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CÉSAR FERNÁNDEZ-DE-LAS-PEÑAS, PT, PhD, DMSc1 • JOSHUA CLELAND, PT, PhD, OCS, FAAOMPT2-4 • MARÍA PALACIOS-CEÑA, PT1
STELLA FUENSALIDA-NOVO, PT1 • JUAN A. PAREJA, MD, PhD5 • CRISTINA ALONSO-BLANCO, PT, PhD1
C
95% CI: 0.5, 1.5). Improvements in self-reported
TTOBJECTIVE: To compare the effectiveness of function and pinch grip force were similar between arpal tunnel syndrome
manual therapy versus surgery for improving self-
reported function, cervical range of motion, and
the groups at 3, 6, and 12 months. Both groups (CTS), a pain condition
reported improvements in symptom severity that
pinch-tip grip force in women with CTS. were not significantly different at all follow-up associated with repetitive
TTMETHODS: In this randomized clinical trial, 100 periods. No significant changes were observed in movements, accounts for
women with CTS were randomly allocated to either pinch-tip grip force on the less symptomatic side nearly 50% of all work-related
J Orthop Sports Phys Ther 2017.47:151-161.
a manual therapy (n = 50) or a surgery (n = 50) and in cervical range of motion in either group.
injuries.31 The prevalence of CTS
group. The primary outcome was self-rated hand
TTCONCLUSION: Manual therapy and surgery had
function, assessed with the Boston Carpal Tunnel in the general population has been re-
similar effectiveness for improving self-reported
Questionnaire. Secondary outcomes included
function, symptom severity, and pinch-tip grip ported to range between 6% and 12%.32
active cervical range of motion, pinch-tip grip
force on the symptomatic hand in women with Individuals diagnosed with CTS have
force, and the symptom severity subscale of the
CTS. Neither manual therapy nor surgery resulted been identified as significantly more
Boston Carpal Tunnel Questionnaire. Patients were
in changes in cervical range of motion.
assessed at baseline and 1, 3, 6, and 12 months likely to miss more work days than
after the last treatment by an assessor unaware TTLEVEL OF EVIDENCE: Therapy, level 1b. Pro- asymptomatic individuals, which results
of group assignment. Analysis was by intention to spectively registered September 3, 2014 at www.
in a massive economic burden to the in-
treat, with mixed analyses of covariance adjusted clinicaltrials.gov (NCT02233660). J Orthop Sports
Phys Ther 2017;47(3):151-161. Epub 3 Feb 2017.
dividual and society.2
for baseline scores.
The management of CTS can be either
TTRESULTS: At 12 months, 94 women completed
doi:10.2519/jospt.2017.7090
TTKEY WORDS: carpal tunnel syndrome, cervical
conservative or surgical. Conservative
the follow-up. Analyses showed statistically sig-
nificant differences in favor of manual therapy at spine, force, manual therapy, neck, surgery management is often chosen as the first
approach when symptoms are mild or
1
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain. 2Department of Physical Therapy,
Franklin Pierce University, Manchester, NH. 3Rehabilitation Services, Concord Hospital, Concord, NH. 4Manual Therapy Fellowship Program, Regis University, Denver, CO.
