Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials (original) (raw)
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Journal of Hand Therapy, 2004
The purpose of this study was to determine the effectiveness of hand therapy interventions for carpal tunnel syndrome (CTS) based on the best available evidence. A qualitative systematic review was conducted. A literature search using 40 key terms was conducted from the earliest available date to January 2003 using seven databases. Articles were randomly assigned to two of five reviewers and evaluated according to predetermined criteria for inclusion at each of the title, abstract, and article levels. Included studies were independently scored by two reviewers using a structured effectiveness quality evaluation scale and also graded according to Sackett's Levels of Evidence. There were 2027 articles identified from the literature search, of which 345 met the inclusion criteria. Twenty-four studies were used to formulate 30 recommendations. Current evidence demonstrates a significant benefit (grade B recommendations) from splinting, ultrasound, nerve gliding exercises, carpal bone mobilization, magnetic therapy, and yoga for people with CTS.
Turkish Journal of Rheumatology, 2012
Bu çalışmada, hafif karpal tünel sendromu (KTS) tedavisinde bazı konservatif yöntemlerle birlikte uygulanan deksametazon iyontoforezi veya ultrason veya plasebo iyontoforezin (deksametazonsuz) etkinliği karşılaştırıldı. Hastalar ve yöntemler: Elektromiyografi ile doğrulanmış hafif KTS tanılı 58 hasta çalışmaya dahil edildi. Hastalar rastgele üç gruba ayrıldı: (i) deksametazon iyontoforezi ile tedavi edilen iyontoforez grubu (n=20); (ii) ultrason ile tedavi edilen grup (n=20) ve (iii) plasebo iyontoforezi uygulananlar (n=18). Bu tedavilerden biri, tüm hastalara üç aylık tendon ve sinir kaydırma egzersizleri, gece splinti ve aktivite modifikasyonları gibi fizyoterapi prosedürleri ile beraber 15 seans uygulandı. Tedavinin başında, tedavi sonunda ve tedavi bitiminden sonra takip sırasında 3. ayda el bileği eklem hareket açıklığı ve kas testleri, Görsel Analog Skalası (VAS), el sıkma testi, pinçmetre ölçümleri, monofilaman ile duyu testleri, iki nokta diskriminasyon testi, Phalen, ters Phalen, Tinel ve karpal kompresyon testleri, Sağlık Değerlendirme Anketi (HAQ), Boston Sorgulama Anketi (BQ) ve elektrofizyolojik ölçümler değerlendirildi. İstatistiksel analiz SPSS (versiyon 10.0, Windows) yazılımı kullanılarak yapıldı. Bulgular: Çalışma sonunda tüm grupların klinik değerlendirmelerinde istatistiksel olarak anlamlı iyileşmeler görüldü (p≤0.05). Ultrason ve plasebo grubu ile karşılaştırıldığında, iyontoforez grubunda daha başarılı sonuçlar alındı; KTS'li hastaların üç ay sonraki takiplerinde pinçmetre, monofilaman, iki nokta diskriminasyon testleri ve BQ skorlarında istatistiksel anlamlı iyileşme gözlemlendi (p≤0.05). İyontoforez ve ultrason grubunda yapılan elektrofizyolojik ölçümlerde de, istatistiksel olarak anlamlı iyileşmeler kaydedildi (p≤0.05). Sonuç: Bu çalışmanın sonuçları, hafif KTS'li hastaların deksametazon iyontoforezi, tendon kaydırma egzersizleri, splint ve aktivite modifikasyonu ile beraber tedavisinin güvenilir ve etkili olduğunu önermektedir. Ancak, bulgularımızı destekleyen daha geniş ölçekli başka çalışmalara da ihtiyaç vardır. Anahtar sözcükler: Karpal tünel sendromu; deksametazon iyontoforezi; egzersiz; splintleme; ultrason. Objectives: In this study, we aimed to compare the efficacy of some conservative methods in combination with dexamethasone iontophoresis, ultrasound therapy or placebo iontophoresis (without dexamethasone) in the treatment of mild carpal tunnel syndrome (CTS). Patients and methods: Fifty-eight patients diagnosed with mild CTS confirmed by electromyography were included in the study. The subjects were divided randomly into three groups: (i) iontophoresis group-treated with dexamethasone iontophoresis (n=20); (ii) ultrasound group-treated with ultrasound (n=20), and (iii) placebo group-treated with placebo iontophoresis (n=18). All patients received one of these treatments in 15 sessions for three months in combination with physiotherapeutic procedures, such as tendon/nerve gliding exercises, night splinting and activity modifications. Wrist range of motion, muscle test, the Visual Analog Scale (VAS), handgrip test, pinch meter measurement, sensory testing with monofilaments, two-point discrimination test, Phalen's, reverse Phalen's, Tinnel's and carpal compression test, the