median nerve,
      since associated peripheral and central sensitization phenomena have been verified. In this
      sense, the decrease in the use of a body segment as a form of protective response to pain,
      favors the reduction of cortical thickness, affecting the primary motor and somatosensory
      area. In this way, in patients with CTS it has been described that the modification of the
      sensory input ends up having an impact on the level of the central nervous system producing
      different brain plastic changes.

      There are non-surgical treatments that can be effective in people who experience mild or
      moderate symptoms derived from CTS. Among them, flexor tendon and median nerve sliding
      exercises may offer an improvement in pain severity and symptoms, strength, wrist joint
      range, functionality, and quality of life for people with CTS. However, there are few studies
      on the effectiveness of treatments focused on the mechanisms of neuroplasticity through
      techniques aimed at rehabilitating different deficits.

      Mirror therapy (MT), which involves the activation of mirror neurons and contributes to the
      cortical representation of movement, has been shown to be beneficial in musculoskeletal
      injuries that occur with pain and reduced functionality of a body segment. Furthermore, it
      has been shown to be effective in motor recovery of the upper limb in patients with acute
      stroke, the restoration of joint range and hand function in patients with orthopedic hand
      injuries, and in the improvement of pain in patients with complex regional pain syndrome type
      1.

      Similarly, in CTS, the application of MT decreases pain at rest during the night, and
      improves sensitivity and function in patients undergoing CTS hand surgery. However, its
      effect has not been studied in patients with CTS in mild or moderate stages where surgical
      treatment is not urgent or indicated.

      Thus, the objective of this study will analyze the effectiveness of MT in combination with
      conventional exercises compared to conventional exercises on aspects related to symptoms of
      median nerve compression, pain, joint range, tension strength and motor functionality of the
      hand in patients with CTS.

      Therefore, this study is a randomized clinical trial in which two groups of twenty people in
      each group will participate, with different interventions:

        -  Mirror therapy group.

        -  Cross-education group (without mirror). Participants will receive six-week intervention,
           2 supervised sessions per week and 3 unsupervised sessions per week.

      Participants will be evaluated in three moments, at baseline, postintervention and
      one-month-follow-up.

      Data analysis will be performed with SPSS statistic program (v26). Normality and
      homoscedasticity will be analyzed by Shapiro-Wilk t-test and Levene test, respectively. For
      comparation between groups Bonferroni will be used. If any confusion factor that not meet
      requirements to be analysed like a covariable exist, ANCOVA will be used. When p<0.0.5
      statistical significant differences will be assumed.
    

Intervention name(s): Mirror therapy; Cross-education treatment
Intervention type(s): Other; Other
Intervention description(s): The patient shall be seated in a chair with a table in front of him/her. On the table there is a mirror in the sagittal plane between the two upper extremities. The affected hand will be behind the mirror, without visibility, while the hand without symptoms will be reflected laterally in the mirror. Thus, the mirror will reflect the movements of the unaffected side as if these movements were executed with the affected side. During the procedure, patients will be instructed to concentrate on the hand reflected in the mirror.; Participants will perform the same exercise protocol with the unaffected hand and without the use of a mirror.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment