Carpal Tunnel Syndrome. Part I: Effectiveness of Nonsurgical Treatments–A Systematic Review

Huisstede, Bionka M. A.; Hoogvliet, Peter; Randsdorp, Manon S.; Glerum, Suzanne; Middelkoop, Marienke van; Koes, Bart W.

doi:10.1016/j.apmr.2010.03.022

Cited by 194 publications

(185 citation statements)

References 74 publications

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“…They found no evidence to suggest that a particular intensity or frequency was more effective. 39 One possible explanation for the difference in responses between patients with CTS and those with neck and arm pain who demonstrate mechanical sensitivity of the median nerve may be that the primary dysfunction in CTS is localized to a relatively small and superficial region, and therefore amenable to focused interventions. In contrast, therapeutic US may not address the more diffuse source of nociceptive input that may be at play in neurogenic neck and arm pain.…”

Section: Discussionmentioning

confidence: 99%

“…Therapeutic US is effective in the management of more localized peripheral neurogenic dysfunction, specifically carpal tunnel syndrome (CTS). 39,63 In a systematic review, Huisstede et al 39 reported that there was no evidence for the benefit of US over placebo at 2-week follow-up, but that there was moderate evidence for symptom improvement at 7 weeks. They found no evidence to suggest that a particular intensity or frequency was more effective.…”

Section: Discussionmentioning

confidence: 99%

“…43,44 Neck Disability Index (NDI) The NDI is a self-report measure containing 10 items that assesses a patient's disability due to neck pain. 45 Test-retest reliability for the NDI in patients with cervical radiculopathy has been reported to be fair (ICC50.55) 39 to moderate (ICC50.68), 46 and the minimal clinically important change has been reported to be range from 7.0 points or 14% 46 to 8.5 points or 17%. 47 …”

Section: Global Rating Of Change (Groc)mentioning

confidence: 99%

“…37,38 A recent systematic review concluded that there is moderate evidence for the use of US in the management of carpal tunnel syndrome, 39 a condition of localized neural mechanosensitivity. Animal research suggests that US may influence spinal nociceptive processing in models of peripheral inflammation.…”

Section: Introductionmentioning

confidence: 99%

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The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

Costello

Puentedura

Cleland

et al. 2016

Journal of Manual & Manipulative Therapy

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Study design: Randomized clinical trial. Objectives: To investigate the immediate effects of soft tissue mobilization (STM) versus therapeutic ultrasound (US) in patients with neck and arm pain who demonstrate neural mechanical sensitivity. Background: While experts have suggested that individuals with neck and arm pain associated with neural tissue mechanical sensitivity may benefit from STM, there has been little research to investigate this hypothesis. Methods: Twenty-three patients with neck and arm pain and a positive upper limb neurodynamic test (ULNT) were randomly assigned to receive STM or therapeutic US during a single session. Outcome measures were collected immediately before and after treatment, and at 2-4 day follow-up. Primary outcomes were the Global Rating of Change (GROC), range of motion (ROM) during the ULNT, and pain rating during the ULNT. Secondary measures included the Neck Disability Index (NDI), Patient-Specific Functional Scale (PSFS), Numeric Pain Rating Scale (NPRS), and active range of shoulder abduction motion combined with the wrist neutral or wrist extension. Results: A greater proportion of patients in the STM group reported a significant improvement on the GROC immediately after treatment (P50.003, STM575%, US59%), and at 2-4 day follow-up (P50.027, STM558%, US59%). Patients who received STM demonstrated greater improvements in ROM during ULNT (P50.026), PSFS (P50.007), and shoulder active ROM combined with wrist extension (P50.028). Improvements in Numeric Pain Rating Scale and pain during the ULNT were observed only in the STM group. There was no difference between groups for the NDI or shoulder abduction ROM with wrist neutral. Conclusion: Patients with neck and arm pain demonstrated greater improvements in ULNT ROM, GROC, and PSFS, and pain following STM than after receiving therapeutic US. Level of evidence: Therapy, level 1b.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Global Rating Of Change (Groc)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