5
Department of Neurology and Neurophysiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain. The local human research committee (HUFA PI-12/0023) approved
the study project. The study was funded by a research project grant (FIS PI14/ 00364) from the Health Institute Carlos III (PN I+D+I 2014-2017; Spanish Government). The study
was prospectively registered September 3, 2014 at www.clinicaltrials.gov (NCT02233660). The authors certify that they have no affiliations with or financial involvement in any
organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr César Fernández de las Peñas,
Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain. E-mail: cesar.fernandez@urjc.es t Copyright ©2017
Journal of Orthopaedic & Sports Physical Therapy®
Symptom severity subscale (1-5) 2.5 ± 0.7 2.6 ± 0.6 this condition.9 A recent randomized clin-
Cervical range of motion, deg ical trial compared the effects of physical
Flexion 49 ± 8 48 ± 7 therapy, consisting of manual therapies
Extension 57 ± 10 57 ± 8 that included desensitization maneuvers
Lateral flexion toward the side of CTS 39 ± 6 40 ± 7 of the central nervous system, with those
Lateral flexion away from the side of CTS 40 ± 6 40 ± 7 of surgery on pain and self-reported func-
Rotation toward the side of CTS 71 ± 10 70 ± 9 tion in CTS.12 The results were significant-
Rotation away from the side of CTS 69 ± 11 71 ± 7 ly in favor of the manual therapy group
Pinch-tip grip force, lb for pain and function at 1 and 3 months;
Thumb-index finger: (more) symptomatic side 4.3 ± 2.2 4.1 ± 2.3 however, no between-group differences
J Orthop Sports Phys Ther 2017.47:151-161.
Thumb-little finger: (more) symptomatic side 1.2 ± 0.7 1.1 ± 0.6 for pain and self-reported function at 6
Thumb-index finger: less (non)symptomatic side 4.4 ± 1.7 4.2 ± 1.6 and 12 months were observed.
Thumb-little finger: less (non)symptomatic side 1.1 ± 0.7 1.1 ± 0.6 The aforementioned trial did not
Abbreviation: CTS, carpal tunnel syndrome. report on measures of physical impair-
*Values are mean ± SD unless otherwise indicated.
ments, despite the fact that it has been
shown that individuals with CTS exhibit
surgery is contraindicated. When symp- this disorder.25 This may be the reason reduced cervical range of motion6,7 and
toms are severe, surgery is often chosen why a recent Delphi study, including decreased pinch grip strength.8,13 In fact,
as the first line of defense.4 Conservative experts, developed a multidisciplinary it has been demonstrated that disability
interventions can include splinting, cor- guideline for the management of CTS and self-reported function are associated
ticosteroid injections, and physical ther- that did not include physical therapy in- with pain, reduced pinch-tip grip force
apy. Though recent Cochrane Reviews tervention, with the exception of exercise between the thumb and little finger, and
have found that splinting and injections postsurgery.16 cervical lateral flexion away from the
may be beneficial in the short term, this While surgery continues to be a com- symptomatic side.11 However, it is not
effect has not been found at long-term monly used intervention, there is much known whether patients with CTS who
follow-ups.23,24 Physical therapy is a com- debate surrounding its efficacy, as more receive either manual therapy or surgery
monly utilized management strategy for than one third of individuals do not re- will exhibit superior outcomes in terms of
people with CTS; however, the most cur- turn to work within 8 weeks after surgi- cervical range of motion and grip strength
rent Cochrane systematic review found cal intervention.26 The most up-to-date associated with changes in self-reported
that there was limited and very low–qual- review analyzing conservative versus function. Therefore, the purpose of our
ity evidence of benefit to support exercise surgical management in CTS showed that randomized clinical trial was to compare
and mobilization for the management of both interventions may achieve benefits the effectiveness of manual therapy ver-
T
syndrome screened for Excluded, n = 40
his study was a single-blind, eligibility criteria, n = 140 • Previous surgery, n = 20
randomized clinical trial (regis- • Pregnancy, n = 8
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tions targeting the scalene muscles, cos- performance of 8 common hand-related as affected/unaffected, whereas in those
toclavicle space, pectoralis minor, biceps tasks and (2) symptom severity on a sub- with bilateral symptoms, the most pain-
brachii muscle, bicipital aponeurosis, pro- scale9 that assesses pain severity, numb- ful side was considered as the affected
nator teres, transverse carpal ligament, ness, and weakness at night and during side and the less painful side as the unaf-
palmar aponeurosis, and lumbrical mus- the day. Items of the BCTQ are answered fected side. The mean of 2 measurements
cles were also applied. These techniques on a 5-point scale, ranging from 1 (no for each motion was used in the analysis.
