Carpal Tunnel Syndrome:
Manual Therapy or Surgery for Carpal Tunnel Syndrome?
Surgery to address carpal tunnel syndrome (CTS) is the most common upper limb orthopedic surgery in the United States with annual costs estimated in excess of $2 billion. In western countries, the waitlist for such a procedure is often greater than five months, and the demand is expected to double in the coming decades. This can pose a serious challenge to a country’s healthcare system. What can be done to lessen this burden?
To answer this question, researchers conducted a randomized, controlled trial using multiple treatment sites (four public hospitals) utilizing non-surgical treatment methods on 105 CTS patients who were on a surgical waitlist. The experimental group (52 patients) received education, splinting, and nerve gliding exercises while remainder served as a group that remained on the waitlist without additional care. After 24 weeks, the patients in the experimental group were less likely to require surgery (59% vs 80%) and were two times more likely to report an improvement in their symptoms with respect to pain and disability.
The authors point out that the benefits obtained in this small sample of 105 CTS patients should be cautiously interpreted when applied to the thousands of CTS patients currently on surgical waitlists. However, this study demonstrates that the non-surgical approaches had a significant impact on the treated group compared to the untreated group. Moreover, the participants reported no serious adverse effects.
Another study compared the benefits of three manual therapy treatment sessions to surgery (60 patients in each group), and the researchers observed similar improvements in both groups a year later. Intrigued by their results, the researchers followed up with these patients again after five years and noted similar outcomes between both groups.
The treatments provided in these studies—education, splinting, nerve gliding exercises, and manual therapies—are all provided by doctors of chiropractic and are often used as part of a multimodal approach for the management of CTS. Additionally, chiropractors will look for nerve entrapment elsewhere on the median nerve as it’s very common for the mobility of the nerve to be restricted at two or more sites, and these will all need to be addressed for a satisfactory outcome. If non-musculoskeletal factors are suspected, your doctor of chiropractic will co-manage the condition with an allied healthcare provider.