Health Assessment Questionnaire (HAQ), the Boston Questionnaire (BQ) and electrophysiological assessment were performed at baseline, at the end of therapies and at threemonths during follow-up. Statistical analysis was performed using SPSS software (version 10.0 for Windows). Results: Statistically significant improvements in the clinical status of all groups were observed at the end of the study (p≤0.05). Compared to ultrasound group and placebo group, more successful outcomes were seen in the iontophoresis group, resulting in statistically significant improvements in the pinch meter measurements, monofilament and two-point discrimination tests, and in BQ scores at three months during follow-up (p≤0.05). A statistically significant improvement was also recorded in the electrophysiological measurements in the iontophoresis group and ultrasound group (p≤0.05). Conclusion: Our study results suggest that dexamethasone iontophoresis administration combined with tendon gliding exercises, splint and activity modification is reliable and effective in the treatment of patients with mild CTS. However, further large-scale studies are required to confirm these findings.
Systematic review of treatment methods for the carpal tunnel syndrome
Timisoara Physical Education and Rehabilitation Journal
The carpal tunnel syndrome is a common condition, localized at the hand and knuckle level, caused by a compression of the median nerve as it travels the rigid structures of the carpal tunnel. This phenomenon is, essentially, a compressive neuropathy.Aim: The purpose of our research is to comparatively analyze the treatment methods of the carpal tunnel syndrome: treatment by acupuncture, fascial manipulation, low-level laser therapy, cupping treatment, kinesiotaping, surgical treatment, orthosis method, nerve and tendon gliding exercises, and ultrasound therapy, based on the review of specialized articles relevant for the last 10 years.Methods: The research method consisted of 3 steps. First, we analyzed and selected 160 specialized articles, based on titles and key words; in the second step, we analyzed the summaries of the articles, thus, reducing the number to 50 articles. The third step consisted of selecting 7 relevant articles based on an article content review.Results: The res...
Comparison of three conservative treatment protocols in carpal tunnel syndrome
International Journal of Clinical Practice, 2006
The aim of this study was to investigate and compare the therapeutic effect of three different combinations in the conservative treatment of carpal tunnel syndrome (CTS) by means of clinical and electrophysiological studies. The combinations included tendon-and nerve-gliding exercises in combination with splinting, ultrasound treatment in combination with splinting and the combination of ultrasound, splinting, tendon-and nerve-gliding exercises. A total 28 female patients (56 wrists) with clinical and electrophysiologic evidence of bilateral CTS were studied. In all patient groups, the treatment combinations were significantly effective immediately and 8 weeks after the treatment. The results of the long-term patient satisfaction questionnaire revealed that symptomatic improvement is more prominent in the group treated with splinting, exercise and ultrasound therapy combination. Our results suggest that a combination of splinting, exercise and ultrasound therapy is a preferable and an efficacious conservative type of treatment in CTS.
Caspian Journal of Internal Medicine, 2020
Background: Manual therapy techniques are part of physiotherapy treatment of carpal tunnel syndrome (CTS) which are classified into two groups including nerve mobilization and mechanical interface mobilization. The aim of the study was to find which manual therapy method-technique directed to mechanical interface and nerve mobilization–has superior beneficial effects on clinical and electrophysiological findings in conservative management of patients with CTS. Methods: Thirty patients with CTS participated into two groups namely: mechanical interface and nerve mobilization in this randomized clinical trial. The intervention was performed three times weekly for 4 weeks. Mechanical interface mobilization was directed to structures around the median nerve at the forearm and wrist. Techniques of median nerve gliding and tension were used in the nerve mobilization group. The outcome measures included visual analogue scale (VAS), symptom severity scale (SSS), hand functional status scale ...
