Carpal tunnel syndrome is often regarded as an issue for those sitting and using the computer for long hours. We used to isolate this problem with computer engineers and computer programmers. Nowadays everyone’s using the computer too much and is at risk for carpal tunnel syndrome (sorry to be bleak, but we all use devices too much)! Each day, Americans spent an average of 5.2 hours on the phone, computer, or tablet. This time has certainly increased over the past few years and is likely higher in the Silicon Valley (San Jose, Santa Clara, Sunnyvale, Cupertino, etc.). The increase in hand use increases the need of physical therapy for carpal tunnel syndrome, but is physical therapy for carpal tunnel syndrome more effective than surgery?
The excessive length of time people use the Internet has increased the risk of many injuries –ranging from neck pain, carpal tunnel syndrome, and even thumb osteoarthritis!
As a physical therapist specializing in manual therapy, my hands are placed under high stress. I’ve personally had carpal tunnel and had to perform self-treatment physical therapy for carpal tunnel syndrome techniques. Our staff was lucky enough to chat with Dr. César Fernández De Las Peñas regarding carpal tunnel syndrome.
How do You Diagnose Carpal Tunnel Syndrome?
Diagnosis of carpal tunnel syndrome is complex since there is a lack of association between clinical, functional, and electromyography outcomes. The most used clinical tests for clinical examination are the phalen and tinnel tests.
The tests should reproduce the patient’s symptoms during the examination. However, sensitivity and specificity of these tests are moderate, so their results should be considered with caution in a complex process of clinical reasoning.
The main issue with carpal tunnel syndrome diagnosis is the presence of pain and sensory symptoms in the hand. There are several structures that can produce similar symptoms mimicking carpal tunnel syndrome.
In 2009 for instance, a great study demonstrated that from patients with clinical pain and sensory symptoms of carpal tunnel syndrome, but was negative in EMG (electromyography), so carpal tunnel syndrome was excluded. In 65% of the patients, the symptoms were reproduced by muscle referred pain from the shoulder muscles.
Is Imaging Helpful for Carpal Tunnel Syndrome?
There is no specific imaging for carpal tunnel syndrome diagnosis. For proper diagnosis, experts use a combination of clinical and EMG outcomes. This is important since not all individuals with symptoms compatible with carpal tunnel syndrome have this syndrome.
The main problem is that the sensitivity of EMG or any other imaging procedure is moderate/poor for carpal tunnel syndrome. In fact, several individuals without symptoms can exhibit EMG-positive (false positives) results. Further, EMG is not enough for a proper analysis of small fibers, so there can be the opposite, patients with symptoms but small affectation of these small sensory fibers, and EMG negative (false negative).
What is the Standard of Care for Physical Therapy for Carpal Tunnel Syndrome?
Standard physical therapy commonly includes the use of splint, local ultrasound, laser, tens, manual physical therapy, and steroid injections. The main issue is that all the interventions proposed for management of carpal tunnel syndrome are local, focusing just on the carpal tunnel. In fact, there are several systematic reviews supporting the use of local steroid injections for carpal tunnel syndrome.
How Effective is Physical Therapy for Carpal Tunnel Syndrome?
The results of standard physical therapy are controversial as some studies have found positive results against surgery but others did not. Most patients usually experience improvements in their symptoms from one to three months after the use of splints, but symptoms appear again.
In general, there are few high-quality studies investigating standard physical therapy interventions. Interestingly, in these studies, differences between surgery and physical therapy were small at long-term.
If Physical Therapy for Carpal Tunnel Syndrome Doesn’t Help, How Effective is Surgery for Carpal Tunnel Syndrome?
This is a complex and delicate question. The results of surgery can be positive or negative. There are patients experiencing huge improvements after surgery. There are also others who did not experience any change.
One problem with the surgery is its potential side effects. Although rare, they can be highly invalidating. Another problem is that most patients after surgery usually need a month to recover, requiring them to take a leave from work for at least 30 days. Finally, a moderate rate of patients receiving surgery needs a second operation in the same hand. Some also develop pain symptoms in the other hand.
What Does the Latest Research Looking at for Carpal Tunnel Syndrome?
We have published different randomized controlled trials comparing a multimodal manual therapy approach. These are based on neuro-modulation reasoning of the central nervous system versus surgery for pain, function, disability, force, and sensitivity outcomes. All studies demonstrated that this manual therapy approach was similarly effective at 6 and 12 months compared to surgery.
One important thing is that patients in the manual therapy group received only three sessions –once per week– of manual therapy. The effects of these sessions were maintained at 12 months follow-up. Obviously, patients were asked to do some nerve gliding exercises at home.
The results of our studies suggest that patients with carpal tunnel syndrome should first undergo treatment including a manual physical therapy program prior to undergoing surgical intervention for most cases.
What Future Research is Needed on Physical Therapy for Carpal Tunnel Syndrome?
Our studies included only women with carpal tunnel syndrome because they are twice as likely to experience the condition than men. Therefore, we do not know the response of men with carpal tunnel syndrome. Multi-center studies including different physical therapists and surgeons from different countries should be conducted to determine the differences in responses between countries, centers, and therapists.
Self Physical Therapy for Carpal Tunnel Syndrome Treatments
Self-manual therapy is possible and beneficial in some cases for carpal tunnel syndrome. Here are a few treatments we have given patients in the Santa Clara area. If you live in the Bay Area and are feeling any symptoms in your hands, schedule a Free Physical Therapy Consultation.
SMR Forearm and Hand
Physical Therapy for Carpal Tunnel Syndrome Conclusion
When considering any treatment for wrist, forearm, or hand pain, make sure to weigh all the options. As a healthcare professional, our goal is to make you better! Physical therapy for carpal tunnel syndrome appears as effective as surgery but has a lower risk of complications. If your pain persists after an elite manual physical therapy for carpal tunnel syndrome treatment, then surgery should be considered.
Are you in the Bay Area? Schedule your FREE physical therapy consultation and start improving your carpal tunnel syndrome pain today!