Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial

Tomasz Wolny; Edward Saulicz; Paweł Linek; Michael Shacklock; Andrzej Myśliwiec

doi:10.1016/j.jmpt.2017.02.004

Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial

J Manipulative Physiol Ther. 2017 May;40(4):263-272. doi: 10.1016/j.jmpt.2017.02.004. Epub 2017 Apr 8.

Authors

Tomasz Wolny¹, Edward Saulicz¹, Paweł Linek², Michael Shacklock³, Andrzej Myśliwiec¹

Affiliations

¹ Department of Kinesiotherapy and Special Physiotherapy Methods, the Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
² Department of Kinesiotherapy and Special Physiotherapy Methods, the Jerzy Kukuczka Academy of Physical Education, Katowice, Poland. Electronic address: linek.fizjoterapia@vp.pl.
³ Neurodynamic Solutions, Adelaide, Australia.

PMID: 28395984
DOI: 10.1016/j.jmpt.2017.02.004

Abstract

Objective: The purpose of this randomized trial was to compare the efficacy of manual therapy, including the use of neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS).

Methods: The study included 140 CTS patients who were randomly assigned to the manual therapy (MT) group, which included the use of neurodynamic techniques, functional massage, and carpal bone mobilizations techniques, or to the electrophysical modalities (EM) group, which included laser and ultrasound therapy. Nerve conduction, pain severity, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire were assessed before and after treatment. Therapy was conducted twice weekly and both groups received 20 therapy sessions.

Results: A baseline assessment revealed group differences in sensory conduction of the median nerve (P < .01) but not in motor conduction (P = .82). Four weeks after the last treatment procedure, nerve conduction was examined again. In the MT group, median nerve sensory conduction velocity increased by 34% and motor conduction velocity by 6% (in both cases, P < .01). There was no change in median nerve sensory and motor conduction velocities in the EM. Distal motor latency was decreased (P < .01) in both groups. A baseline assessment revealed no group differences in pain severity, symptom severity, or functional status. Immediately after therapy, analysis of variance revealed group differences in pain severity (P < .01), with a reduction in pain in both groups (MT: 290%, P < .01; EM: 47%, P < .01). There were group differences in symptom severity (P < .01) and function (P < .01) on the Boston Carpal Tunnel Questionnaire. Both groups had an improvement in functional status (MT: 47%, P < .01; EM: 9%, P < .01) and a reduction in subjective CTS symptoms (MT: 67%, P < .01; EM: 15%, P < .01).

Conclusion: Both therapies had a positive effect on nerve conduction, pain reduction, functional status, and subjective symptoms in individuals with CTS. However, the results regarding pain reduction, subjective symptoms, and functional status were better in the MT group.

Keywords: Carpal Tunnel Syndrome; Manual Therapy; Physical Therapy.

Publication types

Comparative Study
Multicenter Study
Randomized Controlled Trial

MeSH terms

Adult
Carpal Tunnel Syndrome / diagnosis*
Carpal Tunnel Syndrome / therapy*
Electromyography / methods
Female
Humans
Low-Level Light Therapy / methods*
Male
Median Nerve / physiopathology
Middle Aged
Musculoskeletal Manipulations / methods*
Neural Conduction / physiology
Pain Measurement
Patient Satisfaction / statistics & numerical data
Physical Therapy Modalities
Prognosis
Risk Assessment
Severity of Illness Index
Single-Blind Method
Treatment Outcome
Ultrasonic Therapy / methods*

Associated data

ANZCTR/ACTRN12614000367640