Effect of median nerve neuromobilization on functional status in patients with carpal tunnel syndrome: A double blinded randomized control trial.

Objectives: To measure additional benefits of neuromobilisation along with conventional treatment in improving the functional status in patients having carpal tunnel syndrome. METHODS: The prospective, double-blind randomised controlled trial was conducted from August 2018 to June 2019 at the Physiotherapy outdoor clinic of Mayo Hospital, Lahore, Pakistan, and comprised patients of either gender aged 20-45 years with <3-month history of carpal tunnel syndrome. The patients were randomised into control group 1 and experimental group 2. Group 1 received conservative treatment including ultrasound therapy, wrist splinting, and tendon-gliding exercises, while Group 2 additionally received neuromobilisation. Functional limitation was measured using the Functional Status Scale and the Symptom Severity Scale of the Boston Carpal Tunnel Syndrome Questionnaire. Patients had 2 sessions per week for 6 weeks. Clinical data was noted at baseline, after 3 weeks of treatment and finally at the end of the 6-week intervention. Data was analysed using SPSS 21. RESULTS: Of the 66 patients, there were 33(50%) in Group 1; 3(9.1%) males, 30(90.9%) females, overall mean age 37.79 ±5.91 years. The remaining 33(50%) were in Group 2; 2(6.1%) males, 31(93.9%) females, overall mean age 35.58 ±7.15 years. Both the groups showed significant improvement (p <0.05), but the addition of neuromobilisation in Group 2 showed better results compared to Group 1(p<0.05). CONCLUSIONS: The addition of neuromobilisation to routine physical therapy was found to have significantly decreased the symptoms of carpal tunnel syndrome and improved the functional status of the patients. Registration No: ChiCTR2000029377(http://www.chictr.org.cn/showproj.aspx?proj=48704).

Comparison of conservative exercise therapy with and without Maitland Thoracic Manipulative therapy in patients with subacromial pain: Clinical trial.

OBJECTIVE: To determine the effect of conservative exercise therapy with and without Maitland thoracic manipulation in patients with subacromial pain. METHODS: The randomised controlled trial study was conducted at the Mayo Hospital, Lahore, Pakistan, from June 2015 to February 2016, and comprised patients with subacromial pain (group 1) and controls (group 2).Pre-assessment was done by using numeric pain rating scale and shoulder pain and disability index as subjective measurements, while range of motion was taken as objective measurement. SPSS version 21 was used for data analysis. RESULTS: Of the 40 participants, there were 20(50%) in each group. The baseline pain intensity on numeric pain rating scale for group 1 was 5.05±1.538 and for group 2 was 5.35±1.137; the values later changed to 0.70±0.923 and 2.30±0.979, respectively. The baseline functional status score according to shoulder pain and disability index for group 1 and 2 was 40.25±12.354 and 43.15±7.343 that changed to 12.30±4.714 and 22.55±5.577, respectively. CONCLUSIONS: Maitland thoracic spinal manipulation with conservative exercise therapy was more effective than conservative exercise therapy alone.

Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome.

Background: Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective: To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods: A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results: Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions: The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

Role of Weight-Bearing Exercises in the Treatment of Post-Menopausal Osteoporosis.

OBJECTIVE: To determine the change in T-score of post-menopausal osteoporosis patients with weight-bearing exercises. STUDY DESIGN: A quasi-experimental study. PLACE AND DURATION OF STUDY: Physiotherapy Department and Orthopedic Unit I, Mayo Hospital, Lahore, from May to October 2014. METHODOLOGY: Two hundred and seventy-four patients were randomly divided into two groups according to inclusion and exclusion criteria using non-probability purposive sampling technique. The group 1 was treated by medication and weightbearing exercises and group 2 was given medication alone. The dual energy X-ray absorptiometry (DEXA)scan was used tofind the T-score before and after treatment and improvement was compared. A p-value less than 0.05 was taken as significant. RESULTS: The results showed that improvement was occurred in both groups after treatment. The DEXAscan median values after treatment were changed to 3.00 (0) for group 1 (exercises and medication) and 2.00 (1) for group 2 (medication). CONCLUSION: The physical activity along with medication play vital role in the treatment of post-menopausal osteoporosis than medication alone.