Abstract
BackgroundCarpal tunnel syndrome (CTS) is a common, compressive nerve-entrapment disorder with symptoms of numbness, paresthesia, and pain. Carpal tunnel release surgery is the only known long-term effective treatment. However, surgery is invasive and up to 30% of patients report recurrence or persistence of symptoms or suffer from post-surgical complications. A promising non-surgical treatment for CTS is mechanical wrist traction. The purpose of this study was to evaluate clinical outcomes following mechanical traction in patients with CTS compared to care as usual.MethodsAdult patients (N = 181, mean age 58.1 (13.0) years, 67% women) with electrodiagnostically confirmed CTS were recruited from an outpatient neurology clinic in the Netherlands between October 2013 and April 2015. After baseline assessments, patients were randomized to either the intervention group (12 treatments with mechanical traction, twice a week for a period of 6 weeks) or “care as usual”. The main clinical outcome measure was surgery during 6 months’ follow-up. In addition, symptom severity was measured using the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline, 3, and 6 months’ follow-up. Baseline characteristics and severity of CTS symptoms at follow-up were compared between the intervention and care-as-usual groups using a t test and χ2 tests. Time to event (surgery) between the groups was analyzed using Kaplan-Meier survival analysis and Cox proportional hazards analysis.ResultsThe intervention group had fewer surgeries (28%) compared to the care-as-usual group (43%) during follow-up (χ21 = 4.40, p = .036). Analyses of the survival curves revealed a statistically significant difference between the groups over time (log-rank test χ21 = 6.94, p = .008). At 6 months’ follow-up, symptom severity and functional status scores had significantly decreased from baseline in both groups (p < .001) and the improvements did not differ between the two groups.ConclusionsMechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months’ follow-up was similar in both groups. The long-term effects of mechanical traction require further evaluation.Trial registrationClinicalTrials.gov, ID: NL44692.008.13. Registered on 19 September 2013.
Highlights
Carpal tunnel syndrome (CTS) is a common, compressive nerve-entrapment disorder with symptoms of numbness, paresthesia, and pain
Electrodiagnostic values were considered abnormal if there was a difference greater than 0.5 ms on distal sensory latency (DSL) between the ulnar and median nerves in digit IV or between the radial and median nerves in digit I, a distal motor latency (DML) greater than 3.7 ms across the wrist to digit I of the median nerve, or a difference greater than 0.4 ms in the median nerve across the wrist compared to the palmar branch of the median nerve to digit III
Because up to 30% of patients who received surgery report CTS symptoms at longer follow-up (1 to 2 years), a longer period of observation is needed to compare the long-term effect of mechanical traction to care as usual
Summary
Carpal tunnel syndrome (CTS) is a common, compressive nerve-entrapment disorder with symptoms of numbness, paresthesia, and pain. Initial conservative treatment may be more cost-effective and preferred by the patient [2]. This especially applies to carpal tunnel syndrome (CTS). CTS is a compressive nerve disorder in which the median nerve is compressed in the carpal tunnel [3, 4]. Non-surgical, less-invasive treatment options include oral non-steroidal drugs, corticosteroids (injections), splinting, exercise, and mobilization interventions [10,11,12,13,14]. There is only limited evidence for the effectiveness of splinting, exercise, and mobilization interventions [13, 14]
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