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Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial

  • César Fernández-de-las Peñas
    Correspondence
    Address reprint requests to César Fernández-de-las Peñas, PT, PhD, DMSc, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain.
    Affiliations
    Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

    Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Alcorcón, Madrid, Spain
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  • Ricardo Ortega-Santiago
    Affiliations
    Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

    Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Alcorcón, Madrid, Spain
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  • Ana I. de la Llave-Rincón
    Affiliations
    Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

    Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Alcorcón, Madrid, Spain
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  • Almudena Martínez-Perez
    Affiliations
    Department of Neurology and Neurophysiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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  • Homid Fahandezh-Saddi Díaz
    Affiliations
    Department of Traumatology and Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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  • Javier Martínez-Martín
    Affiliations
    Department of Traumatology and Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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  • Juan A. Pareja
    Affiliations
    Department of Neurology and Neurophysiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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  • Maria L. Cuadrado-Pérez
    Affiliations
    Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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Published:August 14, 2015DOI:https://doi.org/10.1016/j.jpain.2015.07.012

      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

      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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