Costello

Puentedura

Cleland

et al. 2016

Journal of Manual & Manipulative Therapy

View full text Add to dashboard Cite

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“…13 Although further research is required, recent systematic reviews indicate that conservative management with nerve and tendon gliding exercises may be beneficial for patients with CTS. 14,15 It has been proposed that these exercises may improve restricted nerve gliding, reduce scar formation, and increase intraneural blood flow, which may also facilitate a reduction of intraneural edema and dispersion of inflammatory by-products. [16][17][18][19] Albeit plausible, the therapeutic mechanisms by which splinting and nerve and tendon gliding exercises may influence signs and symptoms of CTS remain largely conjectural.…”

mentioning

confidence: 99%

Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome—an MRI study to reveal therapeutic mechanisms

Schmid

Elliott

Strudwick

et al. 2012

Journal Orthopaedic Research

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Splinting and nerve and tendon gliding exercises are commonly used to treat carpal tunnel syndrome (CTS). It has been postulated that both modalities reduce intraneural edema. To test this hypothesis, 20 patients with mild to moderate CTS were randomly allocated to either night splinting or a home program of nerve and tendon gliding exercises. Magnetic resonance images of the wrist were taken at baseline, immediately after 10 min of splinting or exercise, and following 1 week of intervention. Primary outcome measures were signal intensity of the median nerve at the wrist as a measure of intraneural edema and palmar bowing of the carpal ligament. Secondary outcome measures were changes in symptom severity and function. Following 1 week of intervention, but not immediately after 10 min, signal intensity of the median nerve was reduced by $11% at the radioulnar level for both interventions (p ¼ 0.03). This was accompanied by a mild improvement in symptoms and function (p < 0.004). A similar reduction in signal intensity is not observed in patients who only receive advice to remain active. No changes in signal intensity were identified further distally (p > 0.28). Ligament bowing remained unchanged (p > 0.08). Intraneural edema reduction is a likely therapeutic mechanism of splinting and exercise. Keywords: MRI; nerve and tendon gliding exercises; splinting; carpal tunnel syndrome; neurodynamics Carpal tunnel syndrome (CTS) is a peripheral neuropathy at the level of the wrist. Despite considerable efforts, the pathophysiology of CTS is not yet fully understood. 1 There is however a well-established link between an elevated pressure in the carpal tunnel and the development of CTS. 2,3 When the pressure on a peripheral nerve is experimentally increased, a reduction of intraneural microcirculation occurs with subsequent breakdown of the blood nerve barrier and the formation of intraneural and extraneural edema. 4 In CTS, swelling of the median nerve has been identified intra-operatively, 5,6 with ultrasound imaging 7 and with conventional magnetic resonance imaging (MRI). 8,9 If present for prolonged periods, intraneural edema may lead to potentially irreversible fibrotic changes. 4 These fibrotic changes are present in patients with severe CTS. 9 Edema reduction to prevent progression to a fibrotic stage is therefore a plausible target in the management of patients with mild to moderate CTS.Besides advice, splinting and nerve and tendon gliding exercises are the most frequently performed noninvasive treatment modalities for CTS. 10 The beneficial effect of night splinting in a neutral wrist position is commonly attributed to the avoidance of end-range positions associated with high carpal tunnel pressures. 11,12 Maintenance of a neutral wrist position is believed to promote adequate blood circulation with a subsequent reduction of edema. 13 Although further research is required, recent systematic reviews indicate that conservative management with nerve and tendon gliding exercises may be beneficial for patie...

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Ergonomic positioning or equipment for treating carpal tunnel syndrome

O’Connor

Page

Massy‐Westropp

2012

Cochrane Database of Systematic Reviews

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Carpal Tunnel Syndrome. Part I: Effectiveness of Nonsurgical Treatments–A Systematic Review

Cited by 194 publications

References 74 publications

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome—an MRI study to reveal therapeutic mechanisms

Ergonomic positioning or equipment for treating carpal tunnel syndrome

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