When it comes to choosing surgery or physical therapy for carpal tunnel syndrome (CTS), studies have found most people would rather pursue a conservative approach. Now new research from Spain is providing more support for that preference, concluding that in terms of pain and function, physical therapy is equal to surgery at 6 and 12 months after baseline, and actually produces greater improvements earlier on.
In a study e-published ahead of print in the Journal of Pain (abstract only available for free) researchers compared pain and function reports from 111 women who underwent either surgery (56 participants) or physical therapy (55 participants) for CTS. Using the Numerical Pain Rating Scale (NPRS), Boston Carpal Tunnel Questionnaire (BCTQ), and the Global Rating of Change assessment, they analyzed reports at 1, 3, 6, and 12 months after surgery or therapy.
The study found that when it came to self-reported current level of pain and worst pain over the preceding week, the physical therapy participants reported higher decreases on the 11-point pain scale at 1 month (an average 2-point difference from the surgery group) and at 3 months (an average 1.3-point difference). By 6 months, those differences had lessened and were practically nonexistent after 1 year.A similar pattern was uncovered when researchers analyzed BCTQ data, with the physical therapy participants registering significant improvements compared with the surgery group in the first month, decreased but notable differences in month 3, and minimal differences at 6 and 12 months.
Physical therapy used in the study was composed of manual therapies that included desensitization maneuvers of the central nervous system—primarily soft tissue mobilization and nerve/tendon exercises “including manual techniques directed at anatomical sites of potential entrapment of the median nerve,” according to authors. Participants received 3 30-minute treatment sessions provided once a week, and a final educational session on doing the exercises as homework.The surgery group underwent open or endoscopic decompression and release of the carpal tunnel, with the approach based on the preferences of the patient and surgeon. Patients in this group also received the same educational session on the tendon and nerve gliding exercises provided to the physical therapy group.
Authors of the study point out that their study differs from previous research that found surgery to produce greater improvement at 6 and 12 months—a difference they attribute to the kind of physical therapy used for the intervention.”Our results on the physiotherapy arm could have been better than those of prior reports because we have applied manual therapies including desensitization maneuvers of the central nervous system,” they write. ”
Approaches including integrative manual therapies may be more effective than therapeutic interventions targeting only the hand/wrist area, but testing this hypothesis requires further randomized clinical trials.”The real point, according to authors, is that their study supports not only the public’s preference for conservative approaches to CTS, but guidelines from the American Academy of Orthopaedic Surgeons (AAOS).”It seems conservative management may be considered as a front-line treatment in mild to moderate, and sometimes severe, cases of CTS before subsequently considering surgery,” authors write.