Journal Article

Can manual lymphatic drainage be a new treatment option in mild-moderate carpal tunnel syndrome? A randomized controlled study

Cihan, Emine, Akdeniz Leblebicier, Merve, Kavuncu, Vural, Sahbaz Pirincci, Cansu, Ture, Arzu, Yaman, Fatima

2025

Overview

Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity, making it essential to assess the effectiveness of various physiotherapy treatments. This study aimed to determine the clinical and electrodiagnostic improvement in mild-to-moderate carpal tunnel syndrome patients through manual lymphatic drainage (MLD) versus an orthosis alone. This is a prospective randomized controlled study. The sample consisted of a total of 36 patients who met the inclusion criteria. Experimental group received MLD and orthosis, and the control group received only orthosis. The patients were evaluated with electrodiagnostic tests, Visual Analog Scale, algometer measurements (pressure pain threshold), Boston Carpal Tunnel Syndrome Questionnaire before and after treatment. Evaluations were made before and after treatment (4 weeks later). Boston Carpal Tunnel Syndrome Questionnaire scores improved significantly with both treatment methods in both the experimental (p < 0.001, d = 2.0) and control groups (p < 0.001, d = 1.5). The pressure pain threshold significantly increased in the experimental group at the level of the transverse carpal ligament (p = 0.02, d = 0.86, 95% Confidence Interval (CI) = −0.08 to 1.2). At the distal radioulnar joint and extensor digitorum communis muscle levels, the pressure pain threshold similarly increased for two groups after treatment (p = 0.65, d = 0.31, 95% CI = −0.44 to 1.2), but the post-treatment increase in the experimental group was significant (p = 0.007, d = 0.31). In the experimental group, motor velocity (p = 0.001, d = 0.98), amplitude (p = 0.002, d = 1.5), and latency (p = 0.002, d = 0.60) and sensory velocity (p = 0.03, d = 0.91) and latency (p = 0.001, d = 1.2) significantly improved, while in the control group, there was a significant change only in motor velocity and amplitude (p = 0.047, d = 0.59). The post-treatment sensory improvement was significantly higher in the experimental group (p = 0.01, d = 0.81, 95% CI = −0.78 to −0.49). MLD significantly improved sensory conduction velocity, amplitude, and latency of the median nerve. Additionally, MLD and orthosis increased the pain pressure threshold and led to functional improvement. This is listed with study ID: NCT05394870 •Manual lymphatic drainage (MLD) significantly improved sensory conduction the median nerve.•MLD and orthosis increased the pain pressure threshold and functionality.•MLD can be a new option for conservative treatment in carpal tunnel syndrome.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Aged / Amplitudes / Carpal tunnel syndrome / Carpal Tunnel Syndrome - diagnosis / Carpal Tunnel Syndrome - physiopathology / Carpal Tunnel Syndrome - therapy / Contraindications / Edema / Electrodiagnosis / Electrodiagnostic evaluation / Entrapment / Evaluation / Female / Health services / Humans / Latency / Lymphatic drainage / Lymphatic system / Male / Manual lymphatic drainage / Manual Lymphatic Drainage - methods / Median nerve / Middle Aged / Nervous system / Neuropathy / Orthoses / Orthotic Devices / Overuse injuries / Pain / Pain Measurement / Pain Threshold / Patients / Prospective Studies / Questionnaires / Therapeutic applications / Treatment Outcome / Velocity / Visual thresholds