Archives of Physical Medicine and Rehabilitation, 2014
To achieve consensus on a multidisciplinary treatment guideline for carpal tunnel syndrome (CTS). Design: Delphi consensus strategy. Setting: Systematic reviews reporting on the effectiveness of surgical and nonsurgical interventions were conducted and used as an evidencebased starting point for a European Delphi consensus strategy. Participants: In total, 35 experts (hand surgeons selected from the Federation of European Societies for Surgery of the Hand, hand therapists selected from the European Federation of Societies for Hand Therapy, physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Interventions: Not applicable. Main Outcome Measures: Each Delphi round consisted of a questionnaire, analysis, and feedback report. Results: After 3 Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of CTS. The experts agreed that patients with CTS should always be instructed, and instructions combined with splinting, corticosteroid injection, corticosteroid injections plus splinting, and surgery are suitable treatments for CTS. Relevant details for the use of instructions, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of the aforementioned treatment options were identified as follows: severity and duration of the disorder and previous treatments received. A relation between the severity/duration and choice of therapy was found by the experts and reported in the guideline. Conclusions: This multidisciplinary treatment guideline may help physicians and allied health care professionals to provide patients with CTS with the most effective and efficient treatment available.
Clinical management of carpal tunnel syndrome: A 12-year review of outcomes
American Journal of Industrial Medicine, 1999
Single group prospective, in which all patients were assigned to a single treatment group and followed longitudinally. 4. Multiple group retrospective, in which patients were assigned to different treatment conditions, and archival data were analysed to assess outcomes. 5. Single group retrospective, in which patients were assigned to one treatment condition and archival data were used. 6. Case study, which presented data on single patient outcomes. All prospective multiple group studies available were included in the review. Other study designs were included depending on availability of studies with higher levels of study design within the treatment category. Specific interventions included in the review Surgery (open and endoscopic release), pharmacological/vitamins/steroids (taken orally, injected into the carpal canal or transported via iontophoresis), physical therapy (range or motion exercises)/splinting, chiropractic/manipulation, biobehavioural therapies (individual and group cognitive behaviour therapy, muscle activity biofeedback, neuromuscular re-education and movement retraining), and occupational/work rehabilitation. Participants included in the review People with diagnosed carpal tunnel syndrome, or diagnoses such as 'hand pain', both work-related and non-workrelated. Outcomes assessed in the review Medical status (two-point discrimination, nerve conduction velocity, Semmes-Weinstein, Phalen's test, Tinel's test, thenar atrophy, interstitial pressure), symptoms (self report) (pain, tenderness, numbness, parasthesia, weakness, night symptoms, fine dexterity loss), function (grip, key pinch, pulp pinch, range of motion, activities of daily living), work status (median days out of work, workers' compensation status, working with pain), psychological well-being (anxiety, depression, coping strategies, sickness), patient satisfaction (treatment satisfaction rating). How were decisions on the relevance of primary studies made?
Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome
British Journal of Surgery, 2001
Background: Carpal tunnel syndrome (CTS) is a common disorder for which several surgical treatment options are available. However, there is no consensus on the most effective method of treatment. The object of this systematic review is to compare the ef®cacy of the various surgical techniques in relieving the symptoms of CTS and promoting return to work and/or activities of daily living. Methods: Computer-aided searches of Medline, EMBASE and the Cochrane Controlled Trials Register were conducted, together with reference checking. A rating system, based on the number of studies and their methodological quality and ®ndings, was used to determine the strength of the available evidence for the ef®cacy of the treatment. Results: Fourteen studies were included in the review. None of the alternatives to standard open carpal tunnel release (OCTR) seems to offer better relief of symptoms. There is con¯icting evidence about whether endoscopic carpal tunnel release results in earlier return to work and/or activities of daily living. Conclusion: Standard OCTR is still the preferred method of treatment for CTS. It is just as effective as the alternatives, but is technically less demanding, so incurs a lower risk of complications and of added costs.