Non-invasive treatment of idiopathic carpal tunnel syndrome

ABSTRACT

Non-invasive treatment for carpal tunnel syndrome [CTS] is frequently offered to those with mild to moderate symptoms. The effectiveness and duration of benefits from noninvasive treatment remain unknown. To evaluate the therapeutic effect and duration of benefits from non-invasive treatment [other than medical treatment] for treating mild and moderate idiopathic carpal tunnel syndrome. Prospective randomized, before and after treatment trial with assessment at baseline, 4 weeks' treatment, and at a follow up assessment 6 months later [7 months after baseline]. Outpatient Clinic of Rheumatology and Rehabilitation department in Prince Abdulla Bin Abdulaziz Hospital [PABAH], Saudi Kingdom. 45 Patients with mild to moderate idiopathic carpal tunnel syndrome in 57 hands as verified by electroneurography. Three groups, each with 15 cases of carpal tunnel syndrome were randomly established. In group I only a custom made neutral volar splint was given to the patients. The patients were instructed to wear the splints all night and during the day as much as possible for 4 weeks. In group II a custom made neutral volar splints were given to the patients and sessions of ultrasound treatment [1 MHz, 1.0 W/cm2, pulsed mode, 5 minutes per session, 5 sessions a week] were applied to the area over the carpal tunnel of the affected wrist for 4 weeks. In group III a custom made neutral volar splints were given to the patients and they were instructed to perform series of nerve and tendon gliding exercises for 4 weeks. Score of symptom severity scale ratings assessed by visual analogue scale; a functional status scale, electroneurographic measures. Statistically significant improvement was observed in all groups except for distal motor latency [DML] in group I at 4 weeks of therapy and for 2-point discrimination in group I and III and sensory antidromic nerve conduction velocity [SNCV] in group I at 4 weeks of therapy and 6 months' follow up. The improvement in group II was greater than in group I and the difference was statistically significant for grip strength and symptom severity score [p<0.05] at 4 weeks and for all measurements except functional severity score at 6 months. The improvement in group III was greater than group I and the difference was not statistically significant except for symptom severity score at 6 months [p<0.05]. The improvement in group II was greater than group III and the difference was not statistically significant except for grip strength at 4 weeks and 6 months [p<0.05 and <0.01 respectively]. Results suggest there are satisfying longer term effects due to ultrasound treatment and tendon and nerve gliding exercises in patient with mild to moderate idiopathic carpal tunnel syndrome compared with standard conservative treatment of splinting. Findings of ultrasound and exercise treatment need to be compared with invasive treatment options. Combination of these treatment methods needs further investigations