By Tim Bertelsman, DC
A significant amount of new data has been published in the past quarter about the management of carpal tunnel syndrome (CTS). This blog post will equip evidence-based chiropractors with a quick summary of the 10 most significant findings.
Prevalence & Etiology
- CTS affects between 5%-10% of the population
- 66%-75% of CTS sufferers are female
1. “Current literature demonstrates a prevalence of CTS among the general population of 5%. Of those seen by the hand subspecialists, 66% were female, 34% were male with the right hand affected in 42%, left in 26%, and bilateral upper extremities in 32%.”
2. A recent CDC study found that women were more than three times more likely to develop work-related carpal tunnel syndrome compared to men.
Source: Jackson R et al. Rates of Carpal Tunnel Syndrome in a State Workers’ Compensation Information System, by Industry and Occupation — California, 2007–2014. MMWR Morb Mortal Wkly Rep. 2018 Oct 5;67(39):1094-1097.
- Not all “paresthesia in a median nerve distribution” is from CTS
- Phalen’s test only catches about ½ of CTS cases
3. A prospective cohort study of more than 1,100 CTS patients concluded:
- The sensitivity of paresthesias in a median nerve distribution with nocturnal awakening was 77.4%.
- The sensitivity of the Phalen sign was 52.8%
- The sensitivity Hoffman-Tinel sign was only 37.7%
- Conservative care rivals surgery
- Mobilization can increase canal size
- Nerve flossing and KinesioTape both improve outcomes
- Steroids injections and opioids may not be useful
4. A systematic review of carpal tunnel syndrome research comparing surgical vs. non-surgical (i.e., splint, steroid injection, or physical therapy) outcomes found: “No significant differences at 3 or 12 months” in terms of functional status, symptom severity and nerve conduction outcomes.
Source: Qiyun S. et al. Comparison of the Short-term and Long-term Effects of Surgery and Nonsurgical Intervention in Treating Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis. Hand. 2018 Jul 1:1558944718787892. [Epub ahead of print]
5. A new study in the Journal of Clinical Biomechanics demonstrated that “mobilization significantly increased carpal tunnel cross sectional area, anteroposterior diameter, and circularity. The median nerve showed similar behavioral tendencies to the tunnel. Both the carpal tunnel and the median nerve became rounder during the technique.”
Source: Bueno-Gracia, Elena et al. Dimensional changes of the carpal tunnel and median nerve during manual mobilization of the carpal bones — Anatomical study. Clinical Biomechanics, Volume 59, 56 – 61
6. An RCT of 103 patients with mild to moderate carpal tunnel syndrome concluded “the use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.” Specifically, neurodynamic techniques* produced significant improvements in nerve conduction, pain, symptom severity, and functional status. (*To learn more about neurodynamic techniques, see this 2008 article in the Journal of Manual and Manipulative Therapy.)
Source: Wolny T et al. Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial. Clin Rahabil. 2018 Oct 11:269215518805213. doi: 10.1177/0269215518805213. [Epub ahead of print]
7. A randomized clinical trial compared the effectiveness of a splint vs. KinesioTape (KT) for the management of carpal tunnel syndrome: “A significant improvement was observed in the KT group compared to the splint group in terms of electrophysiological changes, provocative test responses, symptom severity, and functional status scores.”
8. “The reviewed evidence supports that oral steroids and corticosteroid injections benefit patient with CTS particularly in the short term. Although a higher dose of steroid injections seems to be more effective in the midterm, the benefits of oral pain medication and corticosteroid injections were not maintained in the long term.”
Source: Bionka M. Huisstede, PhD,a Manon S. Randsdorp, MD,b Janneke van den Brink, MSc, PT,a Thierry P.C. Franke, MSc, PT,a Bart W. Koes, PhD,b Peter Hoogvliet, MD, PhDc Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review Archives of Physical Medicine and Rehabilitation 2018;99:1609-22
9. An RCT of 54 patients demonstrated that a perineural injection of 5% Dextrose (i.e. sugar water) “is more beneficial than that of corticosteroid in patients with mid-to-moderate carpal tunnel syndrome, 4 to 6 months post-injection.”
Source: Wu YT et al. Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Ann Neurol. 2018 Sep 5. doi: 10.1002/ana.25332. [Epub ahead of print]
10. “Most cases (70%) of carpal tunnel surgery patients were prescribed an opioid and 29% were prescribed an opioid contrary to the [American College of Occupational and Environmental Medicine] guidelines. Cases prescribed an opioid contrary to guidelines had disability durations 1.9 days longer and medical costs $422 higher than cases prescribed an opioid according to guidelines.”
Source: Gaspar FW, Kownacki R, Zaidel CS, Conlon CF, Hegmann KT. Reducing Disability Durations and Medical Costs for Patients With a Carpal Tunnel Release Surgery Through the Use of Opioid Prescribing Guidelines. Journal of Occupational and Environmental Medicine. 2017;59(12):1180-1187.
Dr. Bertelsman is co-founder of the online clinical and business resource ChiroUp.com. Dr. Bertelsman graduated from Logan College of Chiropractic with honors and has been practicing in Belleville, Ill., since 1992. He is a post-graduate instructor for the University of Bridgeport Orthopedic Diplomate program. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as immediate past president of its executive board.