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The Somatic Connection  |   January 2017
Evidence Supporting the Benefits of Manual Therapy for Carpal Tunnel Syndrome
Author Notes
  • Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   January 2017
Evidence Supporting the Benefits of Manual Therapy for Carpal Tunnel Syndrome
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 56-57. doi:10.7556/jaoa.2017.008
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 56-57. doi:10.7556/jaoa.2017.008
Fernández-de-Las Peñas C, Ortega-Santaigo R, de la Liave-Rincón A, et al. Manual physical therapy versus surgery for carpal tunnel syndrome: a randomized parallel-group trial.J Pain. 2015;16(11): 1087-1094. doi:10.1016/j.jpain.2015.07.012 
Although nonsurgical approaches to manage carpal tunnel syndrome (CTS) can be beneficial in the short term, medium- and long-term effects are largely unknown. Researchers in Spain conducted a pragmatic, parallel-group, randomized clinical trial to compare the effectiveness of surgery with physical therapy involving manual manipulations to manage symptoms in participants with CTS. 
The researchers recruited women with a diagnosis of CTS, with pain and paresthesia that increased at night, and positive Tinel and Phalen signs that were present for more than 12 months. Participants were excluded if they were older than 65 years or if they had ulnar or radial nerve sensorimotor deficits; systemic disease; trauma to the cervical region, shoulder, and upper extremities; other upper extremity conditions; musculoskeletal conditions; or depression. 
Through a blinded randomization process, 120 participants were divided into 2 treatment groups. The physical therapy group received 3 weekly 30-minute sessions of manual therapy, including desensitization maneuvers of the central nervous system. Desensitization maneuvers included soft tissue mobilization and gliding of the nerve and tendon at the affected wrist and ipsilateral cervical spine. The surgery group underwent open or endoscopic decompression and release of the carpal tunnel. Participants from both groups were educated on how to perform tendon and nerve gliding exercises. 
The primary outcome was pain intensity in the hand, which included average pain and greatest pain level and was measured on an 11-point Numerical Pain Rating Scale. Secondary outcomes included the patients’ functionality and severity of symptoms, which were measured by the Boston Carpal Tunnel Questionnaire, along with self-perceived improvement measured by the Global Rating of Change. The study followed the Consolidated Standards of Reporting Trials guidelines. All outcomes were assessed at 1, 3, 6, and 12 months after the intervention. Statistical analysis was done using SPSS software. Functionality was calculated with intention-to-treat. Data comparison was accomplished with student t tests, χ2 tests, and analyses of covariance. 
A significantly larger decrease in pain intensity and increase in functionality were observed at 1 and 3 months after intervention in participants who received physical therapy compared with those who underwent surgery (P<.001). Both groups exhibited similar “significant and clinically important improvements” in pain intensity, functional ability, and self-perceived improvement at 6- and 12-month follow-ups. 
The researchers concluded that manual physical therapy interventions provided greater short-term (ie, 1 and 3 months after intervention) benefits and similar medium- and long-term (ie, 6 and 12 months after intervention) benefits compared with the use of surgery to manage symptoms in participants with CTS. 
Many osteopathic manipulative treatment (OMT) techniques are similar to the manual therapies used in this study. Although small-scale pilot data1 and a number of case reports on this topic exist,2 the efficacy of OMT in the management of CTS remains inconclusive. Therefore, large-scale randomized controlled trials that assess the efficacy of OMT in the management of CTS are needed. 
References
Burnham T, Higgins DC, Burnham RS, Heath DM. Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome: a pilot project. J Am Osteopath Assoc. 2015;115(3):138-148. doi:10.7556/jaoa.2015.027 [CrossRef] [PubMed]
Sucher BM. Carpal tunnel syndrome: ultrasonographic imagining and pathologic mechanisms of median nerve compression. J Am Osteopath Assoc. 2009;109(12):641-647. [CrossRef] [PubMed]