Carpal Tunnel Syndrome

Abstract

Objective: The objective of this study was to assess whether a protocol with an emphasis on motor control techniques consisting of segmental cervical stabilization and neural mobilization have better results in mechanical reorganization and reduction of symptoms when compared with classic therapeutic exercise techniques in the conservative treatment of carpal tunnel syndrome. Methodology: This was a double-blind, randomized pilot study for which we recruited 11 women with an average age of 54 (±6) years, allocated in classical Kinesiotherapy group or control group (CG) and experimental group (EG). A total of 63.6% were away from work. And 45.4% had completed elementary education degree. All volunteers had right dominance, and of them, 10 (90.9%) were diagnosed with carpal tunnel syndrome in both hands, all being treated conservatively, with an average dysfunction duration of 48 (±30) months. Randomization was performed in the presence of all patients and the physiotherapy team, using 15 envelopes distributed randomly on a table. Patients were directed to pick an envelope from the table in a random fashion, mark it with their name, and hand over to a staff member, without opening. Inside each envelope, the assignment to either the CG or EG was identified. Following the opening of envelopes, performed by a member responsible for allocation, the volunteers received information about the routine of intervention. Patients were unaware of the differences in treatment between the groups. To ensure double-blinding, the examiner was unaware of the composition of the groups before making final evaluations. The evaluation of sensitivity, strength, symptoms and function were performed using Semmes-Weinstein monofilaments, grip and pinch dynamometers of E-Link Kit Biometrics®, The Boston Carpal Tunnel Questionnaire (BCTQ), the Disabilities of the Arm, Shoulder and Hand (DASH), and the Patient Rated Wrist Evaluation (PRWE) respectively. Patients performed the treatment program for 12 weeks, at a frequency of twice a week and duration of 60 minutes per session. All treatment protocols were guided and accompanied by 2 previously trained staff members (called “instructors”). Treatment sessions for both groups were performed at the same time, and on the same days, but in different rooms. All patients received a static splint neutrally positioned. The patients of CG received a classic therapeutic exercise program and the patients of EG received an exercise protocol based on motor control principles and neural mobilization of the median nerve and neuraxis. The data showed normal distribution and the Test T Student was used. Results: In the intragroup analysis, we observed a higher gain in grip strength and pinch for the EG, but this gain was not statistically significant. For most variables, the best results were observed in the EG, but without statistical significance. The effect size for objective variables measured by means of instruments was greater than in the variables measured by questionnaires. Conclusion: The proposed protocol group showed better results in mechanical reorganization, reflected in increased strength, sensitivity, and improved functionality when confronted the group with conventional therapeutic exercise, but without the same impact on reducing symptoms.