Effect Of Forearm Flexors/extensors Strength Training On Functional Capacity After Open Carpal Tunnel Release

Abstract

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy of the upper extremity. Open release surgery for CTS may affect post-operative functional capacity of the operated hand. PURPOSE: This pilot study examined the effects of a progressive strength training program of the forearm flexors and extensors on functional and clinical parameters after open carpal tunnel release (OCTR). METHODS: Seven patients with CTS (5 females and 2 males (age: 57.7 ± 4.8 yrs, height: 169.0±2.5 cm, body mass: 82.0±4.1 kg, BMI: 28.7±1.4) underwent OCTR and then were randomly divided into two groups, the control group (CG; n=4) which received usual physical therapy care, and the intervention group (IG; n=3) which, in addition to the usual care, followed a 9-week strength training program of the wrist flexors/extensors (3 sets of 10 reps, 4 days/week) started 3 weeks after surgery. Hand grip strength (HGS Test), hand pinch strength (HPS Test) and sensibility (Two-point Discrimination Test-TPDT) were assessed before and 3, 6 and 12 weeks after surgery, while load for strength training was set at 2% of the maximal grip strength and was readjusted accordingly during the experimental period. Patients also completed the Boston Carpal Tunnel Questionnaire (BCTQ) before and 12 weeks after surgery. Two-way ANOVA was used for statistics and data are presented as mean±SE. RESULTS: No significant main effect was found for groups or time (p>0.05) in HGS (IG: 31.1±8.2 kg, CG: 27.2±4.6 kg), HPS (IG: 8.0±4.6 kg, CG: 8.5±4.2 kg) and TPDT (IG: 2.0±0.2, CG: 2.5±0.3) at 12 weeks compared to pre-surgery values: HGS (IG: 27.6±12.9 kg, CG: 28.7±6.5 kg), HPS (IG: 7.1±4.1 kg, CG: 8.8±4.4 kg) and TPDT (IG: 2.3±0.4, CG: 3.3±0.4). In BCTQ, no differences were found between groups (p>0.05), however a significant main effect for time (p<0.05) was revealed at 12 weeks (IG: 1.8±0.68, CG: 1.5±0.4) compared to pre-surgery (IG: 3.8±0.76, CG: 3.4±0.5). CONCLUSION: Our findings suggest that the addition of the selected muscle strength training program to usual care after OCTR does not appear to add significant benefits to the functional recovery of those patients. Further research utilizing a larger number of patients and other strength training protocols is needed to reveal the potential role of wrist muscle strength training in functional capacity of patients with CTS after OCTR.