Manual Therapy vs Surgery for Carpal Tunnel Syndrome

Here’s a study that compared carpal tunnel surgery to manual therapy. They concluded that in terms of self-reported function and grip strength, they were about the same.

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

Published: Journal of Orthopaedic & Sports Physical Therapy, 2017 Volume:0 Issue:0 Pages:1–43 DOI: 10.2519/jospt.2017.7090

Study Design
Randomized parallel-group trial.

Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively.

To compare the effectiveness of manual therapy versus surgery for improving self-reported function, cervical range of motion, and pinch grip tip in women with CTS.

In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n=50) or a surgery (n=50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire (BCTQ). Secondary outcomes included active cervical range of motion, pinch tip grip force and symptoms severity subscale of the BCTQ. Patients were assessed at baseline, and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores.

At 12 months, 94 women completed the follow-up. Analyses showed statistically significant differences in favour of manual therapy at 1 month for self-reported function (Δ -0.8, 95%CI -1.1 to -0.5) and pinch tip grip force on the symptomatic side (thumb-index finger: Δ2.0, 1.1 to 2.9; thumb-little finger: Δ1.0, 0.5 to 1.5). Improvements in self-reported function and pinch grip force were similar between both groups at 3, 6 and 12 months. Both groups reported similar improvements in symptoms severity at all follow-up periods. No significant changes were observed for pinch tip grip force on the less symptomatic side and in cervical range of motion in either group.

Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity and pinch tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted in changes in cervical range of motion.

Level of Evidence
Therapy, Level 1b. Prospectively registered September 3, 2014 on (NCT02233660). J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7090

Journal Abstract