Original Article
A Pilot Study Comparing Two Manual Therapy Interventions for Carpal Tunnel Syndrome

https://doi.org/10.1016/j.jmpt.2006.11.014Get rights and content

Abstract

Objective

The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument–assisted soft tissue mobilization (GISTM) and STM administered with the clinician hands.

Methods

The study was a prospective comparative research design in the setting of a research laboratory. Volunteers were recruited with symptoms suggestive of CTS based upon a phone interview and confirmed by electrodiagnostic study findings, symptom characteristics, and physical examination findings during an initial screening visit. Eligible patients with CTS were randomly allocated to receive either GISTM or STM. Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks. Outcome measures included (1) sensory and motor nerve conduction evaluations of the median nerve; (2) subjective pain evaluations of the hand using visual analog scales and Katz hand diagrams; (3) self-reported ratings of symptom severity and functional status; and (4) clinical assessments of sensory and motor functions of the hand via physical examination procedures. Parametric and nonparametric statistics compared treated CTS hand and control hand and between the treatment interventions, across time (baseline, immediate post, and at 3 months' follow-up).

Results

After both manual therapy interventions, there were improvements to nerve conduction latencies, wrist strength, and wrist motion. The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions. Data from the control hand did not change across measurement time points.

Conclusions

Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS.

Section snippets

Study Population

The New York Chiropractic College ethics committee approved all measurement and clinical procedures for this study. Advertisements in local newspapers were used to recruit patients with clinically suspected CTS. A phone interview was used as an initial screening instrument for eligibility to participate in the study. The phone interview addressed the following exclusion criteria: (1) older than 50 years of age; (2) previous treatment interventions with surgery and/or steroid injections; (3) a

Study Population

During a period of 15 months, we phone interviewed 67 patients. Thirty-one of these patients did not qualify based upon our phone interview. Another 10 patients reported to the laboratory for clinical evaluations, but did not meet the inclusion criteria. Twenty-six patients with CTS were enrolled into the research study and were randomly allocated to either GISTM (n = 14) or STM (n = 12). Four of these patients dropped out of the research study. One patient dropped out of the study because of

Discussion

Manual therapies for CTS were effective at improving objective measures of impairments and patient-centered measures of symptom severity and functional abilities. Improvements to nerve conduction latencies, wrist strength, and wrist motion were objective indices of the clinical efficacy of manual therapies for CTS. Severity of symptoms and functional impairments are the major reasons that patients seek treatment. Similarly, relief of symptoms and restoration of functional abilities contribute

Conclusion

The current study addressed the clinical efficacy of manual therapy techniques for CTS, which was lacking sufficient evidence. The data from this prospective comparative research design documented the clinical efficacy of manual therapy for mild to moderate CTS. The recommendation for future research is to conduct randomized controlled trials using patient-centered measures as the primary outcome measures to relatively compare operative and/or nonoperative interventions for CTS to distinguish

Acknowledgment

The authors acknowledge the financial support of TherapyCare Resources, Inc, Indianapolis, Ind. TherapyCare Resources, Inc, is the corporate entity for and owner of Graston Technique. The results presented herein represent the conclusions and opinions of the authors. Publication does not necessarily imply endorsement by TherapyCare Resources, Inc, or endorsement of its products by the authors. No commercial party having a direct interest in the results of the research supporting this article

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