Nine participants completed all aspects of the study treatment and testing. Six participants were female, and 3 were male. The mean (SD) age was 48.6 (17.8) years (range, 27-78 years). The mean (SD) height was 67.6 (3.7) inches (range, 62-72 inches), and the mean (SD) weight was 189.3 (39.5) lb (range, 130-250 lb). The mean (SD) duration of symptoms was 8.6 (9.1) years (range, 1-28 years). Five participants were not receiving concurrent treatment for CTS. Three participants were using nighttime wrist splints, and 1 was taking oral nonsteroidal anti-inflammatory drugs. Seven participants were right-handed. Five symptomatic participants had symptomatic bilateral hand symptoms compatible with CTS with confirmatory median nerve electrophysiologic abnormalities, and 3 participants had unilateral hand symptoms indicative of CTS. In these participants, electrophysiologic abnormalities were seen bilaterally but were worse on the symptomatic side. One participant had unilateral hand symptoms indicative of CTS, with electrophysiologic abnormalities on the symptomatic side.
The effects of OMT on CTS symptoms and function are summarized in
Table 1. The BCTQ findings demonstrated that CTS-related symptoms were worse on the treated side before treatment (
F=8.3;
P=.01) and statistically significantly improved after treatment (
F=11.0;
P=.004). Disability related to CTS was also worse on the treated side before treatment (
F=5.8;
P=.03) and was statistically significantly improved after treatment (
F=6.8;
P=.02). Statistically significant lowering of SSD scores was observed after treatment (
F=4.19;
P=.0002). The composite change from before to after treatment in the SSD scores for all participants is represented in
Figure 4. The perceived overall improvement of symptoms was statistically significantly greater for the treated upper limb (
F=4.8;
P=.046). Notably, greater symptom improvement and patient estimate of overall change and improved function after treatment were seen in the treated upper limb, but these findings did not reach statistical significance (
F=4.3,
P=.054;
F=4.1,
P=.06; and
F=4.2,
P=.06, respectively). All participants were consistently noted to have persistent presence of Chapman point tenderness at the third rib and somatic dysfunction in all spinal regions and extremities. No consistent pattern or predictable palpatory findings were seen in each of the spinal regions or extremities between participants. With OMT, the physician and student subjectively noted an associated reduction in severity of palpatory findings as the participants' symptoms improved. All participants had minimal palpatory findings in all spinal regions as well as the wrist and forearm after the fourth treatment, but tenderness at the Chapman point persisted. By the sixth week of treatment, almost all participants had no pain associated with palpation at any location other than a slight tenderness at the third rib on the affected side.
The effects of OMT on the electrophysiologic function of the median nerve are summarized in
Table 2. Initially, an ANOVA was used to explore the data, revealing a pattern of faster trans–carpal tunnel sensory conduction velocity with successive testing for both median nerves with no side-to-side difference. The mean (SD) sensory conduction velocity before treatment was 34.4 (10.2) m/s; and after the first treatment, 34.2 (10.0) m/s; and after the sixth treatment, 35.6 (10.5) m/s (
F=3.51;
P=.04). Hand surface temperature was notably higher with successive testing sessions (mean [SD] temperature before treatment, 30.6°C [0.97°C]; after the first treatment, 30.7°C [1.3°C]; and after the sixth treatment, 32.2°C [1.3°C];
F=9.0,
P=.0008). The trans–carpal tunnel sensory conduction changes became statistically insignificant when temperature was used as a covariate in the ANCOVA, suggesting that the faster trans–carpal tunnel sensory conduction velocities recorded after the sixth treatment were temperature related. Accordingly, the ANCOVA was used for all of the electrophysiologic data analysis. No statistically significant main or interaction effect changes were found for any of the motor or sensory conduction velocities or amplitude ratios.
Table 3 summarizes the effect of OMT on median nerve and transverse carpal ligament morphology. No statistically significant changes were seen in the cross-sectional area of the median nerve and transverse carpal ligament bowing. Transverse carpal ligament length did increase notably with OMT (
F=14.3;
P<.001), but this change was comparable on both the treated and untreated sides.