are described in detail in APPENDIX A (avail- complaint) to 5 (severe complaint), with For CROM measurements, previous stud-
able at www.jospt.org). Finally, patients a total score on each subscale ranging ies have reported an intratester reliability
performed a cervical spine exercise pro- from 1 to 5, where higher scores indicate of 0.87 to 0.96, a standard error of mea-
gram for stretching neck muscles. Specific worse self-reported function and greater surement of 2.3° to 4.1°, and a minimal
J Orthop Sports Phys Ther 2017.47:151-161.
details regarding cervical spine stretching symptom severity. The BCTQ has been detectable change (MDC) across the 6
exercises are provided in APPENDIX B (avail- shown to be valid, reliable, and respon- movements ranging from 3.6° to 6.5°.3,14
able at www.jospt.org). The third and last sive in individuals with CTS.21 Minimal Pinch-tip grip force between the
treatment appointment included an edu- clinically important differences (MCIDs) thumb and index finger or the thumb and
cational session on how to perform the of 0.74 points in the functional status little finger was measured (in pounds)
cervical exercises as homework during subscale and 1.14 points in the symptom with a pinch-grip dynamometer (Psympt-
the follow-up period, as needed. Patients
were encouraged to not modify any work 5 5
BCTQ Symptom Severity Score
BCTQ Functional Status Score
B
etween September 2014 and Feb-
2 2
ruary 2015, 140 consecutive patients
1 1 * with CTS were screened for eligibil-
J Orthop Sports Phys Ther 2017.47:151-161.
Within-group change: baseline to 3 mo –0.8 (–1.05, –0.55) –1.1 (–1.3, –0.9) –0.3 (–0.4, –0.2)
6 mo 1.6 ± 0.6 (1.5, 1.7) 1.4 ± 0.5 (1.2, 1.6)
Within-group change: baseline to 6 mo –0.9 (–1.1, –0.7) –1.2 (–1.5, –0.9) –0.3 (–0.5, –0.1)
12 mo 1.6 ± 0.6 (1.5, 1.7) 1.4 ± 0.5 (1.25, 1.55)
Within-group change: baseline to 12 mo –0.9 (–1.2, –0.6) –1.2 (–1.4, –1.0) –0.3 (–0.6, –0.0)
Pinch-tip grip force: thumb-index finger on (more) symptomatic side
Baseline 4.3 ± 2.2 (3.7, 5.0) 4.1 ± 2.3 (3.5, 4.8)
1 mo 5.3 ± 2.2 (4.7, 5.9) 3.3 ± 2.1 (2.7, 3.9)
Within-group change: baseline to 1 mo 1.0 (0.5, 1.5) –1.2 (–1.6, –0.8) 2.2 (1.8, 2.6)†
3 mo 5.4 ± 2.6 (4.6, 6.1) 4.8 ± 2.7 (4.1, 5.5)
J Orthop Sports Phys Ther 2017.47:151-161.
Within-group change: baseline to 3 mo 1.1 (0.5, 1.7) 0.7 (0.2, 1.1) 0.4 (0.2, 0.6)
6 mo 5.3 ± 2.5 (4.7, 5.9) 4.6 ± 2.2 (4.0, 5.3)
Within-group change: baseline to 6 mo 1.0 (0.4, 1.6) 0.5 (0.2, 0.8) 0.5 (0.2, 0.8)
12 mo 5.3 ± 2.9 (4.6, 5.9) 4.9 ± 2.4 (4.2, 5.7)
Within-group change: baseline to 12 mo 1.0 (0.5, 1.5) 0.8 (0.2, 1.4) 0.2 (0.0, 0.4)
Table continues on page 157.
