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The Somatic Connection  |   January 2017
Inconclusive Evidence of Benefits of Nonsurgical Interventions 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
Inconclusive Evidence of Benefits of Nonsurgical Interventions for Carpal Tunnel Syndrome
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 57-58. doi:10.7556/jaoa.2017.009
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 57-58. doi:10.7556/jaoa.2017.009
Burton CK, Chesterton, LS, Chen Y, van der Windt DA. Clinical course and prognostic factors in conservatively managed carpal tunnel syndrome: a systematic review. Arch Phys Med Rehabil. 2016;97(5):836-852.e1. doi:10.1016/j.apmr.2015.09.013 
Carpal tunnel syndrome (CTS) is a common chronic entrapment neuropathy that affects the muscles and upper extremities. Current guidelines for patients with CTS recommend surgery for those with severe denervation and nonsurgical interventions for those with mild symptoms or those who cannot tolerate surgery. However, limited evidence exists for the efficacy of these conservative interventions, such as osteopathic manipulative treatment (OMT), physical therapy, splints, postural adjustments, steroid injections, and electrotherapy. Researchers in the United Kingdom conducted a systematic review to investigate the effectiveness of nonsurgical interventions for patients with CTS. 
Appraised studies were prospective and retrospective longitudinal studies published before December 2013 in which all patients were adults with a diagnosis of CTS who received no treatment or nonsurgical interventions for at least 6 weeks. Studies involving special populations were excluded. No clinical trials on OMT were identified. 
A systematic literature search was performed using online databases. Studies were screened for inclusion criteria and risk of bias by multiple reviewers using the Quality in Prognosis Studies tool, and 16 studies were identified. Data were extracted and appraised by 2 reviewers. 
The studies assessing corticosteroid injections concluded that steroid injections offer greater improvement in symptoms than placebo, but for only up to 1 month. There was inconclusive evidence supporting the use of night splints in the short term. The patients who were not treated appeared to have negative long-term outcomes, whereas patients who received some type of conservative treatment had symptom improvement. Moreover, patients with CTS who had a longer duration of symptoms, positive Phalen test result, and thenar muscle wasting had poor outcomes with conservative interventions. 
However, results from the studies examined could not be synthesized because of differences in CTS diagnostic criteria, patient population, type of conservative treatments evaluated, and outcome measures. Also, all of the appraised studies demonstrated a moderate or high risk of bias. Long-term follow-up was also lacking. Although OMT has been shown to have potential short-term benefits for patients with CTS,1 long-term, randomized clinical trials 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]