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Effects of Manual Therapy on Patients With Carpal Tunnel Syndrome

  • Janice Blumer
Published/Copyright: July 1, 2017
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 117 Issue 7

Wolny T, Saulicz E, Linek P, Shacklock M, Mysliwiec A. Efficacy of manual therapy including neurodynamic techniques for the treatment of carpal tunnel syndrome: a randomized controlled trial. J Manipulative Physiol Ther. 2017;40(4):263-272. doi:10.1016/j.jmpt.2017.02.004

Carpal tunnel syndrome (CTS) is a commonly reported neuropathic condition with an incidence varying from 1.5% to 3.8% in the United States.1 Strategies to manage symptoms of CTS range from conservative approaches (eg, night splints, manual therapy, cortisone injections, and pharmacotherapy) to surgical decompression of the median nerve.2 Physical therapists also include the use of electrophysiologic models and neurodynamic techniques in addition to manual therapies to manage symptoms of CTS.3

Management approaches can be controversial, as studies indicate that surgical procedures may be more effective than manual therapies for managing CTS.4 A multicenter, single-blinded, randomized controlled study conducted by researchers in Poland evaluated the efficacy of manual therapy in the management of CTS compared with electrophysiologic modalities. The study included 140 participants who were aged 18 years or older with a diagnosis of CTS. The participants were randomly assigned to either the manual therapy group, which included neurodymanic techniques, functional massage, and carpal bone mobilization techniques, or the electrophysiologic modalities group, which included laser and ultrasound therapy. Each group received 20 treatments (2 sessions per week for 10 weeks).

The outcome measures were assessed before and after treatment and included nerve conduction, pain severity, functional status, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire. The mean sensory conduction velocity improved 34% in the manual therapy group and 3% in the electrophysiologic modalities group by the end of the final session. The self-reported pain scores decreased 4.2 points in the manual therapy group (P<.01) and 1.7 points in the electrophysiologic modalities group (P<.01). Improvements in functional status were also observed (67% in the manual therapy group and 15% in the electrophysiologic modalities group).

These findings support the efficacy of manual therapy in the management of CTS symptoms over electrophysiologic therapies. Although both groups demonstrated improvement, the improvement in the manual therapy group was greater. Limitations of this study include the lack of a control group as well as the fact that some improvements could be attributed to the placebo effect.

Western University of Health Science College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon

References

1. de Krom MC , KnipschildPG, KesterAD, ThijsCT, BoekkooiPF, SpaansF. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992;45(4):373-376.10.1016/0895-4356(92)90038-OSearch in Google Scholar

2. Gerritsen AA , de VetHC, ScholtenRJ, BertelsmannFW, de KromMC, BouterLM. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288(10):1245-1251.10.1001/jama.288.10.1245Search in Google Scholar PubMed

3. Coppieters MW , ButlerDS. Do ‘sliders’ slide and ‘tensioners’ tension: an analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008;13(3):213-221.10.1016/j.math.2006.12.008Search in Google Scholar PubMed

4. Hui AC , WongS, LeungCH, et al.. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64(12):2074-2078.10.1212/01.WNL.0000169017.79374.93Search in Google Scholar PubMed

Published Online: 2017-07-01
Published in Print: 2017-07-01

© 2017 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  2. Financing Reform for Long-term Services and Supports
  3. LETTERS TO THE EDITOR
  4. Reclassification of the Sacral Autonomic Outflow to Pelvic Organs as the Caudal Outpost of the Sympathetic System Is Misleading
  5. CORRECTION
  6. Correction
  7. AOA COMMUNICATION
  8. Official Call: 2017 Annual Business Meeting of the American Osteopathic Association (Reprint)
  9. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics (Reprint)
  10. ORIGINAL CONTRIBUTION
  11. Cardiovascular Disease Risk Factors After an Employer-Based Risk Reduction Program: An Observational Cohort Study
  12. Effect of Latitude on Vitamin D Levels
  13. REVIEW
  14. Reducing Off-Label Antipsychotic Use in Older Community-Dwelling Adults With Dementia: A Narrative Review
  15. MEDICAL EDUCATION
  16. Integrating Point-of-Care Ultrasonography Into the Osteopathic Medical School Curriculum
  17. SPECIAL COMMUNICATION
  18. Highlights From the American Diabetes Association's 2017 Standards of Medical Care in Diabetes for Osteopathic Physicians
  19. CASE REPORT
  20. Thrombocytopenia and Spontaneous Intracranial Hemorrhage After Olanzapine Therapy
  21. THE SOMATIC CONNECTION
  22. Heads Up on Headers: Effects of Soccer Ball Heading on Brain Function
  23. Effects of Manual Therapy on Patients With Carpal Tunnel Syndrome
  24. Manual Therapy to Manage Carpal Tunnel Syndrome
  25. Osteopathic Manipulative Therapy for Foot-Pain: How Many Sessions? How Often?
  26. CLINICAL IMAGES
  27. Hematemesis Caused by Forgotten Corrective Device
https://doi.org/10.7556/jaoa.2017.094
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. HEALTH POLICY
  2. Financing Reform for Long-term Services and Supports
  3. LETTERS TO THE EDITOR
  4. Reclassification of the Sacral Autonomic Outflow to Pelvic Organs as the Caudal Outpost of the Sympathetic System Is Misleading
  5. CORRECTION
  6. Correction
  7. AOA COMMUNICATION
  8. Official Call: 2017 Annual Business Meeting of the American Osteopathic Association (Reprint)
  9. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics (Reprint)
  10. ORIGINAL CONTRIBUTION
  11. Cardiovascular Disease Risk Factors After an Employer-Based Risk Reduction Program: An Observational Cohort Study
  12. Effect of Latitude on Vitamin D Levels
  13. REVIEW
  14. Reducing Off-Label Antipsychotic Use in Older Community-Dwelling Adults With Dementia: A Narrative Review
  15. MEDICAL EDUCATION
  16. Integrating Point-of-Care Ultrasonography Into the Osteopathic Medical School Curriculum
  17. SPECIAL COMMUNICATION
  18. Highlights From the American Diabetes Association's 2017 Standards of Medical Care in Diabetes for Osteopathic Physicians
  19. CASE REPORT
  20. Thrombocytopenia and Spontaneous Intracranial Hemorrhage After Olanzapine Therapy
  21. THE SOMATIC CONNECTION
  22. Heads Up on Headers: Effects of Soccer Ball Heading on Brain Function
  23. Effects of Manual Therapy on Patients With Carpal Tunnel Syndrome
  24. Manual Therapy to Manage Carpal Tunnel Syndrome
  25. Osteopathic Manipulative Therapy for Foot-Pain: How Many Sessions? How Often?
  26. CLINICAL IMAGES
  27. Hematemesis Caused by Forgotten Corrective Device
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