Abstract
Aim of the studySystematic review and meta-analysis to assess the effectiveness of manual therapy in improving carpal tunnel syndrome (CTS) symptoms, physical function, and nerve conduction studies.MethodMEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP database, and PEDro databases were searched from the inception to September 2021. PICO search strategy was used to identify randomized controlled trials applying manual therapy on patients with CTS. Eligible studies and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by PEDro scale. Outcomes assessed were pain intensity, physical function, and nerve conduction studies.ResultsEighty-one potential studies were identified and six studies involving 401 patients were finally included. Pain intensity immediately after treatment showed a pooled standard mean difference (SMD) of − 2.13 with 95% confidence interval (CI) (− 2.39, − 1.86). Physical function with Boston Carpal Tunnel Syndrome Questionnaire (BCTS-Q) showed a pooled SMD of − 1.67 with 95% CI (− 1.92, − 1.43) on symptoms severity, and a SMD of − 0.89 with 95% CI (− 1.08, − 0.70) on functional status. Nerve conduction studies showed a SMD of − 0.19 with 95% CI (− 0.40, − 0.02) on motor conduction and a SMD of − 1.15 with 95% CI (− 1.36, − 0.93) on sensory conduction.ConclusionsThis study highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with CTS.
Highlights
Carpal tunnel syndrome (CTS) is considered the result of the compression of the median nerve in the carpal tunnel [1, 2] and is one of the most common upper extremity neuropathies [3–5]
Population were patients diagnosed with CTS; intervention studied was manual therapy techniques applied in isolation; comparison was control, placebo, sham, or simulated intervention; main outcomes were pain intensity, functionality, disability, and nerve conduction studies
Studies were eligible if they met the following criteria: (1) randomized controlled trial design, (2) patients diagnosed with CTS, (3) manual therapy techniques applied in isolation, (4) compared to control, sham, simulated or placebo intervention, (5) studies measuring pain intensity, functionality, disability, Table 1 Keywords used for the search strategy
Summary
Carpal tunnel syndrome (CTS) is considered the result of the compression of the median nerve in the carpal tunnel [1, 2] and is one of the most common upper extremity neuropathies [3–5]. Recent studies show that CTS’s prevalence and the incidence are increasing in the last years [6, 7], causing important socioeconomic cost [4]. Patients with CTS often report pain, paraesthesia, sensory disturbances, weakness in the hand and wrist, causing a physical function decrease that affects daily living activities [8, 9]. Due to the high prevalence of CTS, its effects on daily living activities and the health care cost are necessary to identify the best therapeutic approaches [4]. Secondary causes have been described of CTS including traumatism, metabolic conditions, infections, neuropathies, or other systemic disorders. Most of cases of CTS are idiopathic [4, 5]
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