Objective: The purpose of this randomized trial was to compare the efficacy of manual therapy, including the use of neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS).
Methods: The study included 140 CTS patients who were randomly assigned to the manual therapy (MT) group, which included the use of neurodynamic techniques, functional massage, and carpal bone mobilizations techniques, or to the electrophysical modalities (EM) group, which included laser and ultrasound therapy. Nerve conduction, pain severity, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire were assessed before and after treatment. Therapy was conducted twice weekly and both groups received 20 therapy sessions.
Results: A baseline assessment revealed group differences in sensory conduction of the median nerve (P b .01) but not in motor conduction (P = .82). Four weeks after the last treatment procedure, nerve conduction was examined again. In the MT group, median nerve sensory conduction velocity increased by 34% and motor conduction velocity by 6% (in both cases, P b .01). There was no change in median nerve sensory and motor conduction velocities in the EM. Distal motor latency was decreased (P b .01) in both groups. A baseline assessment revealed no group differences in pain severity, symptom severity, or functional status. Immediately after therapy, analysis of variance revealed group differences in pain severity (P b .01), with a reduction in pain in both groups (MT: 290%, P b .01; EM: 47%, P b .01). There were group differences in symptom severity (P b .01) and function (P b .01) on the Boston Carpal Tunnel Questionnaire. Both groups had an improvement in functional status (MT: 47%, P b .01; EM: 9%, P b .01) and a reduction in subjective CTS symptoms (MT: 67%, P b .01; EM: 15%, P b .01).
Conclusion: Both therapies had a positive effect on nerve conduction, pain reduction, functional status, and subjective symptoms in individuals with CTS. However, the results regarding pain reduction, subjective symptoms, and functional status were better in the MT group. (J Manipulative Physiol Ther 2017;40:263-272)
Carpal tunnel syndrome (CTS) is the most common and most commonly described neuropathy of the peripheral nervous system.1,2 The reported incidence varies from 1.5% to 3.8%. 3-5 Carpal tunnel syndrome often affects persons of working age and may lead to absences from work and a marked decline in performance. 4 High prevalence and the major socioeconomic impact of CTS are reasons to search for effective, inexpensive treatments.6
Both conservative and surgical approaches to treating CTS are used. Conservative medical procedures include splinting the wrist at night, oral pharmacotherapy, and local steroid injections.7 Physical therapy for CTS usually involves electrophysical modalities or manual therapy, including the use of neurodynamic techniques. 6-8 Alternative treatments, such as yoga, acupuncture, massage, and traditional cupping therapy have also been investigated. 9-12