Graded Motor Imagery in Carpal Tunnel Syndrome

Is There an Advantage to Incorporating a Central Nervous System-targeted Intervention Within an Exercise Program for Individuals Diagnosed With Carpal Tunnel Syndrome? A Randomized Controlled Trial

The aim of this study is to investigate whether the addition of Graded Motor Imagery (GMI) to progressive neurodynamic exercises is more effective than progressive neurodynamic exercises alone in individuals with carpal tunnel syndrome (CTS). The objectives are to reduce pain and symptom severity, improve pain, sensorimotor function, physical performance, and grip strength through the addition of GMI.

46 voluntary patients with CTS, aged between 30-60 years will be randomly divided into two groups: GMI and progressive neurodynamic exercise group. Interventions will be applied for 6 weeks, 2 times a week (12 sessions). Both groups will receive progressive neurodynamic exercises and a nighttime resting splint. The GMI group will additionally receive Graded Motor Imagery, while the control group will receive no additional intervention. The patients will be assessed before, and after treatment. Upper extremity function and disability will be assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, cognitive status will be screened using the Mini-Mental State Examination (MMSE), and symptom severity and functional status related to CTS will be evaluated using the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Sensory function will be assessed using the Semmes-Weinstein Monofilament Test and the Two-Point Discrimination Test, fine manual dexterity will be evaluated using the Purdue Pegboard Test, and hand grip strength will be measured using a Jamar hand dynamometer.

Inclusion Criteria:

• mild to moderate unilateral CTS based on the Bland classification of electrodiagnostic testing ;
• positive Phalen or Tinel tests;
• symptoms such as paresthesia and pain associated with CTS that last longer than 3 months;
• patients aged 30-60 years (when CTS becomes more prevalent);
• patients who achieved a minimum score of 24 on the Mini-Mental State Examination (MMSE).

Exclusion Criteria:

• bilateral CTS;
• history of prior CTS surgery;
• clinical indicators of cervical radiculopathy or polyneuropathy;
• pregnancy or cognitive impairment;
• the presence of orthopedic, neurological, or functional problems on the unaffected side that could affect hand function (e.g., history of trauma or surgery, peripheral nerve injury, tendinopathy, tenosynovitis, trigger finger, arthritis, sequelae of a fracture, etc.);
• receipt of any conservative treatment for CTS within the last month.