Author Names
Bongi,S., Signorini,M., Bassetti,M., Del Rosso, A., Orlandi, M., De Scisciolo, G.
Reviewer Name
Jessika Barnes, LPTA, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
In carpal tunnel syndrome (CTS), manual therapy interventions (MTI) reduce tissue adhesion and increase wrist mobility. We evaluated the efficacy of a MTI in relieving CTS signs and symptoms. Twenty-two CTS patients (pts) (41 hands) were treated with a MTI, consisting in 6 treatments (2/week for 3 weeks) of soft tissues of wrist and hands and of carpal bones. Pts were assessed for hand sensitivity, paresthesia, hand strength, hand and forearm pain, night awakening; Phalen test, thenar eminence hypotrophy and Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Median nerve was studied by sensory nerve conduction velocity (SNCV) and distal motor latency (DML). CTS was scored as minimal, mild, medium, severe and extreme. We considered as control group the same pts assessed before treatment: at baseline (T0a) and after 12 weeks (T0b). Pts were evaluated at the end of treatment (T1) and after 24-week (T2) follow-up. At T0b, versus T0a, forearm pain and Phalen test positivity were increased and hand strength reduced (p < 0.05). BCTQ–SSS and BCTQ–FSS scores improved at T1 versus T0b (p < 0.05) with the amelioration maintained at T2. At T1, the number of pts with paresthesia, night awakening, hypoesthesia, Phalen test, hand strength reduction and hand sensitivity was reduced with the lacking of symptoms maintained at T2 (p < 0.05). No changes in SNCV, DML and CTS scoring were shown. MTI improved CTS signs and symptoms, with benefits maintained at follow-up. Thus, it may be valid as a conservative therapy.
NIH Risk of Bias Tool
Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group
- Was the study question or objective clearly stated?
- Yes
- Were eligibility/selection criteria for the study population prespecified and clearly described?
- Yes
- Were the participants in the study representative of those who would be eligible for the test/service/intervention in the general or clinical population of interest?
- No
- Were all eligible participants that met the prespecified entry criteria enrolled?
- Yes
- Was the sample size sufficiently large to provide confidence in the findings?
- No
- Was the test/service/intervention clearly described and delivered consistently across the study population?
- Yes
- Were the outcome measures prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants?
- Yes
- Were the people assessing the outcomes blinded to the participants’ exposures/interventions?
- No
- Was the loss to follow-up after baseline 20% or less? Were those lost to follow-up accounted for in the analysis?
- Yes
- Did the statistical methods examine changes in outcome measures from before to after the intervention? Were statistical tests done that provided p values for the pre-to-post changes?
- Cannot Determine, Not Reported, Not Applicable
- Were outcome measures of interest taken multiple times before the intervention and multiple times after the intervention (i.e., did they use an interrupted time-series design)?
- Yes
- If the intervention was conducted at a group level (e.g., a whole hospital, a community, etc.) did the statistical analysis take into account the use of individual-level data to determine effects at the group level?
- Yes
Key Finding #1
Patients improved significantly in hand symptoms and function, as assessed by Boston Carpal Tunnel Questionnaire and by the reductions in the prevalence of paresthesias, hand pain and sensitivity, and night awakening.
Key Finding #2
The treatment did not improve Nerve Conduction Studies nor change neurophysiological grading of CTS.
Key Finding #3
Conservative management should be the first-step treatment, to be preferred for early and supposedly transient cases of CTS, such as those associated with pregnancy or short-term overuse. For other cases, it might be used for reducing the symptoms of CTS while awaiting surgery.
Please provide your summary of the paper
This pilot study looked at the effects of a manual therapy intervention on CTS symptoms and hand function. Twenty-two carpel tunnel patients were treated with manual therapy interventions, consisting in 6 treatments (2/week for 3 weeks) of soft tissues of wrist and hands and of carpal bones. Pts were assessed for hand sensitivity, paresthesia, hand strength, hand and forearm pain, night awakening by using the Phalen’s test, thenar eminence hypotrophy and Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). The manual interventions in this study included: In the first session (duration, 10 min), the most thickened tissues of hand palmar surface and wrist and forearm volar side were treated by deep transverse massage (cyriax), in order to improve tissue elasticity by detachment maneuvers performed in the cranio-caudal direction. In the second and third sessions (duration, 15 min), performed with the hand maintained in traction, passive mobilizations of the radio-carpal and radio-ulnar joints, and opening of the palmar surface of metacarpal–phalangeal joints were added. In the following (4th to 6th) sessions (duration, 15 min) The wrist, maintained in traction, was treated with passive flexo-extension and transversal movements in order to improve the range of movement of the joints and the elasticity of flexo-extensor and prono-supinator muscles. Also, the palmar aponeurosis and the pollical and the first palmar interosseous muscles were treated, working on the hand that was maintained open and extended. This study considered the control group the same pts assessed before treatment: at baseline (T0a) and after 12 weeks (T0b). Pts were evaluated at the end of treatment (T1) and after 24-week (T2) follow-up. The results of this study concluded that patients improved significantly in hand symptoms and function, as assessed by Boston Carpal Tunnel Questionnaire and by the reductions in the prevalence of paresthesias, hand pain and sensitivity, and night awakening.The manual therapy treatment did not improve Nerve Conduction Studies nor change neurophysiological grading of Carpel Tunnel Syndrome.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
My clinical interpretation of this paper is that manual therapy would be beneficial for patients dealing with the acute affects of carpel tunnel syndrome. More non-conservative measures may be taken into consideration if this is a chronic issue.
