Abstract
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 Physiotherapy Evidence Database.
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 methodologic 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 randomized controlled trials [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
vs placebo, ultrasound as single intervention vs other nonsurgical interventions,
ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave
hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added
to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential
current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint).
In the midterm, 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 the short term and midterm. Future studies should concentrate on long-term
effects and which treatment parameters of physical therapy and electrophysical modalities
are most effective for CTS.
Keywords
List of abbreviations:
CTS (carpal tunnel syndrome), ESWT (extracorporeal shockwave therapy), FSS (Functional Status Scale), LLT (low-level laser therapy), PEDro (Physiotherapy Evidence Database), RCT (randomized controlled trial), SSS (Symptom Severity Scale), TENS (transcutaneous electrical nerve stimulation)To read this article in full you will need to make a payment
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References
- Carpal tunnel syndrome: pathophysiology and clinical neurophysiology.Clin Neurophysiol. 2002; 113: 1373-1381
- The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State.Am J Ind Med. 2007; 50: 155-172
- The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands.J Bone Joint Surg Am. 1966; 48: 211-228
- Pathophysiology of carpal tunnel syndrome.Neurosciences (Riyadh). 2015; 20: 4-9
- Carpal tunnel syndrome: clinical features, diagnosis, and management.Lancet Neurol. 2016; 15: 1273-1284
- Associations between work-related factors and the carpal tunnel syndrome–a systematic review.Scand J Work Env Heal. 2009; 35: 19-36
- Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guidelined-results from the European HANDGUIDE study.Arch Phys Med Rehabil. 2014; 95: 2253-2263
- Static magnetic field therapy for carpal tunnel syndrome: a feasibility study.Arch Phys Med Rehabil. 2010; 91: 1098-1104
- Therapeutic ultrasound for carpal tunnel syndrome.Cochrane Database Syst Rev. 2013; : CD009601
- Evidence for effectiveness of extracorporal shock-wave therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis - a systematic review.Man Ther. 2011; 16: 419-433
- Practice parameter for carpal tunnel syndrome (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology.Neurology. 1993; 43: 2406-2409
- [Guideline ‘Diagnosis and treatment of carpal tunnel syndrome’].Ned Tijdschr Geneeskd. 2008; 152 ([Dutch]): 76-81
- Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments – a systematic review.Arch Phys Med Rehabil. 2010; 91: 981-1004
- Do patients with carpal tunnel syndrome benefit from low-level laser therapy? a systematic review of randomized controlled trials.Arch Phys Med Rehabil. 2017 Jun 16; ([Epub ahead of print])
- Multidisciplinary consensus on the terminology and classification of complaints of the arm, neck and/or shoulder.Occup Environ Med. 2007; 64: 313-319
- Key concepts with electrophysical agents.Phys Ther Rev. 2010; 15: 351-359
- Subacromial impingement syndrome: effectiveness of pharmaceutical interventions–nonsteroidal anti-inflammatory drugs, corticosteroid, or other injections: a systematic review.Arch Phys Med Rehabil. 2013; 94: 961-976
- Frozen shoulder: the effectiveness of conservative and surgical interventions–systematic review.Br J Sports Med. 2011; 45: 49-56
- Carpal tunnel syndrome. Part II: effectiveness of surgical treatments-a systematic review.Arch Phys Med Rehabil. 2010; 91: 1005-1024
- 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group.Spine (Phila Pa 1976). 2009; 34: 1929-1941
- Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group.Spine (Phila Pa 1976). 2003; 28: 1290-1299
- Effects of acupuncture on neuropathic pain: a systematic review and meta-analysis (P3.306).Neurology. 2015; 84: P3.306
- Acupuncture produces brain structural plasticity associated with improved clinical outcomes for carpal tunnel syndrome.Integr Med Res. 2015; 4: 27-28
- Exercise and mobilisation interventions for carpal tunnel syndrome.Cochrane Database Syst Rev. 2012; : CD009899
- Higgins J. Altman D. Sterne J. Cochrane handbook for systematic reviews of interventions. Version 5. 2011 (Available from) (Accessed July 1, 2016)
- Ultrasound treatment for treating the carpal tunnel syndrome: randomised “sham” controlled trial.Br Med J. 1998; 316: 731-735
- The comparison of ultrasound treatment and local steroid injection plus splinting in the carpal tunnel syndrome: a randomized controlled trial.Bratisl Lek Listy. 2010; 111: 659-665
- 1MHz - 3MHz ultrasound applications in carpal tunnel syndrome [Karpal tunel sendromunda 1MHz - 3MHz ultrason uygulamasi].Fiz. Tedavi ve Rehabil Derg. 1995; 19: 141-145
- Ultrasound therapy effect in carpal tunnel syndrome.Arch Phys Med Rehabil. 1998; 79: 1540-1544
- Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises.Am J Phys Med Rehabil. 2002; 82: 108-113
- A randomized sham-controlled trial of a neurodynamic technique in the treatment of carpal tunnel syndrome.J Orthop Sports Phys Ther. 2009; 39: 709-723
