Advertisement

Rheumatology International

, Volume 33, Issue 5, pp 1233–1241 | Cite as

A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study

  • Susanna Maddali Bongi
  • Massimo Signorini
  • Massimo Bassetti
  • Angela Del RossoEmail author
  • Martina Orlandi
  • Giuseppe De Scisciolo
Original Article

Abstract

In carpal tunnel syndrome (CTS), manual therapy interventions (MTI) reduce tissue adhesion and increase wrist mobility. We evaluated the efficacy of a MTI in relieving CTS signs and symptoms. Twenty-two CTS patients (pts) (41 hands) were treated with a MTI, consisting in 6 treatments (2/week for 3 weeks) of soft tissues of wrist and hands and of carpal bones. Pts were assessed for hand sensitivity, paresthesia, hand strength, hand and forearm pain, night awakening; Phalen test, thenar eminence hypotrophy and Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Median nerve was studied by sensory nerve conduction velocity (SNCV) and distal motor latency (DML). CTS was scored as minimal, mild, medium, severe and extreme. We considered as control group the same pts assessed before treatment: at baseline (T0a) and after 12 weeks (T0b). Pts were evaluated at the end of treatment (T1) and after 24-week (T2) follow-up. At T0b, versus T0a, forearm pain and Phalen test positivity were increased and hand strength reduced (p < 0.05). BCTQ–SSS and BCTQ–FSS scores improved at T1 versus T0b (p < 0.05) with the amelioration maintained at T2. At T1, the number of pts with paresthesia, night awakening, hypoesthesia, Phalen test, hand strength reduction and hand sensitivity was reduced with the lacking of symptoms maintained at T2 (p < 0.05). No changes in SNCV, DML and CTS scoring were shown. MTI improved CTS signs and symptoms, with benefits maintained at follow-up. Thus, it may be valid as a conservative therapy.

