In my experience, Carpal Tunnel Syndrome can be caused by more than just a nerve entrapment at the level of the wrist. The peripheral nerve actually emerges from the spinal cord in the neck, then goes through the neck muscles, shoulder muscles/joint, elbow muscles/joint and then finally the wrist muscles/joint. The nerve can be trapped anywhere along its route to the wrist, or any combination of these areas.
That’s why its important to address the whole chain of events to get the best outcomes. That’s what this study focused on in terms of manual therapy.
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
Authors: César Fernández-de-las-Peñas, PT, PhD, DMSc
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.
Background
Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively.
Objective
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.
Methods
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.
Results
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.
Conclusion
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 www.clinicaltrials.gov (NCT02233660). J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7090