Evaluation of Effectiveness of the Wrist Mobilization Compared with Local Corticosteroid Injection in Treatment of Moderate Carpal Tunnel Syndrome

Abstract

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper limbs. Conservative treatment is important in reducing signs and symptoms as well as improving the function of patients with mild and moderate CTS. Objectives: The aim of this study was to compare the therapeutic effect of wrist mobilization with local corticosteroid injection in patients with moderate CTS. Methods: This study was a single-blind study that was performed on 58 hands with moderate CTS. Patients were randomly assigned into two treatment groups with 29 samples. Group 1 was treated with local corticosteroid injection (1 cc Methylprednisolone acetate 40 mg + 0.5 cc lidocaine 2%) in the carpal tunnel. Group 2 was treated with carpal bone and median nerve mobilization at the wrist for 10 sessions, about three weeks. Both groups received wrist splints and oral medication (gabapentin capsule 100 mg and vitamin B6 tablet 40 mg per day) for two months. For evaluation of the outcomes, electrodiagnostic parameters of the median nerve (sensory and motor latency and amplitude) before and two months after treatment and also pain intensity (based on visual analogue scale), symptom severity and functional status (based on Boston carpal tunnel questionnaire) before as well as one and two months after treatment, were used. In addition, in long-term evaluation, patient satisfaction was monitored by telephone six months after treatment. Results: Significant improvement was observed in electrodiagnostic parameters two months after treatment and pain intensity, symptom severity, and functional status one and two months after treatment in both groups (P < 0.05); here was no significant difference between the two groups. In addition, in the telephone assessment of patient satisfaction after 6 months, there was no statically significant difference between the two groups. Conclusions: Our results showed that wrist mobilization at the wrist can be effective in reducing signs and symptoms of moderate CTS such as local corticosteroid injection. In addition, these two methods of combination therapy may be used to prevent or postpone disease progression and surgical intervention.