Tratamiento conservador en pacientes con síndrome del túnel carpiano con intensidad leve o moderada. Revisión sistemática / Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review

INTRODUCCIÓN: El síndrome del túnel carpiano (STC) es la neuropatía periférica más común. Consiste en la compresión del nervio mediano a nivel de túnel carpiano. Tiene una alta prevalencia y genera una situación muy discapacitante desde las primeras fases. En los casos graves el tratamiento suele ser quirúrgico, mientras que en los leves y moderados el tratamiento es conservador. El objetivo de esta revisión es conocer los tratamientos conservadores, así como su efectividad, en pacientes con STC leve y moderado, en los 15 últimos años. DESARROLLO: Se realizó una revisión sistemática según los criterios de PRISMA. Se emplearon las bases de datos Medline, PEDro y Cochrane. Se seleccionaron aquellos ensayos clínicos controlados y aleatorizados que analizasen los efectos del tratamiento conservador sobre los síntomas y la función en pacientes con STC leve o moderado. Se incluyeron 32 ensayos clínicos. Existe evidencia sobre la efectividad de los fármacos orales aunque las infiltraciones parecen ser más efectivas. El uso de férulas ha mostrado ser efectivo y asociado a otras técnicas no farmacológicas también. Las técnicas de electroterapia no han mostrado resultados concluyentes sobre la efectividad de forma aislada. Otras técnicas de tejido blando también han mostrado buenos resultados pero es escasa la evidencia en este campo. También se han propuesto varias combinaciones de tratamiento farmacológico con no farmacológico sin resultados concluyentes. CONCLUSIONES: Existen varios tratamientos conservadores capaces de mejorar los síntomas y la función de los pacientes con STC leve y moderado. Estos incluyen el uso de férulas, fármacos orales, infiltraciones, técnicas de electroterapia, técnicas manuales específicas y ejercicios de deslizamiento neural, así como la combinación de varias de ellas. No ha sido posible describir la mejor técnica o combinación de técnicas debido a las limitaciones de los estudios, por lo que es necesario realizar más estudios con una calidad metodológica adecuada

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. METHODS: A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. CONCLUSIONS: Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed

Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review. / Tratamiento conservador en pacientes con síndrome del túnel carpiano con intensidad leve o moderada. Revisión sistemática.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. METHODS: A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. CONCLUSIONS: Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed.

Integración de técnicas de OMT en la evaluación y tratamiento de un paciente con lesión del sistema neuromotor / Integration of OMT techniques in the evaluation and treatment of a patient with a neuromotor impairment

Introducción. La terapia manual ortopédica (OMT) es una especialidad de la fisioterapia que debería ser tenida en cuenta en otras especialidades como la fisioterapia pediátrica o neurológica. Material y métodos. Se muestra la adaptación del protocolo de Kaltenborn-Evjenth (K-E) para la valoración de este caso, y se integra el tratamiento de OMT en un programa global de reeducación neuromotriz donde intervienen otros profesionales además del fisioterapeuta. Se describen las técnicas específicas para la región de la muñeca y se explica la utilización de técnicas de masaje funcional tanto de forma aislada como integradas en diferentes actividades. Resultados. Se produce un aumento de la movilidad pasiva y desaparición del dolor, que permite al paciente utilizar más su mano y progresar en el tratamiento, mejorando su capacidad para ejecutar tareas que requieren presas finas. Discusión. Aunque las principales causas de la dificultad para ejecutar presas finas son de origen neurológico, el factor biomecánico puede estar condicionando el tratamiento y la evolución del paciente

Introduction. Orthopedic manual therapy (OMT) is a physical therapy specialization that should be considered in other physical therapy specialties, such as neurological and pediatric physiotherapy. Material and methods. This case report describes the adaptation of the Kaltenborn-Evjenth evaluation protocol, and the integration of OMT treatment in a global neuromotor rehabilitation program where other professionals act. This case report also describes the use of specific techniques for the wrist region and it is also explained the use of functional massage techniques, in an isolated way and combined with other activities. Results. The increase of PROM in wrist extension and radial deviation, along with absence of pain, enabled the patient to use his right hand more efficiently. These factors may also contribute to improve the subject's ability to successfully execute a pincer grasp. Discussion. Although the main cause of impaired fine motor function in CVA is of neural origin, restrictions of joint motion may also warrant biomechanical assessment and treatment