A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study

Abstract

In carpal tunnel syndrome (CTS), manual therapy interventions (MTI) reduce tissue adhesion and increase wrist mobility. We evaluated the efficacy of a MTI in relieving CTS signs and symptoms. Twenty-two CTS patients (pts) (41 hands) were treated with a MTI, consisting in 6 treatments (2/week for 3 weeks) of soft tissues of wrist and hands and of carpal bones. Pts were assessed for hand sensitivity, paresthesia, hand strength, hand and forearm pain, night awakening; Phalen test, thenar eminence hypotrophy and Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Median nerve was studied by sensory nerve conduction velocity (SNCV) and distal motor latency (DML). CTS was scored as minimal, mild, medium, severe and extreme. We considered as control group the same pts assessed before treatment: at baseline (T0a) and after 12 weeks (T0b). Pts were evaluated at the end of treatment (T1) and after 24-week (T2) follow-up. At T0b, versus T0a, forearm pain and Phalen test positivity were increased and hand strength reduced (p < 0.05). BCTQ-SSS and BCTQ-FSS scores improved at T1 versus T0b (p < 0.05) with the amelioration maintained at T2. At T1, the number of pts with paresthesia, night awakening, hypoesthesia, Phalen test, hand strength reduction and hand sensitivity was reduced with the lacking of symptoms maintained at T2 (p < 0.05). No changes in SNCV, DML and CTS scoring were shown. MTI improved CTS signs and symptoms, with benefits maintained at follow-up. Thus, it may be valid as a conservative therapy.

The Effectiveness of Carpal Bone Mobilization accompanied by Night Splinting in Idiopathic Carpal Tunnel Syndrome

“…A significant increase in hand grip strength and normalization of motor and sensory latancies were noted. In a recent study comparable with ours (22), after therapy with six sessions of soft tissue and CBM demonstrated that a significant benefit was maintained in pain, Boston symptom severity, and functional scales, whereas there were no changes in electrophysiologic parameters. Burke et al (23) investigated Granston instrument-assisted soft tissue mobilization twice a week for 4 weeks.…”

Effects of diacutaneous fibrolysis in patients with mild to moderate symptomatic carpal tunnel syndrome: a randomized controlled trial

“…The techniques that treated adjacent soft tissues include manual therapy techniques, consisting of mobilization of the soft tissue and the fascia, similar to our study. 19,47 The possible explanation for the better results obtained using this kind of approach are the relationships between the different musculoskeletal structures, which have been demonstrated for between the palmar fascia, transverse ligament, flexor retinaculum and antebrachial fascia. 22,48 As has been demonstrated, there is not only an alteration in the nerve tissues, but also in the adjacent soft tissues.…”

The Effectiveness of Ultrasound-Guided Steroid Injection Combined with Miniscalpel-Needle Release in the Treatment of Carpal Tunnel Syndrome vs. Steroid Injection Alone: A Randomized Controlled Study

“…Patients with symptoms of pain, numbness, or tingling in the median nerve distribution area of hand visited Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, from February 2016 to May 2017. After confirmation by physical and electrophysiological inspection, 51 patients (51 wrists) meeting the following criteria were recruited [23]: (1) pain, numbness, or tingling in the median nerve distribution area of hand, (2) nocturnal worsening of the symptoms, (3) positive Tinel and/or Phalen sign, (4) a slower median nerve conduction (SNCV≦50 m/s and/or DML≧4 ms), (5) patients with unilateral disease, and (6) the desire of the participant to have either a steroid injection or steroid injection plus MSN release. Patients were excluded from this study for the following: (1) symptomatic CTS because of diabetes, thyroid disease, or rheumatic disease, (2) cervical radiculopathy or other polyneuropathy, (3) age<18 years, (4) pregnancy, (5) steroid injection for CTS in the preceding 6 months, (6) history of wrist fracture, (7) prior carpal tunnel decompressive surgery, (8) the presence of infection or skin lesion at the site of injection, (9) patients with bilateral disease, and (10) refusal of informed consent or inability to participate in follow-up.…”