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The Somatic Connection  |   July 2017
Effects of Manual Therapy on Patients With Carpal Tunnel Syndrome
Author Notes
  • Western University of Health Science College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon 
Article Information
The Somatic Connection   |   July 2017
Effects of Manual Therapy on Patients With Carpal Tunnel Syndrome
The Journal of the American Osteopathic Association, July 2017, Vol. 117, 477-478. doi:10.7556/jaoa.2017.094
The Journal of the American Osteopathic Association, July 2017, Vol. 117, 477-478. doi:10.7556/jaoa.2017.094
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. 
References
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Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288(10):1245-1251. [CrossRef] [PubMed]
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Hui AC, Wong S, Leung CH, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64(12):2074-2078. [CrossRef] [PubMed]