Manual therapy compared to surgery in the treatment of moderate carpal tunnel syndrome

Purpose:
The objective of this study was to assess the efficacy of manual therapy, specifically using the Maitland concept, in treating carpal tunnel syndrome (CTS), and to compare its effectiveness with surgical decompression of the median nerve.

Methods:
A total of 69 patients were enrolled and divided into two groups: a control group (undergoing surgery) and treatment group (receiving manual therapy). Subgroups were formed based on gender, considering factors such as grip strength. Inclusion criteria comprised active symptoms of CTS and electrophysiological evidence of nerve lesion. Exclusion criteria included diabetes, thyroid diseases, trauma to the upper limb, and pregnancy. Baseline and 10-12 month post-intervention assessments encompassed EQ-5D-5L, CTS6, DASH, grip strength and electrophysiological studies. The treatment group (43 patients) underwent five weekly manual therapy sessions. A physiotherapist individually assessed and treated patients, emphasizing passive techniques and prescribing home self-neuromobilization. The control group (26 patients) underwent carpal tunnel release surgery.

Results:
Both surgical and manual therapy interventions significantly reduced symptom severity (p < 0.001). Manual therapy improved hand function in females (p < 0.001) and showed positive trends in the control group. The treatment group demonstrated higher grip strength, with significant improvements in females (p < 0.001). Quality of life also improved in females (p < 0.001). No significant differences in distal motor latency though sensory latency showed positive trends in females.

Conclusions:
This research offers a comprehensive understanding of the effectiveness of manual therapy and surgical release in treating CTS. The findings suggest that both interventions can result in improvements in grip strength and quality of life with variations in based on gender and specific outcome measures.