Manual Therapy vs. Surgery for Carpal Tunnel Syndrome – RCT
- RRS Education
Carpal Tunnel Syndrome (CTS) is a common condition caused by compression of the median nerve within the carpal tunnel. CTS can cause considerable pain and disability. However, recent literature has shown that CTS is also associated with widespread pain hypersensitivity, thermal pain hyperalgesia and the wind-up phenomenon (a.k.a. temporal summation) in areas outside the median nerve territory. These findings suggest that widespread sensitization is also involved in the presentation of CTS. While surgery remains one of the most common treatments for CTS, only 33% of individuals who undergo surgical decompression return to work within 60 days (see Review for references). While physical and manual therapies are also advocated, there is a paucity of evidence supporting the use of exercise and mobilization as lone therapies for CTS. Recent evidence suggests that the use of exercises targeted at desensitizing the nervous system, such as pain neuroscience education and nerve flossing, may decrease pressure and thermal sensitivity. However, no studies conducted to date have determined whether patients who receive manual therapy or surgery for CTS exhibit positive changes in pressure pain threshold or thermal sensitivity after a course of treatment. Therefore, the purpose of this RCT (published in the European Journal of Pain in 2017) was to compare the effects of manual therapy (soft-tissue mobilization to nerve entrapment sites) and surgery (endoscopic decompression and release) for improving pain and nociceptive gain (pain sensitivity, temperature sensitivity) in patients with CTS. The authors also sought to determine if changes in pain intensity that occur after manual therapy or surgery are associated with changes in pressure and thermal pain sensitivity…LOG IN OR SUBSCRIBE TO ACCESS THE FULL REVIEW!