Keywords

Carpal tunnel syndrome Manual therapy intervention Rehabilitation Conservative treatments Nerve conduction studies 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    De Krom MC, Knipschild PG, Kester AD et al (1992) Carpal tunnel syndrome, prevalence in the general population. J Clin Epidemiol 45:373–376PubMedCrossRefGoogle Scholar
  2. 2.
    Ashworth N (2010) Carpal tunnel syndrome. Available from: http://www.emedicine.com/pmr/topic21.htm. Accessed on 28 May 2010
  3. 3.
    Fuller D (2012) Carpal tunnel syndrome. Available from: http://www.emedicine.com/orthoped/topic455.htm. Accessed on 14 Jul 2012
  4. 4.
    Mondelli M, Giannini F, Giacchi M (2002) Carpal tunnel syndrome incidence in a general population. Neurology 58:289–294PubMedCrossRefGoogle Scholar
  5. 5.
    Katz JN, Lew RA, Bessette L et al (1998) Prevalence and predictors of longterm work disability due to carpal tunnel syndrome. Am J Ind Med 33:543–550PubMedCrossRefGoogle Scholar
  6. 6.
    Feuerstein M, Miller VL, Burrell LM, Berger R (1998) Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability. J Occup Environ Med 40:546–555PubMedCrossRefGoogle Scholar
  7. 7.
    Latinovic R, Gulliford MC, Hughes RA (2006) Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry 77:263–265PubMedCrossRefGoogle Scholar
  8. 8.
    Hanrahan LP, Higgins D, Anderson H, Smith M (1993) Wisconsin occupational carpal tunnel syndrome surveillance: the incidence of surgically treated cases. Wis Med J 92:685–689PubMedGoogle Scholar
  9. 9.
    Marshall S (2001) Carpal tunnel syndrome. Clin Evid 5:717–728Google Scholar
  10. 10.
    Spinner RJ, Bachman JW, Amadio PC (1989) The many faces of carpal tunnel syndrome. Mayo Clin Proc 64:829–836PubMedCrossRefGoogle Scholar
  11. 11.
    Tanaka S, Wild DK, Cameron LL, Freund E (1997) Association of occupational and non-occupational risk factors with the prevalence of self reported carpal tunnel syndrome in a national survey of the working population. Am J Ind Med 32:550–556PubMedCrossRefGoogle Scholar
  12. 12.
    Keith MW, Masear V, Amadio PC et al (2009) Treatment of carpal tunnel syndrome. J Am Acad Orthop Surg 17:397–405PubMedGoogle Scholar
  13. 13.
    American Academy of Orthopaedic Surgeons Work Group Panel (2012) Clinical practice guideline on the treatment of carpal tunnel syndrome. Available at: www.aaos.org/research/guidelines/CTStreatmentguide.asp. Accessed on 14 Jul 2012
  14. 14.
    Jarvik JG, Comstock BA, Kliot M et al (2009) Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet 374:1074–1081PubMedCrossRefGoogle Scholar
  15. 15.
    Verdugo RJ, Salinas RA, Castillo JL, Cea JG (2008) Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev, Issue 4. Art. No.: CD001552Google Scholar
  16. 16.
    Harter BT Jr, McKiernan JE Jr, Kirzinger SS, Archer FW, Peters CK, Harter KC (1993) Carpal tunnel syndrome: surgical and non-surgical treatment. J Hand Surg 18A:734–739Google Scholar
  17. 17.
    Davis PT, Hulbert JR, Kassak KM, Meyer JJ (1998) Comparative efficacy of conservative medical and chiropractic treatment or carpal tunnel syndrome: a randomized clinical trial. J Manipulative Physiol Ther 21:317–326PubMedGoogle Scholar
  18. 18.
    Sucher BM (1994) Palpatory diagnosis and manipulative management of carpal tunnel syndrome. J Am Osteopath Assoc 94:647–663PubMedGoogle Scholar
  19. 19.
    Bonebrake AR (1994) A treatment for carpal tunnel syndrome: results of follow-up study. J Manipulative Physiol Ther 17:565–567PubMedGoogle Scholar
  20. 20.
    Valente R, Gibson H (1994) Chiropractic manipulation in carpal tunnel syndrome. J Manipulative Physiol Ther 17:246–249PubMedGoogle Scholar
  21. 21.
    Sucher BM, Hinrichs RN (1998) Manipulative treatment of carpal tunnel syndrome: biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament. J Am Osteopath Assoc 98:679–686PubMedGoogle Scholar
  22. 22.
    Sucher BM (1993) Myofascial manipulative release of carpal tunnel syndrome: documentation with magnetic resonance imaging. J Am Osteopath Assoc 93:1273–1278PubMedGoogle Scholar
  23. 23.
    Butler D (1991) Mobilization of the nervous system, 1st edn. Churchill Livingstone, MelbourneGoogle Scholar
  24. 24.
    Tal-Akabi A, Rushton A (2000) An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome. Man Ther 5:214–222PubMedCrossRefGoogle Scholar