be found in FIGURE 1, which provides a effect size was large (SMD, 1.6). Chang- teractions for pinch-tip grip force on the
flow diagram of patient recruitment and es in self-reported function were similar symptomatic side (thumb-index finger: F
retention. in both groups at 3-, 6-, and 12-month = 6.550, P = .01 and thumb-little finger: F
Adjusting for baseline outcomes, follow-ups (P>.4). Additionally, both = 4.625, P = .036). Patients who received
the mixed-model analysis of covariance groups exhibited similar improvements manual therapy exhibited higher increas-
found a significant group-by-time inter- in severity of symptoms at all follow-up es in pinch-tip grip force on the symp-
action for the functional status subscale periods (TABLE 2). The manual therapy tomatic hand at 1 month (thumb-index
(F = 13.512, P<.001), but not for the group and the surgical group did not finger: mean change, 2.0; 95% CI: 1.1, 2.9
symptom severity subscale (F = 0.678, P significantly differ in success criteria in and thumb-little finger: mean change,
= .382), of the BCTQ, in that patients re- the intention-to-treat analyses at 6 (48% 1.0; 95% CI: 0.5, 1.5) than patients who
ceiving manual therapy exhibited a sta- versus 52%; χ2 = 0.093, P = .459) and 12 received surgery (FIGURE 3). The between-
tistically greater increase in self-reported (57% versus 64%; χ2 = 1.314, P = .273) group effect size was large (SMD, 1.1).
function at 1 month (mean change, –0.8; months. Changes in pinch-tip grip force on the
95% CI: –1.1, –0.5) than those receiving The intention-to-treat analysis also symptomatic hand were similar in both
surgery (FIGURE 2). The between-group revealed significant group-by-time in- groups at 3, 6, and 12 months (P>.2). No
Within-group change: baseline to 3 mo 0.0 (–0.4, 0.4) 0.1 (–0.3, 0.5) 0.1 (–0.1, 0.3)
6 mo 4.5 ± 2.0 (4.0, 5.0) 4.3 ± 1.4 (3.8, 4.8)
Within-group change: baseline to 6 mo 0.1 (–0.4, 0.6) 0.1 (–0.1, 0.3) 0.0 (–0.3, 0.3)
12 mo 4.6 ± 2.1 (4.1, 5.1) 4.2 ± 1.7 (3.5, 4.9)
Within-group change: baseline to 12 mo 0.2 (0.0, 0.4) 0.0 (–0.4, 0.4) 0.2 (0.0, 0.4)
Pinch-tip grip force: thumb-little finger on less (non)symptomatic side
Baseline 1.1 ± 0.7 (0.9, 1.3) 1.1 ± 0.6 (0.9, 1.3)
1 mo 1.3 ± 0.9 (1.1, 1.5) 1.1 ± 0.7 (0.9, 1.3)
Within-group change: baseline to 1 mo 0.2 (0.0, 0.4) 0.0 (–0.2, 0.2) 0.2 (0.0, 0.4)
3 mo 1.3 ± 0.9 (1.0, 1.6) 1.3 ± 0.8 (1.1, 1.5)
J Orthop Sports Phys Ther 2017.47:151-161.
Within-group change: baseline to 3 mo 0.2 (–0.1, 0.5) 0.2 (–0.1, 0.5) 0.0 (–0.3, 0.3)
6 mo 1.5 ± 1.0 (1.3, 1.7) 1.3 ± 0.7 (1.1, 1.5)
Within-group change: baseline to 6 mo 0.4 (0.1, 0.7) 0.1 (0.0, 0.2) 0.3 (0.1, 0.5)
12 mo 1.5 ± 0.9 (1.1, 1.9) 1.3 ± 0.7 (1.0, 1.6)
Within-group change: baseline to 12 mo 0.4 (0.2, 0.6) 0.1 (–0.1, 0.3) 0.3 (0.0, 0.6)
Abbreviation: BCTQ, Boston Carpal Tunnel Questionnaire.
*Outcome values at each time point are mean ± SD (95% confidence interval) and values for change scores are mean (95% confidence interval).
