In terms of pain and function, manual physical therapy provided similar long-term results to surgery and was even more effective early on for patients with carpal tunnel syndrome, according to a Spanish study.
The randomized, controlled trial explored the efficacy of manual physical therapy including desensitization maneuvers and surgery for CTS. Findings were published online Aug. 15 ahead of print in The Journal of Pain.
Past research has suggested 61% of people with carpal tunnel syndrome try to avoid surgical interventions and pursue a more conservative approach, according to the study background.
For the study, researchers enrolled 111 women with CTS between February 2013 and January 2014 from a public hospital in Madrid. The women randomly were assigned to receive either manual physical therapy (55 patients) or surgery (56 patients). For the physical therapy group, the intervention consisted of three 30-minute treatment sessions provided once a week.
The manual therapies included desensitization maneuvers aimed at the central nervous system, especially soft tissue mobilization and nerve/tendon gliding exercises. The treatments included “manual techniques directed at anatomical sites of potential entrapment of the median nerve,” authors wrote. During their last treatment session, members of the physical therapy group also were taught how to continue to perform the nerve and tendon gliding exercises as homework if needed.
Patients who were assigned to surgery underwent decompression and release of the carpal tunnel. Surgeons referred patients to postop hand therapy as needed. These patients also attended a session to learn how to perform the nerve and tendon gliding exercises at home.
Researchers measured outcomes at baseline and again at one, three, six and 12 months after the intervention. The main outcome measure was the intensity of hand pain, using an 11-point Numerical Pain Rating Scale. For secondary outcomes, the team looked at the functional status and severity subscales of the Boston Carpal Tunnel Questionnaire and the patient’s self-perceived improvement using the Global Rating of Change.
When it came to self-reported current level of pain and worst pain during the preceding week, the findings showed physical therapy group members reported larger decreases on the pain scale at one month, scoring an average of two points lower compared with surgical group patients. At three months, the physical therapy group patient scores were an average of 1.3 points lower compared with the surgical patients, the study found. At six and 12 months, the differences were no longer significant, findings showed.
Using the BCTQ function subscale, researchers found a similar pattern. Patients in the physical therapy group showed a higher improvement in function compared with the surgical group at one month, findings showed. By the three-month follow-up, the difference between groups had decreased, and at six and 12 months, there was no significant difference, according to the study.
Study authors note the findings are not consistent with an earlier study, which found surgery had better outcomes at six and 12 months, while their data show equal outcomes. They wrote the type of physical therapy included in the study could contribute to the difference.
“Otherwise, our results on the physiotherapy arm could have been better than those of prior reports because we have applied manual therapies including desensitization maneuvers of the central nervous system,” the authors wrote. “Approaches including integrative manual therapies may be more effective than therapeutic interventions targeting only the hand/wrist area, but testing this hypothesis requires further randomized clinical trials.”
Findings from the study support using manual physical therapy as a first treatment for CTS, the authors wrote, noting the results also fall in line with current American Academy of Orthopaedic Surgeons’ treatment guidelines for CTS.
“Therefore, it seems that conservative management may be considered as front-line treatment in mild to moderate and, sometimes severe, cases of CTS before subsequently considering surgery,” the authors wrote.