Mulligan Mobilization With Arm Movement in CTS Patients

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.

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 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.