Carpal Tunnel Syndrome (CTS) iscaused when the distal portion of the median nerve is compressed.
Causesinclude fracture, overuse injury, diabetes and thyroid diseases. Carpal Tunnelis usually characterized by pain or numbness in the fingers, weak gripstrength, and pain when gripping objects. Treatment may includeanti-inflammatory drugs and cortisone shots, but if these are not effectivethen surgery to relieve pressure on the median nerve is commonly undertaken. In the study Evaluation of Carpal Arch Widening and Outcomes After Carpal TunnelRelease researchers attempted to determine what effect, if any, an increasein the carpal arch width had on patient outcomes after surgical carpal tunnelrelease. 76 patients were chosen and underwent pre-surgical testing. The testsincluded a radiological measurement of the carpal arch width (measured fromtrapezium to hamate), a grip strength test, and a Disabilities of the Arm,Shoulder, and Hand (DASH) questionnaire. All patients underwent an open carpaltunnel release surgery.
All tests were administered again at a 6 month followup. Statistical analysis used a paired t-test and Pearson correlation analysis.Statistically significant findings were set at p<.05.
Mean carpal arch width before surgerywas 25.1 mm. After surgery the mean change in carpal arch width was +1.8 mm,with a range of -.
03 mm to 5.2 mm. The change in carpal arch width pre-surgeryto post-surgery was found to be significant (p<.05). The mean grip strengthincreased from 26 kg to 31 kg (p<.05). Mean DASH scores improved from 41 to17 (p<.
05) When these findings were correlated with the amount of carpalarch width increase there was no significance. This study shows that althoughpatient outcomes were much better after the carpal tunnel release surgery,there is no apparent correlation between increase in carpal arch width andpatient outcomes. In the study Efficacy of Manual Therapy Including Neurodynamic Techniques for theTreatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial researchersconducted a study to see if manual therapies such as massage and carpal bonemobilization were more effective for treating CTS than electrophysicaltherapies such as ultrasound and low-level laser. 160 patients total werechosen to take part in the study. These patients had been diagnosed with CTS bya physician and had at least 2 symptoms of CTS. Patients were excluded forprior surgery for CTS, receiving medications for CTS, diabetes, pregnancy,tendon sheath inflammation, cervical radiculopathy, past acute wrist injury,and atrophy of the thenar eminence.
Dueto issues at the follow-up exams only 140 patient records were able to be usedfor the study. 70 of these patients were in the manual therapy group, and 70were in the electrophysical therapy group. Pre-treatment, all participants weregiven tests for nerve conduction and all scores equal to or greater than 50 m/swere deemed normal. Normal distal motor latency, once standardized, was equalor lower than 0.
7 m/s. Patients also used a visual analogue scale(VAS) on ascale from 1-10 to assess hand pain, and Boston Carpal Tunnel Questionnaire(BCTQ) was used to determine severity of CTS and the physical disability. Both the manual therapy group and theelectrophysical therapy group were exposed to 10 weeks of physical therapytreatment, 2 sessions per week, for a total of 20 sessions. The manual therapygroup was given functional massage and 3 sets of 60 repetitions using wristmobilization techniques during each session. The electrophysical therapy groupwas given treatment with a red laser, an infrared laser, and lastly with ultrasoundtherapy during each session.
Statistical analysis was done with independentt-test, chi squared test, one-way analysis of variance, and Bonferroni’s posthoc test. Statistically significant findings were set at a p<.05. Both groups experienced benefits fromthe therapies they received, though the manual therapy group had slightlybetter outcomes. The manual therapy group had significantly better scores fordecrease in pain levels, symptom severity, and functional status (p<.
01).Though statistical analysis showed that electrophysical therapy did have asignificant effect on positive patient outcomes, these therapies were not aseffective as manual therapy. This study states that it is the first to evaluatethe efficacy of manual therapy on CTS patients.
These findings suggest thatmanual therapy is more effective than other commonly used treatments and meritsfurther research.