Effect of Myofascial Release Versus Acupressure on Carpal Tunnel Syndrome in Postnatal Period

N/ANot Yet RecruitingNCT07086846

Cairo University60 enrolled

Overview

This study will be conducted to compare the effect of myofascial release and acupressure on postnatal carpal tunnel syndrome.

Various factors, such as an increase in body mass index (BMI), hormones (relaxin), fluid redistribution, and maternal age, are involved in the etiology of pregnancy related carpal tunnel syndrome (CTS). In terms of prognosis, although it has been reported that pregnancy related CTS generally regresses completely spontaneously or with conservative treatment methods after birth, residual symptoms and neurophysiological findings that require surgical decompression up to a year after birth have also been reported. In clinical practice guidelines, conservative treatment is recommended for mild and moderate cases, while a surgical approach is recommended for patients with severe CTS . Some clinical conditions such as hormonal alteration and edema for menopause and pregnancy due to alteration of the fluid balance in the body. Myofascial release is considered a safe, non-invasive, and simple method for decreasing pain intensity and numbness sensation severity and for improving hand function in pregnant women with CTS. Acupressure is the supportive therapies based on Chinese medicine. Pressure is applied to the affected areas without the use of needles. PC7 or the Daling point is especially considered when managing CTS; it was found to cause an increase of endomorpin-1, beta-endorphin, serotonin, dopamine, and enkephalin levels in the brain tissues and plasma. Acupressure was found to be more effective compared to the placebo and splints re- garding the functional status and nerve conduction studies.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Carpal Tunnel Syndrome

Interventions

Night splintOTHER

All participants will be treated conservatively by wrist splint in a neutral position.

Myofascial release techniqueOTHER

The participant will receive myofascial release using M2T blade. It will be applied on the carpal tunnel over and above the wrist creases on the ventral aspect of the forearm for 15 minutes, 3 sessions weekly for 6 weeks (total of 18 sessions).

AcupressureOTHER

It will be applied on the pericardium 6 point (PC-6) for 3 minutes, three times per week for 6 weeks (total of 18 sessions). It is located on the palm side of the wrist a couple of inches toward the body in between the two tendons (palmaris longus \& flexor carpi radialis) that run approximately down the center of the forearm.

Eligibility

Sex: FEMALEMin age: 25 YearsMax age: 35 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Postpartum women with mild to moderate carpal tunnel syndrome (CTS). * Their ages will range from 25 to 35 years old. * Their body mass index (BMI) will range from 25 to 30 Kg/m2. * The electrophysiological evidence of mild or moderate median nerve lesion at wrist (mild: sensory nerve conduction velocity slow on finger/wrist measurement, sensory nerve latency \>3.5 ms, normal terminal motor latency; moderate: sensory potential preserved with motor slowing, distal motor latency to abductor pollicis brevis (APB) \< 6.5 ms) * Positive phalen's test. * Positive tinel's test. * Unilateral or bilateral carpal tunnel affection will be included. Exclusion Criteria: * History of brachial plexopathy or malignancy. * Radial, ulnar neuropathy, proximal median neuropathy or polyneuropathy. * Previous wrist surgery or steroid injection for CTS. * History of trauma, fracture, deformity or inflammation in the wrist, such as rheumatoid arthritis. * Coagulation abnormalities, pregnancy, fever and infections. * Skin disease and skin cancer. * Spots, birthmarks or tattoos over the work points. * Pacemaker and implementable medical devices.

Locations (1)

Amr Kamal Abd El-Aal

Cairo, Egypt

Outcomes

Primary Outcomes

Pain intensity

The visual analogue scale (VAS) will be used to assess pain intensity before and after intervention. The VAS is usually presented as a 10-cm horizontal line on which the patient's pain intensity is represented by a point between the extremes of "no pain at all" and "worst pain imaginable."

Time frame: 6 weeks

Sensory conduction velocity

Electromyography device (Tru Trace EMG, 2ch Head box device, manufactured by deymed Diagnostic Pvt., Ltd., Czech Republ) will be used to assess sensory conduction velocity of median nerve before and after the treatment. A pair of ring electrodes will be placed on the index finger for recording, and the sensory nerve will be stimulated antidromically. The stimulating electrodes will be placed at the wrist proximal to carpal tunnel for the distal segment stimulation and at the elbow medial to biceps tendon for the proximal segment stimulation. Conduction velocity is the speed at which the electrical signal travels along the nerve. A reduced velocity can also indicate nerve damage. Its normal range is from 44-60 ms.

Time frame: 6 weeks

Sensory distal latency

Electromyography device (Tru Trace EMG, 2ch Head box device, manufactured by deymed Diagnostic Pvt., Ltd., Czech Republ) will be used to assess sensory distal latency of median nerve before and after the treatment. A pair of ring electrodes will be placed on the index finger for recording, and the sensory nerve will be stimulated antidromically. The stimulating electrodes will be placed at the wrist proximal to carpal tunnel for the distal segment stimulation and at the elbow medial to biceps tendon for the proximal segment stimulation. The distal motor latency is measured from the onset of the stimulating artifact to the onset of the compound muscle action potential. Its normal range is from 2.5-3.5 ms.

Time frame: 6 weeks

Median nerve amplitude

The amplitude of the median nerve (specifically, the sensory nerve action potential, or SNAP) will be measured by electromyography (Tru Trace EMG, 2ch Head box device, manufactured by deymed Diagnostic Pvt., Ltd., Czech Republ) during nerve conduction study before and after treatment. It is measured in microvolts (µV) and reflects the number of nerve fibers conducting the electrical signal. During a nerve conduction study, a small electrical stimulus is applied to the median nerve, and the resulting electrical activity is recorded. The amplitude is then measured as the height of the waveform generated by this activity. Its normal value should be at least 6 microvolt (6 µV).