The mean age of the patients in the present study, as well as the gender distribution and the rate of positivity in the provocative tests, was in consistent with the literature [13
]. We believe that the prevalence of CTS is higher among women, because the works such as house cleaning, knitting, and sewing are in their responsibility.
Splint was first used in CTS in 1947 with the study conducted by Roaf [14
]. The pressure in the carpal tunnel is the lowest in neutral position and significantly increases when the wrist is in flexion or extension [16
]. In the present study, we compared the splint therapy, of which the validity and reliability is well known, with our massage technique. The aim of the present study was to evaluate the efficacy and reliability of this massage technique; meantime, we applied splint and exercise program to all the patients in order to maintain the treatment CTS. However, we presumed that this massage technique would be as simple and easy to apply as the splint therapy used in the treatment of CTS. Therefore, we compared the results of the group applied splint and massage with the group applied only splint in order to determine the efficacy of this technique. The results revealed that improvement was higher in the group applied massage technique. Therefore, the new massage technique can be considered as a beneficial therapy method. Further studies conducted on larger patient groups are needed to show that this massage technique alone is also an effective and reliable therapy.
There are limited studies in the literature about massage therapy in CTS. Based on these data, we applied a new technique, which was easy to apply to the hands, included all massage modalities and had a name. Investigators have shown that massage therapy is not only beneficial in hands but also associated with significant decrease in pain scores in the locomotor diseases, particularly in fibromyalgia, back pain, arthritis, and migraine [13
]. Pugatch et al. [17
] found that serotonin was increased after the massage therapy in the patients who underwent massage therapy because of pain syndrome. In the present study, we did not measure the hormone levels of the patients; however, we used the scales developed to evaluate pain and functional capacity of the hand. We, therefore, thought that we could have an idea about the symptom severity and functional capacity of the hand via the questionnaires. We observed that the improvement in the group applied massage technique was higher than the group applied splint only.
Studies have suggested that massage plays a role in the reduction of the pain severity by decreasing the muscular tonus and increasing the local sympathetic activity [18
]. Furthermore, it has been reported that “gate control mechanism” is also effective in the pain-relieving role of massage therapy and that massage therapy increases the level of oxytocin hormone, which has pain-relieving feature [18
In the study of Field et al. [9
] about efficacy of massage on CTS, they have suggested that significant improvement was observed in the massage group in terms of pain, anxiety, depression, hand grip strength, and median nerve peak latency scores; however, the increase in median nerve conduction velocity was not significant. Moreover, no statistically significant improvement was also found in any of the parameters in the control group [9
]. The most important difference between the abovementioned successful study and the present study was the massage technique that we used. Moreover, in the present study the duration of massage was 3 min. This shorter duration of massage may be advantageous during the busy days; thus, the time that the patients would use for therapy is of great importance. On the other hand, each massage modality has individual benefit. All of these effects can be provided also with MHMT. The compliance of the patient with the therapy and efficacy and reliability of the technique suggest that MHMT can be recommended as the first choice of therapy in the future likewise the splint technique.
In another study by Moraska et al. [18
] about efficacy of massage on CTS, as a result, statistically significant improvement was obtained regarding symptomatic pain scores; whereas only the group that received CTS-related hand massage showed significant improvement regarding the scores of functional hand evaluation and hand grip strength [18
]. This successful study suggested that local massage was likely to be effective in the treatment of CTS. In the present study, the significant improvement in pain scores in the massage group can be attributed to the local massage therapy performed via MHMT, particularly to the decreased pressure on the median nerve due to the decreased muscle tonus and the increased local sympathetic activity as well as the lymphatic and venous return resulted from effleurage process, and to the increased pain threshold via friction process. We believe that effectively and accurately applied massage can provide these benefits. In the present study, we also applied an effective and accurate massage in a short duration of time and the results confirmed us.
The mechanism of action of message shows parallelism with the benefits of ultrasound (US) which is among the physical therapy modality. US are primarily used to warm the tissues of muscle-skeletal system such as joint structures, muscle and tendon, and penetration into the deep tissues are associated with its frequency [19
]. In the present study, the fact that the improvement in patient-related and electrophysiological parameters with the massage therapy was similar to that obtained with the US therapy suggested that both the thermal and mechanical effects of these two therapies had an important role on the treatment. In the literature, it has been shown that the conduction velocity is increased in the peripheral nerves due to the thermal effect resulted from US therapy [19
]. In the present study, we thought that the massage therapy might have led to an increase in the nerve conduction velocity via the same effect.
In a study conducted by Akalin et al. [11
] with CTS, patients were performed splint and splint together with tendon and nerve stretching exercises. They reported statistically significant improvement in the clinical, patient-related, and neurophysiological findings in both groups [11
]. In the present study as well, all the patients were asked to do these exercises in order the outcomes not to be affected. The only difference was the massage technique in the massage group.
Boston Scale is used for the patient-based evaluation of the symptom severity and functional capacity [20
]. In the present study, we also used the Boston Questionnaire to observe the efficacy of splint and massage therapy. The symptom severity was decreased and the functional capacity was increased in both groups, being more significant in the massage group.
To the best our knowledge, the present study is the first and largest study in the literature conducted on the massage technique that will contribute to the treatment of CTS. As this new massage technique is easy for self-application, cheap, and practical, every patient with CTS can apply the massage to him/herself easily.