Long-term patient observation after conservative treatment of carpal tunnel syndrome: a summary of two randomised controlled trials

Abstract

BackgroundPhysiotherapy of carpal tunnel syndrome (CTS) involves manual therapy based on neurodynamic techniques. Until now, two randomized controlled trials have shown that immediately after therapy, CTS patients who received neurodynamic techniques had significant improvement in nerve conduction, pain, symptom severity (SSS), functional state (FSS), muscle strength (MS) and two-point discrimination (2PD). However, long-term effects seem to be more important, as they are the only ones that can significantly improve the patient’s health and influence economic and social costs. Thus, the objective of this study was to evaluate the long-term (six months) effects of neurodynamic techniques in the conservative treatment of CTS patients.MethodsCarpal tunnel syndrome patients (107) from two previously published randomised clinical trials were observed for six months after the treatment based on neurodynamic techniques.ResultsThe sensory conduction velocity, motor conduction velocity, and motor latency were not subject to statistically significant changes within six months after therapy (p > 0.05). In both groups, there was further pain reduction (p < 0.05). In Group B, the symptom severity improved significantly (p < 0.05), while the functional status in both groups remained unchanged (p > 0.05). In both groups, there was muscle strength improvement (p < 0.05). Two-point discrimination remained unchanged six months after the therapy.ConclusionThe use of manual therapy based on neurodynamic techniques maintains the beneficial effects 6 months after therapy in CTS patients.

Effect of Persian manual therapy (Fateh technique) on patients with mild and moderate carpal tunnel syndrome: a clinical trial

“…In previous studies, different manual interventions (based on soft tissue, carpal bone treatment, and median nerve and mobilization) showed signs reduction in patients with carpal tunnel syndrome, 12,34,35 which in some survival studies of these signs were also evaluated and approved for months. 24 In the study of Linek & Wolny, which was performed on 103 patients with mild and moderate CTS Symptom Severity and Functional Status, pain significantly decreased, 36 which is consistent with the findings of our study. We also saw similar results in another study of Wolny et al 23 as well as Madenci et al 12 The nerve conductivity velocity is not evaluated in all studies, and in most of them, statistical evaluation has not been performed due to the low number of recorded patients, and additionally, considering the difference in manual therapy and their prescribed time, definitive conclusions in the effect of these interventions have not been performed in neurophysiological registration.…”

“…Although there are various results of the effectiveness of manual therapy in the treatment of carpal tunnel syndrome, which varies from ineffective to useful, there is evidence to suggest that different methods of manual therapy of the wrist area are effective in the treatment of carpal tunnel syndrome and can help reduce pain and symptoms. 18,23,24 In this study, we introduce an Iranian manual therapy method called Fateh hand method, which is one of the manual therapies of Iranian folklore. About four decades ago, Mohammad Fateh invented manual therapy methods to manage lower and upper limb problems.…”

Diagnosis Accuracy of Carpal Tunnel Syndrome in Diabetic Neuropathy

“…Diagnosing CTS in diabetic patients and surgical treatment in certain cases, show an increase in the long-term quality of life [ 30 ]. Moreover, conservative treatment, such as physiotherapy based on neurodynamic techniques, had a positive effect in CTS subjects with an improvement in the NCV and maintaining amelioration until 6 months after the last session of procedures [ 31 , 32 ]. This important observation can probably be easily applied with success in clinical practice in diabetic patients.…”

Neurodynamics: is tension contentious?

“…In larger human clinical trials, neural mobilization is typically part of a multimodal intervention [52][53][54][55]. If neural mobilization is evaluated as a unimodal intervention, different neurodynamic techniques are often combined [52,53], making it impossible to isolate the effects of tensioning techniques.…”