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Manual therapy versus surgery for carpal tunnel syndrome: 4-year follow-up from a randomized controlled trial
Fernandez-de-Las-Penas C, Arias-Buria JL, Cleland JA, Pareja JA, Plaza-Manzano G, Ortega-Santiago R
Physical Therapy 2020 Nov;100(11):1987-1996
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: No study has investigated the effects longer than 1-year of manual therapy in carpal tunnel syndrome (CTS). The purpose of this study was to investigate the effects of manual therapy versus surgery at 4-year follow-up and to compare the post-study surgery rate in carpal tunnel syndrome CTS. METHODS: This randomized controlled trial was conducted in a tertiary public hospital and included 120 women with CTS who were randomly allocated to manual therapy or surgery. The participants received 3 sessions of physical therapy including desensitization maneuvers of the central nervous system or carpal tunnel release combined with a tendon/nerve gliding exercise program at home. Primary outcome was pain intensity (mean and the worst pain). Secondary outcomes included functional status, symptom severity, and self-perceived improvement measured using a global rating of change scale. Outcomes for this analysis were assessed at baseline, 1 year, and 4 years. The rate of surgical intervention received by each group was assessed throughout the study. RESULTS: At 4 years, 97 (81%) women completed the study. Between-group changes for all outcomes were not significantly different at 1 year (mean pain mean difference (MD) -0.3, 95% CI -0.9 to 0.3; worst pain MD -1.2, 95% CI -3.6 to 1.2; function MD -0.1, 95% CI -0.4 to 0.2; symptom severity MD -0.1, 95% CI -0.3 to 0.1), and 4 years (mean pain MD 0.1, 95% CI -0.2 to 0.4; worst pain MD 0.2, 95% CI -0.8 to 1.2; function MD 0.1, 95% CI -0.1 to 0.3; symptom severity MD 0.2, 95% CI -0.2 to 0.6). Self-perceived improvement was also similar in both groups. No between-group differences (15% physical therapy versus 13% surgery) in surgery rate were observed during the 4-years. CONCLUSIONS: In the long term, manual therapy including desensitization maneuvers of the central nervous system resulted in similar outcomes and similar surgery rates compared to surgery in women with CTS. Both interventions were combined with a tendon/nerve gliding exercise program at home. IMPACT: This is the first study to report clinical outcomes and surgical rates during a 4-year follow-up and will inform decisions regarding surgical versus conservative management of CTS.

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