†
Statistically significant between-group difference (analysis of variance) (P<.05).
changes were observed in pinch-tip grip the symptomatic side (F = 0.115, P = .805) self-reported function, symptom sever-
force on the less-affected side at any fol- (TABLE 3). ity, and pinch grip strength than surgery,
low-up period (P>.12) (TABLE 2). No association was observed between but yielded similar outcomes at 6 months
Finally, no significant changes were changes in self-reported function, cervi- and 1 year. While the 1-month between-
observed in cervical range of motion in cal range of motion, and pinch-tip grip group differences were statistically sig-
both groups for any motion: flexion (F = force in either group (all, P>.5). nificant, they did not surpass the MCID
0.117, P = .740), extension (F = 0.550, P for self-reported function19 or the MDC
= .655), lateral flexion toward the most DISCUSSION for pinch-tip grip strength,29 calling into
symptomatic side (F = 0.220, P = .965), question the clinical relevance. Similarly,
T
lateral flexion away from the most symp- he current randomized clinical changes observed in both groups at all
tomatic side (F = 0.185, P = .670), rota- trial found that multimodal manual follow-ups were also modest and did not
tion toward the symptomatic side (F = therapy resulted in significantly surpass the MCID for the functional sta-
0.415, P = .495), and rotation away from greater improvements at 1 month in tus subscale of the BCTQ19 or the MDC
Cervical Range-of-Motion Outcomes by Group and
TABLE 3
Within-Group and Between-Group Change Scores*
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Within-group change: baseline to 12 mo 2.0 (–1.5, 5.5) 1.0 (–2.3, 4.3) 1.0 (0.0, 2.0)
Cervical extension, deg
Baseline 57 ± 10 (55, 59) 57 ± 8 (54, 60)
1 mo 59 ± 9 (56, 62) 57 ± 9 (54, 60)
Within-group change: baseline to 1 mo 2.0 (–1.5, 5.5) 0.0 (–1.7, 1.7) 2.0 (–0.8, 4.8)
3 mo 60 ± 10 (58, 62) 59 ± 8 (56, 62)
Within-group change: baseline to 3 mo 3.0 (–0.5, 6.5) 2.0 (–0.5, 4.5) 1.0 (–1.5, 3.5)
6 mo 59 ± 8 (57, 61) 58 ± 8 (56, 60)
Within-group change: baseline to 6 mo 2.0 (–1.5, 5.5) 1.0 (–1.4, 3.4) 1.0 (–1.3, 3.3)
12 mo 59 ± 8 (57, 61) 58 ± 7 (56, 60)
Within-group change: baseline to 12 mo 2.0 (–0.7, 4.7) 1.0 (–1.3, 3.3) 1.0 (0.0, 3.0)
Cervical lateral flexion toward the side of CTS, deg
Baseline 39 ± 6 (37, 41) 40 ± 7 (38, 42)
1 mo 39 ± 7 (37, 41) 40 ± 7 (37, 43)
Within-group change: baseline to 1 mo 0.0 (–2.0, 2.0) 0.0 (–2.2, 2.2) 0.0 (–1.5, 1.5)
3 mo 40 ± 9 (38, 42) 40 ± 6 (37, 43)
Within-group change: baseline to 3 mo 1.0 (–1.5, 3.5) 0.0 (–1.8, 1.8) 1.0 (–1.2, 3.2)
6 mo 41 ± 8 (38, 44) 41 ± 6 (39, 43)
Within-group change: baseline to 6 mo 2.0 (–0.5, 4.5) 1.0 (–1.2, 3.2) 1.0 (–2.0, 4.0)
12 mo 40 ± 6 (38, 42) 40 ± 6 (38, 42)
Within-group change: baseline to 12 mo 1.0 (–1.4, 3.4) 0.0 (–1.9, 1.9) 1.0 (0.0, 2.0)
Table continues on page 159.
