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Physical Therapy for carpal tunnel

Physical Therapy for carpal tunnel syndrome pain often as effective as surgery

Compared with surgery, manual physical therapy was similarly effective in improving pain and function for patients with carpal tunnel syndrome, according to a randomized clinical trial.

PT_news-01Findings were published in the November issue of The Journal of Pain, which is the peer-review publication of the American Pain Society.

A multicenter team of Spanish researchers conducted a randomized clinical trial to compare the one-year effectiveness of manual physical therapies, including desensitization maneuvers of the central nervous system, and surgery in patients with CTS. According to the study’s background information, CTS surgery has the highest use rate among upper extremity procedures performed.

CTS is a pain disorder in the upper extremity caused by compression of the median nerve at the carpal tunnel. Prevalence in the United States is estimated at 6% to 11%, and six-year cumulative lost income per patient ranges from $45,000 to $89,000, according to the study. Treatment can be conservative or surgical, but scientific evidence for each therapeutic option is conflicting, the researchers wrote.

For the study, 120 women with CTS were randomized in two groups: treatment with physical therapy and treatment with surgery. Patients in the physical therapy group received three sessions of manual physical therapy that included soft tissue stabilizing and nerve/tendon gliding exercises focused on areas of potential entrapment of the median nerve. The weekly sessions lasted 30 minutes. The last treatment session included instruction on how patients could complete the tendon and nerve gliding exercises as homework if necessary. Patients in the surgery group underwent open or endoscopic carpal tunnel decompression and release procedures.

Outcomes were assessed at baseline, one, three, six and 12 months after the interventions. The trial’s primary outcome was intensity of hand pain, measured on an 11-point numerical pain rating scale. Secondary outcomes were measured using the Boston Carpal Tunnel Questionnaire’s functional status and symptom severity subscales, and patients’ self-perceived improvement. At 12 months, 92% of the study participants completed the follow-up.

The researchers found patients who had surgery and those treated with physical therapy showed similar outcomes for pain relief and function at six months and 12 months. However, patients assigned to physical therapy experienced significantly greater relief of symptoms and improvements in hand function at one and three months.

“Based on these results, our trial supports the use of conservative treatment, as applied in the current trial, as the first management option for CTS,” the researchers wrote. “Most individuals typically prefer conservative management as the first therapeutic option because of the higher rate of complications associated with surgery (pooled relative risk 2.03, 1.28–3.22). Therefore, it seems that conservative management may be considered as a frontline treatment in mild to moderate and sometimes severe cases of CTS before subsequently considering surgery.”

The researchers note further study is needed because the trial participants were all women, so researchers could not determine if results would be the same in men with CTS. They also pointed out the patients in the manual physical therapy group received three treatment sessions, and it is possible additional sessions would have resulted in more of a difference between the two interventions.

The Chicago-based American Pain Society is a multidisciplinary community that works to bring together scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.

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