Professional manual care of carpal tunnel syndrome
While Carpal tunnel syndrome is often treated successfully with surgery, a recent study shows high success with manual care without the risks or high costs of surgery.
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) occurs when a tunnel shaped set of bones and cartilage in the wrist, which the median nerve and other tendons pass through, squeezes the median nerve as it passes from the forearm into the hand. Symptoms tend to build gradually. You might feel an itching numbness in the palm of the hand and the fingers, especially the thumb, index, and middle fingers. You might wake up at night with the feeling that you need to “shake out” the hand or wrist. It may progress to tingling in the hand, or a sharp pain that shoots from the wrist up your arm. Grip strength decreases making it hard to hold small objects or do manual tasks.
What causes carpal tunnel syndrome?
The cause is often something of a mystery. Some think it is mainly a congenital problem where some people just are born with a smaller tunnel than others. But trauma to the wrist that causes swelling may contribute, as could arthritis or a cyst or tumor in the canal.
Most common symptoms of carpal tunnel syndrome
- Severe pain in dominant hand and wrist which may radiate into forearm
- Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers
- Weakness and swelling of fingers
- Tingling in hands during the day
- Weakened grip strength (makes it hard to form a fist or grasp small objects)
- Atrophy of muscles at base of the thumb
Research on effectiveness of graston technique on carpal tunnel syndrome
In the recent study using manual therapy, patients with mild to moderate CTS were divided into two groups. Both received soft tissue mobilization, but in one group it was done by hand, strictly manually, while in the second group it was done with small hand tools (called the Graston Technique). Both methods can be done by chiropractic doctors and this study was designed to see which was better. The patients were seen 10 times over 6 weeks. In both groups objective measures showed range of motion and grip strength returned within normal limits similar to the patient’s other (unaffected) hand. The severity of their symptoms decreased and their ability to function improved in both groups.4
Relief of symptoms and return to function directly affect patient satisfaction with their care and accordingly the satisfaction ratings were very high. None of the patients were “very dissatisfied” or “dissatisfied”. In the Graston group all the patients, 100%, were either “satisfied” or “very satisfied” both at the end of the care period and at 3 month follow-up. In the strictly manual group 90 percent were satisfied or very satisfied, at the end of care. Ten percent felt “neutral”. After 3 months, 20 percent felt neutral but still 80 percent were satisfied (or very satisfied) with their results.5
While the Graston group appeared in the raw numbers to do slightly better, the study group was too small for that difference to be considered statistically significant. Future larger studies may show that it is.
In comparison surgery leads to relief of symptoms 75 to 99% of the time according to prior research referenced in this study which is similar to the 80 to 100% that were satisfied (or very satisfied) after 3 months in this study. However surgery results in complications in 1 to 2 patients out of a hundred and of these up to 12% may need a second surgery.6
The only complication of the manual care in this study was temporary bruising on the forearm.
The researchers concluded, “Manual therapies for CTS were effective at improving objective measures of impairments and patient-centered measures of symptom severity and functional abilities.”7
Our take on this is that if you suffer with CTS you would do well to try chiropractic care first. Surgery is still an option if you are dissatisfied but in this study none of the patients were. This is in keeping with the American Academy of Neurology that already recommends conservative management of CTS prior to surgical intervention.8
.National Institute of Neurological Disorders and Stroke, National Institutes of Health, webpage http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. 2
. Ibid. 3
. Ibid. 4
. J. Burke, et al., “A Pilot Study Comparing Two Manual Therapy Interventions for Carpal Tunnel Syndrome,” January 2007, Journal of Manipulative & Physiological Therapeutics, Vol. 30, No. 1, p. 59. 5
. Ibid., Table 5, p. 58. 6
. Ibid., pp. 50-51. 7
. Ibid., pp. 58-59. 8
. Ibid., p. 50.