Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial.
This randomized clinical trial investigated the effectiveness of surgery compared with physical therapy consisting of manual therapies including desensitization maneuvers in carpal tunnel syndrome (CTS). The setting was a public hospital and 2 physical therapy practices in Madrid, Spain. One hundred twenty women with CTS were enrolled between February 2013 and January 2014, with 1-year follow-up completed in January 2015. Interventions consisted of 3 sessions of manual therapies including desensitization maneuvers of the central nervous system (physical therapy group, n = 60) or decompression/release of the carpal tunnel (surgical group, n = 60). The primary outcome was pain intensity (mean pain and the worst pain), and secondary outcomes included functional status and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire and the self-perceived improvement. They were assessed at baseline and 1, 3, 6, and 12 months by a blinded assessor. Analysis was by intention to treat. At 12 months, 111 (92%) women completed the follow-up (55/60 physical therapy, 56/60 surgery). Adjusted analyses showed an advantage (all, P < .01) for physical therapy at 1 and 3 months in mean pain (Δ -2.0 [95% confidence interval (CI) -2.8 to -1.2]/-1.3 [95% CI -2.1 to -.6]), the worst pain (Δ -2.9 [-4.0 to -2.0]/-2.0 [-3.0 to -.9]), and function (Δ -.8 [-1.0 to -.6]/-.3 [-.5 to -.1]), respectively. Changes in pain and function were similar between the groups at 6 and 12 months. The 2 groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire at all follow-ups. In women with CTS, physical therapy may result in similar outcomes on pain and function to surgery.


BACKGROUND
http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT01789645.


CONCLUSIONS
This study found that surgery and physical manual therapies including desensitization maneuvers of the central nervous system were similarly effective at medium-term and long-term follow-ups for improving pain and function but that physical therapy led to better outcomes in the short term.
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Alcorcón, Madrid, Spain. Electronic address: cesar.fernandez@urjc.es.
César
C
Fernández-de-Las Peñas
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Alcorcón, Madrid, Spain.
Ricardo
R
Ortega-Santiago
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Alcorcón, Madrid, Spain.
Ana I
AI
de la Llave-Rincón
Department of Neurology and Neurophysiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
Almudena
A
Martínez-Perez
Department of Traumatology and Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
Homid
H
Fahandezh-Saddi Díaz
Department of Traumatology and Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
Javier
J
Martínez-Martín
Department of Neurology and Neurophysiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
Juan A
JA
Pareja
Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
Maria L
ML
Cuadrado-Pérez
D002349:Carpal Tunnel Syndrome / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D010146:Pain / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery; D010147:Pain Measurement; D013997:Time Factors; D016896:Treatment Outcome
Carpal tunnel syndrome; manual therapy; pain; physical therapy; surgery