Highlights
- •We examine effectiveness of manual therapy and surgery in pain and function in carpal tunnel syndrome.
- •Manual therapy was more effective in the short term than surgery.
- •Manual therapy was similarly effective at medium-term and long-term follow-up to surgery.
Abstract
This randomized clinical trial investigated the effectiveness of surgery compared
with physical therapy consisting of manual therapies including desensitization maneuvers
in carpal tunnel syndrome (CTS). The setting was a public hospital and 2 physical
therapy practices in Madrid, Spain. One hundred twenty women with CTS were enrolled
between February 2013 and January 2014, with 1-year follow-up completed in January
2015. Interventions consisted of 3 sessions of manual therapies including desensitization
maneuvers of the central nervous system (physical therapy group, n = 60) or decompression/release
of the carpal tunnel (surgical group, n = 60). The primary outcome was pain intensity
(mean pain and the worst pain), and secondary outcomes included functional status
and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire and the
self-perceived improvement. They were assessed at baseline and 1, 3, 6, and 12 months
by a blinded assessor. Analysis was by intention to treat. At 12 months, 111 (92%)
women completed the follow-up (55/60 physical therapy, 56/60 surgery). Adjusted analyses
showed an advantage (all, P < .01) for physical therapy at 1 and 3 months in mean pain (Δ −2.0 [95% confidence
interval (CI) −2.8 to −1.2]/−1.3 [95% CI −2.1 to −.6]), the worst pain (Δ −2.9 [−4.0
to −2.0]/−2.0 [−3.0 to −.9]), and function (Δ −.8 [−1.0 to −.6]/−.3 [−.5 to −.1]),
respectively. Changes in pain and function were similar between the groups at 6 and
12 months. The 2 groups had similar improvements in the symptoms severity subscale
of the Boston Carpal Tunnel Questionnaire at all follow-ups. In women with CTS, physical
therapy may result in similar outcomes on pain and function to surgery.
Trial registration
http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT01789645.
Perspective
This study found that surgery and physical manual therapies including desensitization
maneuvers of the central nervous system were similarly effective at medium-term and
long-term follow-ups for improving pain and function but that physical therapy led
to better outcomes in the short term.
Key words
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Article info
Publication history
Published online: August 14, 2015
Accepted:
July 19,
2015
Received in revised form:
July 12,
2015
Received:
June 9,
2015
Footnotes
The authors have no conflicts of interest to declare. The study was funded by a research project grant (FIS PI11/01223) from the Health Institute Carlos III and PN I + D + I 2012-2014, Spanish Government. The sponsor had no role in the design, collection, management, analysis, or interpretation of the data, draft, review, or approval of the manuscript or its content. The authors were responsible for the decision to submit the current manuscript for publication, and the sponsor did not participate in this decision.
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© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