  25. 25.
    Page MJ, O’Connor D, Pitt V, Massy-Westropp N (2012) Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev 6:CD009899PubMedGoogle Scholar
  26. 26.
    Padua L, Lo Monaco M, Padua R et al (1997) Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci 18:145–150PubMedCrossRefGoogle Scholar
  27. 27.
    Padua R, Padua L, Romanini E et al (1998) Versione italiana del Boston Carpal Tunnel Questionnaire. Giornale italiano di ortopedia e traumatologia 24:121–129Google Scholar
  28. 28.
    de Carvalho Leite JC, Jerosch-Herold C, Song F (2006) A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord 7:78CrossRefGoogle Scholar
  29. 29.
    Scholten RJ, Gerritsen AA, Uitdehaag BM, van GD, de Vet HC, Bouter LM (2004) Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev CD003905Google Scholar
  30. 30.
    Thoma A, Veltri K, Haines T, Duku E (2004) A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression. Plast Reconstr Surg 114:1137–1146PubMedGoogle Scholar
  31. 31.
    Shi Q, MacDermid JC (2011) Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res 11(6):17CrossRefGoogle Scholar
  32. 32.
    Katz RT (1994) Carpal tunnel syndrome: a practical review. Am Fam Physician 49:1371–1379PubMedGoogle Scholar
  33. 33.
    Botte MJ, von Schroeder HP, Abrams RA, Gellman H (1996) Recurrent carpal tunnel syndrome. Hand Clin 12:731–743PubMedGoogle Scholar
  34. 34.
    Tung TH, Mackinnon SE (2001) Secondary carpal tunnel surgery. Plast Reconstr Surg 107:1830–1843 (quiz 1844,1933)PubMedCrossRefGoogle Scholar
  35. 35.
    Steyers CM (2002) Recurrent carpal tunnel syndrome. Hand Clin 18:339–345PubMedCrossRefGoogle Scholar
  36. 36.
    Ono S, Clapham PJ, Chung KC (2010) Optimal management of carpal tunnel syndrome. Int J Gen Med 30(3):255–261Google Scholar
  37. 37.
    Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM (2002) Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA 11(288):1245–1251CrossRefGoogle Scholar
  38. 38.
    Katz JN, Keller RB, Simmons BP, Rogers WD, Bessette L, Fossel AH, Mooney NA (1998) Maine Carpal Tunnel Study: outcomes of operative and non operative therapy for carpal tunnel syndrome in a community-based cohort. J Hand Surg Am 23:697–710PubMedCrossRefGoogle Scholar
  39. 39.
    Practice parameter for carpal tunnel syndrome (summary statement) (1993) Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurolog 43:2406–2409Google Scholar
  40. 40.
    O’Connor D, Marshall S, Massy-Westropp N (2003) Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 1:CD003219PubMedGoogle Scholar
  41. 41.
    George JW, Tepe R, Busold D, Keuss S, Prather H, Skaggs CD (2006) The effects of active release technique on carpal tunnel patients: a pilot study. J Chiropr Med 5:119–122PubMedCrossRefGoogle Scholar
  42. 42.
    Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD (2007) A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther 30:50–61PubMedCrossRefGoogle Scholar
  43. 43.
    Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR (1998) Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA 280:1601–1603PubMedCrossRefGoogle Scholar
  44. 44.
    Manente G, Torrieri F, Di Blasio F, Staniscia T, Romano F, Uncini A (2001) An innovative hand brace for carpal tunnel syndrome: a randomized controlled trial. Muscle Nerve 24:1020–1025PubMedCrossRefGoogle Scholar
  45. 45.
    Harter BT Jr, McKiernan JE Jr, Kirzinger SS, Archer FW, Peters CK, Harter KC (1993) Carpal tunnel syndrome: surgical and nonsurgical treatment. J Hand Surg Am 18:734–739PubMedCrossRefGoogle Scholar
  46. 46.
    Finestone HM, Woodbury GM, Collavini T, Marchuk Y, Maryniak O (1996) Severe carpal tunnel syndrome: clinical and electrodiagnostic outcome of surgical and conservative treatment. Muscle Nerve 19:237–239PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Susanna Maddali Bongi
    • 1
  • Massimo Signorini
    • 3
  • Massimo Bassetti
    • 1
  • Angela Del Rosso
    • 1
    Email author
  • Martina Orlandi
    • 1
  • Giuseppe De Scisciolo
    • 2
  1. 1.Division of Rheumatology, Department of Biomedicine, Denothe Centre, Careggi Hospital (AOUC)University of FlorenceFlorenceItaly
  2. 2.Neurophysiology Unit, Department of Neurology and PsychiatryCareggi Hospital (AOUC)FlorenceItaly
  3. 3.Center of Manual TherapyFlorenceItaly

Personalised recommendations