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Extremities Feature

Source: Wikimedia Commons and Olimane

PT as Effective as Surgery for Carpal Tunnel Syndrome

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, March 20th, 2017

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Physical therapy is as effective as surgery in treating carpal tunnel syndrome, according to a new study published in the March 2017 issue of the Journal of Orthopaedic & Sports Physical Therapy. The work, entitled, “Carpal Tunnel Syndrome: Physical Therapy or Surgery?” was performed by researchers in Spain and the U.S.

According to the March 2, 2017 news release, “…one year following treatment, patients with carpal tunnel syndrome who received physical therapy achieved results comparable to outcomes for patients who had surgery for this condition. Further, physical therapy patients saw faster improvements at the one-month mark than did patients treated surgically.”

"Conservative treatment may be an intervention option for patients with carpal tunnel syndrome as a first line of management prior to or instead of surgery," says lead author César Fernández de las Peñas, P.T., Ph.D., D.M.Sc., with the Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine at Universidad Rey Juan Carlos, Alcorcón, Spain.

“Dr. de las Peñas and his fellow researchers studied the cases of 100 women with carpal tunnel syndrome. By random allocation, 50 women were treated with physical therapy and 50 with surgery. Patients assigned to the physical therapy group were treated with manual therapy techniques that focused on the neck and median nerve for 30 minutes, once a week, with stretching exercises at home.”

“After one month, the patients in the physical therapy group had better hand function during daily activities and better grip strength (also known as pinch strength between the thumb and index finger) than the patients who had surgery. At three, six, and 12 months following treatment, patients in the surgery group were no better than those in the physical therapy group. Both groups showed similar improvements in function and grip strength. Pain also decreased similarly for patients in both groups. The researchers conclude that physical therapy and surgery for carpal tunnel syndrome yield similar benefits one year after treatment. No improvements in cervical range of motion were observed in either patient group.”

Co-author Joshua Cleland, P.T., Ph.D., O.C.S., F.A.A.O.M.P.T., is with Franklin Pierce University and Concord Hospital in New Hampshire. Dr. Cleland told OTW, “I was not surprised that a multi-modal manual physical therapy program resulted in similar benefits as surgery at long-term follow-up in patients with carpal tunnel syndrome as this was our original hypothesis. However, I was surprised to find that even individuals classified as having severe carpal tunnel syndrome experienced similar outcomes with both interventions despite the fact that when symptoms are severe surgery is the first treatment option.”

“Based on the results of the current study and a previously published study in 2015 we would suggest that patients with carpal tunnel syndrome should first undergo a conservative approach to treatment including a multi-modal manual physical therapy program prior to surgical intervention in most cases.”

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One Response to “PT as Effective as Surgery for Carpal Tunnel Syndrome”

  1. D Mark Allison says:

    I am surprised by these outcomes but have not seen the original paper.

    At one month I would expect the PT group to have better grip strength than the surgery group because of discomfort. That discomfort may go on for up to 12 months.

    Carpal tunnel syndrome it a space problem within the osseous-fibrous space of the carpal tunnel; surgery increases that space but I fail to see how PT can.

    It is well recognised that some people tolerate the symptoms of CTS better than others and one wonders if the PT was just improving the tolerance of the symptoms.

    I have the following questions:

    1. Was the diagnosis confirmed by NCS
    2. Were these studies repeated at the end in the PT group.

    I will endeavour to read the original article if I can get hold of it. I should like to point out that an ongoing audit of carpal tunnel survey release by the Australian Hand Surgery Society over ten years has shown that surgery is safe and effective in almost all cases.

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