Clinical and Ultrasonographic Evaluation of the Effectiveness of Manual Lymphatic Drainage

Study Overview
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Brief Summary
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Carpal tunnel syndrome (CTS) occurs as a result of compression of the median nerve under the transverse ligament along the carpal tunnel. The main cause of median nerve compression and carpal tunnel syndrome is the increase in volume in the carpal tunnel. The pressure exerted by the edema on the nerve should be brought under control in the early period. Edema that continues beyond the inflammatory process may contribute to the fibrotic phase, delaying healing and even causing complications such as pain and stiffness. Manual lymph drainage (MLD) is a special technique that includes light massage techniques and follows lymphatic pathways from proximal to distal and then from distal to proximal. On the basis of this concept; Stimulating the lymph system and increasing circulation, removing biochemical residues, reducing edema and pain, regulating sympathetic and parasympathetic system responses. It is known that MLD rapidly regulates lymphatic circulation by creating changes in interstitial fluid pressure, thus preventing even arthrofibrotic tissue that may occur after a traumatic situation, reducing edema, which is a predisposing factor for pain, and increasing mobility. The aim of this study is to determine the effectiveness of manual lymphatic drainage on clinical and ultrasonographic findings in carpal tunnel syndrome.

Official Title
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Clinical and Ultrasonographic Evaluation of the Effectiveness of Manual Lymphatic Drainage in Patients With Mild-to-moderate Carpal Tunnel Syndrome

Conditions
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Ultrasound Evaluation of the Effect of Manual Lymph Drainage, Effect of Manual Lymph Drainage on Carpal Tunnel Syndrome

Intervention / Treatment
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* Other: Manual lymphatic drainage
* Device: splint


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of mild to moderate carpal tunnel syndrome on electrodiagnostic examination Being between 20-55 years old Volunteering to participate in the treatment to be given Exclusion Criteria: Have a systemic inflammatory disease Having any disease that may cause polyneuropathy, such as diabetes mellitus Cognitive impairment Receiving psychotherapy Having a pacemaker illiterate Having a disease affecting the central nervous system Having a hearing problem Any skin disease that would contraindicate manual lymphatic drainage Arterial or venous circulatory disorders that would contraindicate manual lymphatic drainage NSAID drug use

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Kontrol group<br> | Device: splint<br>* In splint treatment, a volar-supported splint that keeps the wrist in a neutral position will be preferred and it will be recommended to both groups to be used only at night for 4 weeks.<br>|
| Experimental: Treatment group<br> | Other: Manual lymphatic drainage<br>* Manual lymphatic drainage will be applied 5 days a week for about 15 minutes every day for 4 weeks.<br>Device: splint<br>* In splint treatment, a volar-supported splint that keeps the wrist in a neutral position will be preferred and it will be recommended to both groups to be used only at night for 4 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ultrasonographic Evaluation | Median nerve diameter measurements and depths of the participants will be made by USG with a multifrequency (7-15 MHz) linear probe. With USG, the median CBF and its depth will be measured distally from the level of the scaphoid bone (wrist; carpal tunnel level) and the midpoint of the forearm. | 20 minutes | 
| Evaluation of symptom severity and functional status | It will be assessed with the Boston Carpal Tunnel Questionnaire (BCTQ). 1. The symptom severity scale (BCTQSS) has 11 items that evaluate pain, paresthesia, and weakness. 2. The functional status scale (BCTQ-FS) evaluates the ability to perform manual activities with 8 items. Each item evaluates the increasing severity of symptoms or difficulty with a higher score. | 10 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ultrasonographic evaluation, carpal tunnel syndrome, manual lymph drainage, edema, pain