Cervical Range-of-Motion Outcomes by Group and
TABLE 3
Within-Group and Between-Group Change Scores* (continued)
T
which may have an impact on future he results of the current trial Sports Phys Ther. 2010;40:318-323. https://doi.
org/10.2519/jospt.2010.3180
meta-analysis. Further, patients undergo- suggest that manual therapy and 4. Burton CL, Chesterton LS, Chen Y, van der Windt
Downloaded from www.jospt.org by Univ Canberra on 12/29/17. For personal use only.
ing surgery typically exhibit a higher rate surgery have similar outcomes in DA. Clinical course and prognostic factors in
of complications than those who receive self-reported function and pinch-tip grip conservatively managed carpal tunnel syndrome:
conservative therapy (pooled risk ratio = force at long-term follow-up periods, but a systematic review. Arch Phys Med Rehabil.
2016;97:836-852.e1. https://doi.org/10.1016/j.
2.03; 95% CI: 1.28, 3.22).18 Perhaps this manual therapy exhibited significant apmr.2015.09.013
is why most patients with CTS typically clinical improvements at 1-month follow- 5. Butler DS. The Sensitive Nervous System. Ad-
prefer conservative management as the up in a sample of women with CTS. No elaide, Australia: Noigroup Publications; 2000.
first therapeutic option.30 Our study ob- changes in cervical range of motion were 6. de-la-Llave-Rincón AI, Fernández-de-las-Peñas C,
Laguarta-Val S, Ortega-Santiago R, Palacios-Ce-
served that the current manual therapy observed after either manual therapy or
surgery. t
ña D, Martínez-Perez A. Women with carpal tun-
program was equally effective as surgery nel syndrome show restricted cervical range of
for improving self-reported function and motion. J Orthop Sports Phys Ther. 2011;41:305-
J Orthop Sports Phys Ther 2017.47:151-161.
@ MORE INFORMATION
Practice parameter: electrodiagnostic studies in N. Exercise and mobilisation interventions
carpal tunnel syndrome. Report of the American for carpal tunnel syndrome. Cochrane Data-
Association of Electrodiagnostic Medicine, Amer- base Syst Rev. 2012:CD009899. https://doi. WWW.JOSPT.ORG
Technique: lateral glides applied to the cervical spine Technique: longitudinal stroke over the scalene muscles
Description of technique: the patient lies supine with the head in a neutral Description of technique: the patient lies supine with the neck in a neu-
position. The therapist supports the patient’s head with the mobilization tral position. Longitudinal strokes over the anterior and middle scalene
hand at the C5-C6 level. The other hand is placed on the contralateral muscles were performed from a cranial to caudal direction. A total of 5
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side of the patient’s neck. The lateral glide of the cervical spine was ap- strokes on each muscle were applied. The degree of pressure was based
plied as a translational movement of the neck away from the symptomatic on the tension perceived by the clinician from the patient’s tissue, which
side. This transverse movement was performed until the therapist felt tis- was usually pain free
sue resistance (Maitland grade III). The intervention was completed over
5 minutes in 2 sets of 2 minutes each, with 1 minute of rest between sets
J Orthop Sports Phys Ther 2017.47:151-161.
Technique: stretching of the transverse carpal ligament Technique: manual compression of the lumbrical muscles
Description of technique: the clinician places the thumbs on the region of Description of technique: the clinician places the thumbs over the palmar
the carpal tunnel and the flexed index fingers, over the back of the wrist, face of the metacarpophalanx articulations, so that they may separate
forming a clamp. From that position, the clinician rhythmically induces an the proximal phalanxes of the patient’s fingers. The other fingers stabilize
extension movement of the wrist 10 times the patient’s hand. The clinician induces an opening motion of the meta-
carpophalanx articulations for 2 minutes
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J Orthop Sports Phys Ther 2017.47:151-161.
