Physical Therapy for Carpal Tunnel Syndrome

Overseen By Cortney C Shewmaker, DPT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Brooke Army Medical Center

Disqualifiers: Radiculopathy, Bilateral CTS, Hand surgery, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

48 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore how physical therapy affects small nerve fibers in people with carpal tunnel syndrome (CTS). Researchers seek to determine if changes in these small nerve fibers relate to patients' feelings and functions after therapy. The trial seeks participants who experience pain or tingling in areas served by the median nerve and have positive results from specific hand tests, such as Phalen and Tinel tests. Those willing to attend physical therapy sessions and have CTS in one hand may find this trial suitable. As an unphased trial, this study offers a unique opportunity to contribute to understanding the broader impacts of physical therapy on nerve health.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this physical therapy is safe for carpal tunnel syndrome?

Research has shown that physical therapy for carpal tunnel syndrome (CTS) is generally safe and well-tolerated. One study found that patients experienced significant symptom relief after undergoing physical therapy, suggesting it does not lead to major side effects. Another study found no difference in results between various treatments, indicating that physical therapy is as safe as other options. While effectiveness can vary, no major safety concerns have been reported for using physical therapy to treat CTS. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using physical therapy for carpal tunnel syndrome because it offers a non-invasive alternative to traditional treatments like medications, wrist splints, or surgery. Unlike these standard options, physical therapy aims to address the root cause of symptoms by improving flexibility, strength, and posture. This approach can potentially reduce pain and improve function without the side effects associated with medication or the recovery time needed for surgery. Plus, it empowers patients by teaching them exercises and techniques they can continue at home, promoting long-term relief and prevention.

What evidence suggests that physical therapy is effective for carpal tunnel syndrome?

Research shows that physical therapy can help treat carpal tunnel syndrome (CTS). Studies have found that manual therapy, a type of physical therapy, lessens pain and improves hand use in people with CTS. One study found that manual therapy improved hand function and grip strength in women with CTS more effectively than surgery. Another review confirmed that various physical therapy methods, including manual therapy, reduce pain and improve nerve function in the short to midterm. Overall, strong evidence supports the effectiveness of physical therapy in managing CTS symptoms. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for individuals aged 18-65 with Carpal Tunnel Syndrome, experiencing pain and abnormal sensations in the areas served by the median nerve. Participants must have positive results on specific physical tests (Phalen's and Tinel's) and be willing to attend physical therapy sessions.

Inclusion Criteria

A positive Phalen test

A positive Tinel test over the carpal tunnel

I experience pain and tingling in my hand where the thumb nerve is.

Exclusion Criteria

Suspected radial and ulnar nerve involvement based on monofilament testing

Currently pregnant or postpartum within the last 6 months

I have symptoms that suggest a pinched nerve in my spine.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a course of standard physical therapy interventions to assess changes in small nerve fiber activity

12 weeks

Follow-up

Participants are monitored for changes in A-beta, A-delta, and C-fiber function and patient-reported outcomes

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Physical Therapy

Trial Overview The study is testing how standard physical therapy affects small nerve fibers in patients with Carpal Tunnel Syndrome using Quantitative Sensory Testing (QST). It aims to see if changes in these nerves relate to patient outcomes after therapy.

How Is the Trial Designed?

Group I: Carpal Tunnel Syndrome Experimental Treatment 1 Intervention

Age 18-65 years with unilateral carpal tunnel syndrome.

Who Is Running the Clinical Trial?

Brooke Army Medical Center

Lead Sponsor

Trials

134

Recruited

28,100+

Published Research Related to This Trial

Carpal tunnel syndrome, a common work-related injury, leads to significant pain and can result in missed work, with surgery often being a last resort due to its risks and the fact that over a third of patients may not return to work within 8 weeks post-operation.

Physical therapy is a viable initial treatment option for carpal tunnel syndrome, allowing patients to explore non-surgical methods before considering the potential complications of surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carpal Tunnel Syndrome: Physical Therapy or Surgery? [2018]

Surgical interventions, particularly endoscopic release, showed better outcomes in terms of physical functioning and quicker return to work compared to open release surgery for carpal tunnel syndrome (CTS).

Other treatments like steroid injections, cognitive behavior therapy, and multidisciplinary occupational rehabilitation also demonstrated benefits, but the overall evidence for various interventions remains limited and lacks strong scientific support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical management of carpal tunnel syndrome: a 12-year review of outcomes. Feuerstein, M., Burrell, LM., Miller, VI., et al.[2019]

Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome in the upper extremities, leading to reduced sensation and function, and can cause irreversible nerve damage if left untreated.

The clinical practice guidelines published in May 2019 provide evidence-based recommendations for the examination, diagnosis, and treatment of CTS, helping physical therapists deliver effective care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carpal Tunnel Syndrome: A Summary of Clinical Practice Guideline Recommendations-Using the Evidence to Guide Physical Therapist Practice. [2020]

A survey of 508 Italian physiotherapists revealed that while most are knowledgeable about carpal tunnel syndrome (CTS) and commonly use effective treatments like education and manual therapy, their management practices do not always align with current evidence-based guidelines.

