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Carpal tunnel syndrome: effectiveness of physical therapy and electrophysical modalities. an updated systematic review of randomized controlled trials
Huisstede BMA, Hoogvliet P, Franke TPC, Randsdorp MS, Koes BW
Archives of Physical Medicine and Rehabilitation 2018 Aug;99(8):1623-1634
systematic review

OBJECTIVE: To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS). DATA SOURCES: The Cochrane Library, PubMed, Embase, CINAHL, and PEDro. STUDY SELECTION: Two reviewers independently applied the inclusion criteria to select potential eligible studies. DATA EXTRACTION: Two reviewers independently extracted the data and assessed the methodological quality using the Cochrane risk of bias tool. DATA SYNTHESIS: A best-evidence synthesis was performed to summarize the results of the Included studies (2 reviews and 22 RCTs). For physical therapy moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active trigger points, or low-level laser therapy in the short-term. For several electrophysical modalities moderate evidence was found in the short-term (ultrasound versus placebo, ultrasound as single intervention versus other non-surgical interventions, ultrasound versus a corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia versus placebo, iontophoresis versus phonophoresis, pulsed radiofrequency added to a wrist splint, continuous versus pulsed versus placebo shortwave diathermy, and interferential current versus transcutaneous electrical nerve stimulation versus a night only wrist splint). In the mid-term moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs optimal treatment parameters could not be identified. CONCLUSIONS: Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in short-term and mid-term. Future studies should concentrate on long-term effects and which treatment parameters of physical therapy and electrophysical modalities are most effective for CTS.

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