Manual therapy vs. surgery in carpal tunnel syndrome

In this randomized clinical trial, the effectiveness of manual therapy vs. surgery in the management of CTS was tested in a population consisting of 100 women. This trial’s results indicate that multimodal MT and surgery show no differences in outcomes in long-term follow-up but MT showed significant improvement at 1-month follow-up. Neither MT nor surgery produced differences in cervical range of motion.

Carpal tunnel syndrome (CTS) comprises nearly 50% of all work-related injuries. Conservative treatment is generally applied in milder cases or when surgery is refused or contraindicated. Surgery is usually advised as a second line of treatment in more severe cases. There is some controversy about whether outcomes between the two approaches vary significantly. Recent trials have not been conclusive and failed to report outcome measures commonly found to be altered in patients with CTS such as cervical range of motion and pinch grip strength.

This single-blind randomized clinical trial included 100 women with CTS randomized to the MT and surgery groups. Symptom intensity/duration, Boston Carpal Tunnel Questionnaire (BCTQ), cervical range of motion and pinch-tip grip force were measured at baseline and at 1, 3, 6 and 12 months follow-up. 

The authors found a greater improvement in self-reported function at 1 month follow-up in the manual therapy (MT) group.  No differences in improvement of self-reported function and pinch grip force were found between groups at 3, 6 and 12 months. Both groups produced similar improvements in symptom intensity at all follow-up periods. No group produced a significant change in cervical range of motion.

> From: Fernández-De-Las-Peñas et al., J Orthop Sports Phys Ther 47 (2017) 151-161(Epub ahead of print). All rights reserved to Journal of Orthopedic & Sports Physical Therapy. Click here for the online summary.