Physical Therapy Works as well as, sometimes even better than, surgery for Carpal Tunnel Syndrome

A compelling argument for physical therapy vs. surgery for carpal tunnel syndrome

How compelling? Researchers found similar improvement in self-reported function and CTS symptoms severity for both surgical and physical therapy patients after 1 year, but the physical therapy group reported more significant gains in the first month. That speedier gain early on is worth noting, researchers believe, because it allows those patients to return to work and other activities sooner than their peers who underwent surgery. Results were published in the Journal of Orthopedic and Sports Physical therapy. 

The study, conducted in Spain, focused on 100 women who had experience CTS symptoms for at least a year, including pain and paresthesia in the median nerve distribution, positive Tinel sign, and positive Phalen sign. Participants also underwent electrodiagnostic examination to verify deficits in sensory and motor median nerve conduction.

Once accepted into the program, the women were randomly divided into 2 groups of 50. One group received endoscopic decompression and release of carpal tunnel through surgery. The other group received 3 treatment sessions of manual therapies that targeting areas “anatomically related to potential entrapment of the median nerve (e.g., shoulder, elbow, forearm, wrist and fingers), “ as well as the cervical spine (more on that later).

Patients in the physical therapy group also received cervical spine exercises for stretching neck muscles, which they were encourage to perform at home during the follow-up period as needed. Based on earlier studies by others, the researchers hypothesized that patients with CTS also were experiencing limits on cervical range of motion, area as well. Ultimately, the cervical work didn’t result in any notable changes in cervical range of motion for the women in either group. 

But a different story surfaced when it came to improvement in self-reported function as measured through the Boston Carpal Tunnel Questionnaire (BCTQ) as well as pinch-tip grip force. The physical therapy group shoed average 1-month gains that exceeded those of the surgery group by nearly 1 point on the 5-pint BCTQ scale. Pinch-tip grip force improvements also bettered the surgery group a the 1-month mark. When reassessed at 6 and 12 months, however, the groups posted similar scores on both assessments. 

“The findings of the current study have potential clinical implications and open new lines of research.” The authors wrote. “Because better short-term outcomes were found with manual therapy, patients may be able to return earlier to their activities of daily living and work when they receive manual therapy, compared to those who undergo surgery.”

While earlier studies tended to give surgery the edge over conservative treatments, those ‘conservative” approaches usually lumped physical therapy with a host of ineffective treatments that included splints, steroid injection, lasers, and transcutaneous electrical nerve stimulation. Authors of the current study say theirs is the first to make a clean comparison between surgery and well-defined multi-modal manual therapy.

To review referenced article go to: https://www.ncbi.nlm.nih.gov/pubmed/28158963/ PTinMOTIONmag.org/June 2017.

If you are experiencing an onset of hand cramping or numbness in some or all of your fingers, you may be experiencing carpal tunnel syndrome and/or issues in the elbow, shoulder or cervical spine that have negatively impacted your nerve health as it travels down to your hand and wrist. Physical therapy can help you determine where the problem may be and how to alleviate your symptoms. 

Call for a free phone 15-20 consultation with Cindy at BodyFit Physical Therapy to see if physical therapy can help you.

Call Cindy at 860-507-7365 or email cindy@bodyfitphysicaltherapy.com.