Manual Therapy to Manage Carpal Tunnel Syndrome

Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Pareja JA, Alonso-Blanco C. The effectiveness of manual therapy versus surgery on self-reported function, cervical range of motion, and pinch grip force in carpal tunnel syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2017;47(3):151-161. doi:10.2519/jospt.2017.7090

Carpal tunnel syndrome (CTS) is the most expensive upper extremity musculoskeletal disorder in the United States.¹ Researchers in Spain performed a single-blinded randomized clinical trial comparing the effectiveness of manual therapy vs a surgical procedure in both short- and long-term outcomes in women with CTS. Self-reported functional status and symptom severity were assessed along with pinch grip force and cervical range of motion.

One hundred forty consecutive female patients with clinical and electrophysiological signs of CTS were screened from a local regional hospital. Exclusion criteria included women with deficits in the ulnar or radial nerves; previous surgical procedure or steroid injections; upper extremity diagnoses; cervical, shoulder, or head trauma; systemic diseases that could potentially cause CTS; and comorbid musculoskeletal conditions. Women who were pregnant or aged 65 years or older were also excluded. One hundred participants were randomly assigned to a manual therapy group (n=50; mean [SD] age, 46 [9] years) or a surgical procedure group (n=50; mean [SD], age 47 [8] years). The manual therapy group underwent 30-minute treatment sessions performed by manual therapists once per week for 3 weeks. The protocols included articulatory and soft tissue maneuvers targeting the cervical spine, shoulder, elbow, forearm, wrist, and fingers. Surgical procedures included endoscopic decompression of the carpal tunnel. Specific procedures were based on each surgeon's and patient's preference. Both groups received education for performing cervical exercises as homework during the follow-up periods. Use of nonsteroidal anti-inflammatory drugs was the only other intervention allowed in both groups.

The Boston Carpal Tunnel Questionnaire was used to assess the self-reported functional status and severity of symptoms of the participants at baseline and 1, 3, 6, and 12 months after the final therapy session. Cervical range of motion and pinch grip force were also assessed. Patients in the manual therapy group showed a statistically significant improvement in self-reported functioning (P<.001) and pinch-grip force 1 month after therapy compared with the surgical procedure group (P=.01 and P=.036 for thumb-index and thumb-little finger, respectively). No significantly different outcomes between groups were reported in other follow-up periods (P>.4). There were also no significant differences in symptom severity (P=.382), pinch grip in the unaffected side (P>.12), and cervical range of motion between the groups (P>.495).

This trial demonstrates that multimodal and nonlocalized manual therapy treatments can result in greater short-term improvements along with similar long-term outcomes in self-reported functioning and pinch grip strength than surgical procedures in patients with CTS. These findings create several avenues for future research. Specifically, the effect of osteopathic manipulative treatment on patients with CTS should be studied and compared with the effects of surgical procedures and multimodal manual therapy.