- Can we use nerve gliding exercises in women with carpal tunnel syndrome?.Adv Ther. 2005; 22: 467-475
- An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome.Man Ther. 2000; 5: 214-222
- Comparison of three conservative treatment protocols in carpal tunnel syndrome.Int J Clin Pract. 2006; 60: 820-828
- A pilot study comparing two manual therapy interventions for carpal tunnel syndrome.J Manipulative Physiol Ther. 2007; 30: 50-61
- Comparison of a targeted and general massage protocol on strength, function, and symptoms associated with carpal tunnel syndrome: a randomized pilot study.J Altern Complement Med. 2008; 14: 259-267
- Evaluation of the clinical efficacy of conservative treatment in the management of carpal tunnel syndrome.Adv Ther. 2009; 26: 107-116
- Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial.Arch Phys Med Rehabil. 2007; 88: 1429-1435
- The role of nerve and tendon gliding exercises in the conservative treatment of carpal tunnel syndrome.Journal Med Counc Islam Repub Iran. 2006; 24: 5-12
- The effects of neural mobilization in addition to standard care in persons with carpal tunnel syndrome from a community hospital.J Hand Ther. 2008; 21 (quiz 241): 229-240
- The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial.Am J Phys Med Rehabil. 2011; 90: 435-442
- Carpal tunnel syndrome symptoms are lessened following massage therapy.J Bodyw Mov Ther. 2004; 8: 9-14
- The effectiveness of pulsed magnetic field theraphy in idiopathic carpal tunnel syndrome: a randomized, double blind, sham controlled trial.Turkish J Phys Med Rehabil. 2011; 14: 1-13
- Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial.Eur J Phys Rehabil Med. 2015; 51: 521-528
- Effect of radial shock wave therapy for carpal tunnel syndrome: a prospective randomized, double-blind, placebo-controlled trial.J Orthop Res. 2016; 34: 977-984
- The effectiveness of extracorporeal shock wave therapy vs. local steroid injection for management of carpal tunnel syndrome.Am J Phys Med Rehabil. 2013; 92: 327-334
- Corticosteroid iontophoresis to treat carpal tunnel syndrome: a double-blind randomized controlled trial.Muscle Nerve. 2009; 39: 627-633
- Phonophoresis of dexamethasone sodium phosphate may manage pain and symptoms of patients with carpal tunnel syndrome.Clin J Pain. 2013; 29: 348-353
- A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome.J Can Chiropr Assoc. 2010; 54: 155-163
- Comparison of the short-term effectiveness of short-wave diathermy treatment in patients with carpal tunnel syndrome: a randomized controlled trial.Arch Rheumatol. 2014; 29: 298-303
- Short-term effects of local microwave hyperthermia on pain and function in patients with mild to moderate carpal tunnel syndrome: a double blind randomized sham-controlled trial.Clin Rehabil. 2011; 25: 1109-1118
- The effect of polarized polychromatic noncoherent light (bioptron) therapy on patients with carpal tunnel syndrome.J Lasers Med Sci. 2014; 5: 39-46
- Ultrasound-guided pulsed radiofrequency for carpal tunnel syndrome: A single-blinded randomized controlled study.PLoS One. 2015; 10: 1-12
- The effectiveness of carpal bone mobilization accompanied by night splinting in idiopathic carpal tunnel syndrome.Turkish J Phys Med Rehabil. 2015; 61: 45-50
- Assessment of the effectiveness of interferential current therapy and TENS in the management of carpal tunnel syndrome: a randomized controlled study.Rheumatol Int. 2014; 34: 1639-1645
- Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial.Clinics (Sao Paulo). 2014; 69: 524-528
- Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome.Int J Immunopathol Pharmacol. 2015; 28: 252-262
- A randomized controlled trial of the effects of a combination of static and dynamic magnetic fields on carpal tunnel syndrome.Pain Med. 2008; 9: 493-504
- Assessment of phonophoresis and iontophoresis in the treatment of carpal tunnel syndrome: a randomized controlled trial.Rheumatol Int. 2012; 32: 717-722
- Conservative interventions for carpal tunnel syndrome.J Orthop Sport Phys Ther. 2004; 34: 589-600
- Effects of neuromobilization maneuver on clinical and electrophysiological measures of patients with carpal tunnel syndrome.J Phys Ther Sci. 2014; 26: 1017-1022
- Conservative treatment of carpal tunnel syndrome: Comparison between laser therapy and fascial manipulation®.J Bodyw Mov Ther. 2015; 19: 113-118
- Reliability and efficacy of the new massage technique on the treatment in the patients with carpal tunnel syndrome.Rheumatol Int. 2012; 32: 3171-3179
- Ultrasound in contemporary physiotherapy practice.Ultrasonics. 2008; 48: 321-329
- Biologic effects of ultrasound.Am J Phys Med. 1958; 37: 111-121
- Therapeutic heat and cold.Williams & Wilkins, Baltimore1982
- A quantitative similarity between some biological effects of ultrasound and microwaves.Br J Cancer Suppl. 1982; 5: 93-94
- Rate of regeneration of amphibian peripheral nerves at different temperatures.Acta Biol Exp. 1950; 15: 125-145
- Empirical evidence of an association between internal validity and effect size in randomized controlled trials of low-back pain.Spine (Phila Pa 1976). 2009; 34: 1685-1692
Article info
Publication history
Published online: September 20, 2017
Footnotes
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
