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Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials

Published:September 20, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.482

      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)
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