The Journal of the American Osteopathic Association, 2006/08, 106(8):477. doi: 10.7556/jaoa.2006.106.8.471, type of study: ,rct,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2006.106.8.471/html)

Keywords:

carpal tunnel syndrome [40]
median nerve [15]
OMT [3924]
osteopathic manipulative treatment [3945]
randomized controlled trial [947]
wrist [18]

Abstract:

Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy. Conservative treatment includes NSAIDs, wrist splints, and exercises. Diagnosis can be made by using nerve conduction studies (NCS), or by showing median nerve swelling with ultrasound (US). In numerous studies OMT improved pain and Phalen tests, and was linked in pilot projects to trends in NCS improvement and decreased median nerve swelling. Hypothesis: The addition of OMT to standard medical therapy for CTS will: decrease median nerve cross-sectional area (CSA), decrease Symptom Severity Scale (SSS) scores, and decrease Functional Status Scale (FSS) scores. Methods: 23 patients with mild-to-moderate CTS diagnosed by NCS in 39 wrists were randomized into OMT (n=21) or sham laser (n=18) groups. US measurements of all median nerves were obtained, and all patients completed SSS and FSS prior to treatment. These subjects were provided eight weekly sessions of OMT (MFR/BLT) or sham laser. All patients were provided wrist splints, exercises, and ibuprofen if not contraindicated. Survey data on pain level, medication use, splint wearing, and exercises were recorded weekly. NCS, US, SSS, and FSS data were collected after the last treatment. Results: There was a positive correlation between US measurements of the median nerve CSA and the severity of CTS as diagnosed by NCS (P=0.012). Comparison of pre-, post-, and post- minus pre-treatment groups revealed no significant difference in median nerve CSA. Regression analysis of the US measurements and SSS and FSS scores showed an increase in median nerve CSA was related to an increase in SSS in the laser post-treatment group (P=0.007). There were no significant changes in the OMT group. Head to head analysis of the post-treatment groups showed significantly higher SSS scores (P=0.013) and FSS scores (P=0.005) in the sham laser group. Conclusions: While US was shown to correlate with the diagnosis of CTS, it did not detect any significant change in median nerve CSA in patients receiving OMT or sham laser after eight treatments. Weekly OMT was shown to slow, if not halt, the progression of symptoms and the decline in function in patients with CTS, while those receiving sham laser treatments had more symptoms and worse function.