Physical Therapy Matches Surgery for Carpal Tunnel Syndrome

Researchers at Universidad Rey Juan Carlos conducted a randomized, parallel-group trial involving 100 women with CTS who were randomly allocated to surgery or a physical therapy regimen focusing on the neck and median nerve for 30 minutes, once a week. Patients were assessed at baseline and at one, three, six, and 12 months after treatment, with the primary outcome being self-rated hand function, as assessed by the Boston CTS questionnaire. Secondary outcomes included active cervical range of motion, pinch-tip grip force, and severity subscale on the Boston questionnaire.

After one month, patients in the physical therapy group had better hand function during daily activities and better grip force than the patients who underwent surgery. At three, six, and 12 months after treatment, patients in the surgery group were no better than those in the physical therapy group; both groups showed similar improvement in function, grip strength, and pain reduction. No improvements in cervical range of motion were observed in either patient group. The study was published in the March 2017 issue of the Journal of Orthopedic & Sports Physical Therapy.

“Conservative treatment may be an intervention option for patients with carpal tunnel syndrome as a first line of management prior to, or instead of surgery,” said lead author César Fernández de las Peñas, PT, PhD, DMSc, of the department of physical therapy, occupational therapy, rehabilitation, and physical medicine. “Because the study only included women from a single hospital, additional research needs to be done to generalize findings.”

CTS involves idiopathic median neuropathy with a pathophysiology not completely understood, but is considered a compression of the median nerve traveling through the carpal tunnel. The main symptom is an intermittent numbness of the thumb, index, long and radial half of the ring finger, which usually occurs at night and is relieved by wearing a wrist splint that prevents flexion. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of muscles in the thenar eminence, and weakness of palmar abduction; risk factors are primarily genetic, rather than environmental.