Technique: self-stretching of the upper fibers of the trapezius muscle Technique: self-stretching of the upper fibers of the scalene muscles
Description of technique: the patient is sitting in a relaxed position. With Description of technique: the position is the same as for the other stretch-
the contralateral hand, the patient grasps her head, whereas the homolat- ing exercises. The scalene muscles are stretched with slight cervical
eral hand grasps the chair to avoid shoulder elevation. The upper fibers of extension, contralateral lateral flexion, and contralateral rotation. The
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the trapezius muscle are stretched by including cervical flexion, contralat- stretching position was maintained for 45 seconds 2 times. Opinions dif-
eral lateral flexion, and homolateral rotation. This stretching position was fer on the degree and direction of rotation required for the stretch of the
maintained for 45 seconds 2 times scalene muscles
J Orthop Sports Phys Ther 2017.47:151-161.
C
arpal tunnel syndrome causes pain, numbness, and Although surgery may be considered when the symptoms are se-
weakness in the wrist and hand. Nearly 50% of all vere, more than a third of patients do not return to work within 8
work-related injuries are linked to carpal tunnel syn- weeks after an operation. Based on the potential side effects and
drome, and people with this injury are more likely risks of surgery, patients often ask if they might try physical therapy
to miss work because of it. Patients with carpal tun- first. An article in the March 2017 issue of JOSPT assesses the ef-
nel syndrome can be treated with physical therapy or surgery. fectiveness of therapy and surgery to treat carpal tunnel syndrome.
NEW INSIGHTS
The researchers studied the cases of 100 women
with carpal tunnel syndrome and compared 50
patients who were treated with physical therapy
and 50 patients who were treated with surgery. The
patients who did not receive surgery were treated
with manual therapy techniques that focused on
Downloaded from www.jospt.org by Univ Canberra on 12/29/17. For personal use only.
stretching exercises (B) to improve your recovery from carpal tunnel syndrome. These illustrations show a few of the
manual therapy and exercise treatment options your therapist may recommend and use.
PRACTICAL ADVICE
This JOSPT Perspectives for Patients is based on an article by Fernández-de-las-Peñas et al, titled “The Effectiveness The researchers found that after 1 year, patients
of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in who had physical therapy that focused on manual
Carpal Tunnel Syndrome: A Randomized Clinical Trial” (J Orthop Sports Phys Ther 2017;47(3):151-161. doi:10.2519/ therapy of the neck and median nerve, combined with
jospt.2017.7090). stretching exercises, had outcomes similar to those
of patients who had surgery. In addition, the physical
This Perspectives article was written by a team of JOSPT’s editorial board and staff. Deydre S. Teyhen, PT, PhD, Editor,
therapy patients experienced faster improvements at
and Jeanne Robertson, Illustrator.
the 1-month mark than did patients whose condition
was treated surgically. This research supports the
decision of patients who want to try physical therapy
first before considering surgery. If you have been
diagnosed with carpal tunnel syndrome, physical
therapy offers strong evidence-based treatment
options to help you recover. Evidence indicates that
physical therapy is as effective as surgery to treat this
condition.
For this and more topics, visit JOSPT Perspectives for
Patients online at www.jospt.org.
JOSPT PERSPECTIVES FOR PATIENTS is a public service of the Journal of Orthopaedic & Sports Physical Therapy®. The information and recommendations
contained here are a summary of the referenced research article and are not a substitute for seeking proper health care to diagnose and treat this condition. For
more information on the management of this condition, contact your physical therapist or other health care provider specializing in musculoskeletal disorders.
JOSPT Perspectives for Patients may be photocopied noncommercially by physical therapists and other health care providers to share with patients. The
official journal of the Orthopaedic Section and the Sports Physical Therapy Section of the American Physical Therapy Association (APTA) and a recognized
journal of more than 35 international partners, JOSPT strives to offer high-quality research, immediately applicable clinical material, and useful supplemental
information on musculoskeletal and sports-related health, injury, and rehabilitation. Copyright ©2017 Journal of Orthopaedic & Sports Physical Therapy ®
162 | march 2017 | volume 47 | number 3 | journal of orthopaedic & sports physical therapy