Comparison of Three Conservative Treatment Protocols In Carpal Tunnel Syndrome

O. Baysal; Z. Altay; C. Ozcan; K. Ertem; S. Yologlu; A. Kayhan

Disclosures

Int J Clin Pract. 2006;60(7):820-828. 

In This Article

Summary and Introduction

Summary

The aim of this study was to investigate and compare the therapeutic effect of three different combinations in the conservative treatment of carpal tunnel syndrome (CTS) by means of clinical and electrophysiological studies. The combinations included tendon- and nerve-gliding exercises in combination with splinting, ultrasound treatment in combination with splinting and the combination of ultrasound, splinting, tendon- and nerve-gliding exercises. A total 28 female patients (56 wrists) with clinical and electrophysiologic evidence of bilateral CTS were studied. In all patient groups, the treatment combinations were significantly effective immediately and 8 weeks after the treatment. The results of the long-term patient satisfaction questionnaire revealed that symptomatic improvement is more prominent in the group treated with splinting, exercise and ultrasound therapy combination. Our results suggest that a combination of splinting, exercise and ultrasound therapy is a preferable and an efficacious conservative type of treatment in CTS.

Introduction

The carpal tunnel syndrome (CTS), caused by compression of the median nerve at the wrist, is considered to be the most common entrapment neuropathy.[1] Symptoms of CTS include pain, paraesthesia, numbness or tingling involving the fingers innervated by the median nerve. Symptoms are worst at night and often wake the patient.[2] To relieve the pressure on the median nerve, several treatment options, both surgical and conservative, are available.[1] The benefit of non-surgical treatment seems to be limited, although not all patients respond to surgery.[3,4,5] Surgical treatment's complications and failures have been shown to occur in 3-19% in large series, requiring re-exploration in up to 12% for a variety of causes.[6,7,8,9,10] Advocates of early surgery refer to its safety and effectiveness in electrophysiologically confirmed cases with no underlying reversible disorder. In addition, they point out that conservative therapy generally offers only temporary symptom relief and that surgery is unnecessarily delayed, causing further damage to the median nerve.[11] Advocates of initial conservative management of CTS, however, refer to the potential benefits and safety of conservative treatment options and the potential complications of surgery.[12] The current conservative treatments include splints, activity modification, non-steroidal anti-inflammatory drugs, diuretics, pyridoxine, and local injection of corticosteroids. In addition, yoga, chiropractics, ultrasound and laser treatment have been advocated.[1,6,7,8,9,10] Splinting is the most popular method among the conservative treatments of CTS.[7,8,11] Immobilization of the wrist in a neutral position with a splint maximizes carpal tunnel volume and minimizes pressure on the median nerve.[1] There are conflicting results on the efficacy of therapeutic ultrasound in the treatment of CTS, and only a few studies reported the benefit of ultrasound in CTS treatment.[1,2,12,13,14]

Of the many studies of conservative treatment of CTS, only a few has used exercise treatment. Tendon- and nerve-gliding exercises have been used particularly for the management of postoperative CTS,[15] while only two studies in the literature has used tendon- and nerve-gliding exercises in conservative management of CTS. The value of these exercises in conservative management of CTS is not well understood.[16,17]

In this study, we used different combinations of ultrasound, splinting and tendon- and nerve-gliding exercises in the conservative management of CTS. These combinations included tendon- and nerve-gliding exercises in combination with splinting, ultrasound treatment in combination with splinting and the combination of ultrasound, splinting and tendon- and nerve-gliding exercises.

The aim of this study was to investigate and compare the therapeutic effect of these three different combinations in the treatment of CTS by means of clinical and electrophysiological studies.

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