Only about half of the physiotherapists reported using orthotic interventions for CTS, indicating a gap in adherence to recommended treatment strategies, particularly among those with less experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carpal Tunnel Syndrome: A National Survey to Monitor Knowledge and Operating Methods. Scalise, V., Brindisino, F., Pellicciari, L., et al.[2021]

In a review of studies on carpal tunnel syndrome (CTS) treated conservatively, the prognosis varied widely, with negative outcomes reported in 23% to 89% of patients over a 3-year follow-up period.

Factors such as longer symptom duration, a positive Phalen's test, and thenar wasting were associated with poorer outcomes in conservative management, although the evidence was inconclusive due to variability and potential bias in the studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Course and Prognostic Factors in Conservatively Managed Carpal Tunnel Syndrome: A Systematic Review. Burton, CL., Chesterton, LS., Chen, Y., et al.[2022]

Conservative treatments, including pharmacology, electrotherapy, and manual therapy, have shown benefits for carpal tunnel syndrome (CTS) across varying severity levels, including severe cases with systemic conditions, based on a review of 29 randomized controlled trials.

While these treatments can be effective, the optimal combination of techniques remains unclear, highlighting the need for future studies to include patients with systemic conditions to better understand their efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Conservative Treatment According to Severity and Systemic Disease in Carpal Tunnel Syndrome: A Systematic Review. Hernández-Secorún, M., Montaña-Cortés, R., Hidalgo-García, C., et al.[2021]

A systematic review of 12 randomized clinical trials found that local corticosteroid injections for carpal tunnel syndrome may lead to better improvements in nerve function, specifically in distal motor latency and compound muscle action potential, compared to physical therapy.

However, overall primary outcomes, including patient-reported symptoms, did not show significant differences between corticosteroid injections and physical therapy, suggesting that both treatments can be effective but corticosteroids may offer additional benefits in nerve conduction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Local corticosteroid injection versus physical therapy for the treatment of carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Mao, B., Li, Y., Yin, Y., et al.[2023]

Moderate evidence supports the effectiveness of various physical therapy techniques, such as myofascial massage and low-level laser therapy, for short-term relief of carpal tunnel syndrome (CTS) based on a review of 22 randomized controlled trials.

Electrophysical modalities, including ultrasound and radial extracorporeal shockwave therapy (ESWT), also showed moderate evidence for short- to mid-term effectiveness in treating CTS, but no studies assessed long-term effects, highlighting a need for further research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials. Huisstede, BM., Hoogvliet, P., Franke, TP., et al.[2019]

Wearing a wrist support splint for 8 weeks, combined with a formal education program, significantly improved symptom severity and functional status in patients with carpal tunnel syndrome (CTS) compared to a control group.

Factors such as higher symptom severity, functional deficits, and pain scores were associated with a greater desire for surgical intervention among patients, indicating that conservative treatment can effectively reduce the need for surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial. Hall, B., Lee, HC., Fitzgerald, H., et al.[2013]

For patients with mild to moderate carpal tunnel syndrome (CTS), a conservative treatment approach including wrist splinting, nerve-gliding exercises, and activity modification is recommended to alleviate symptoms.

If conservative measures do not provide sufficient relief, referral to a hand surgeon for further interventions, such as injections or surgery, may be necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Conservative interventions for carpal tunnel syndrome. Michlovitz, SL.[2022]

Physical therapy is a widely used, non-invasive, and cost-effective treatment option for carpal tunnel syndrome (CTS), which is a common condition causing significant disability in the upper limb.

The publication outlines various physiotherapeutic methods that can be applied both before and after surgical treatment for CTS, highlighting the need for a standardized approach in physical therapy for this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical Therapy and Rehabilitation Approaches in Patients with Carpal Tunnel Syndrome. Zaralieva, A., Georgiev, GP., Karabinov, V., et al.[2020]

Physiotherapy and sports therapy interventions for carpal tunnel syndrome (CTS) have been shown to be effective in reducing symptoms and improving hand function, often achieving results comparable to surgery within just 2 weeks of treatment.

Manual therapy, along with techniques like mobilization, massage, kinesiotaping, and yoga, demonstrated positive effects on CTS symptoms, providing a non-invasive alternative that avoids the risks associated with surgical procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Physiotherapy and sports therapeutic interventions for treatment of carpal tunnel syndrome : A systematic review]. Gräf, JK., Lüdtke, K., Wollesen, B.[2022]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/28942118/

Effectiveness of Physical Therapy and Electrophysical ... Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8782801/

The effectiveness of manual therapy on pain, physical function ... The results of this systematic review suggest that conservative treatment based on manual therapy is effective for reducing pain intensity and ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0031940625003189

A systematic review and meta-analysis of the effectiveness ... This review confirms HILT's effectiveness in reducing pain and disability and improving electrophysiological parameters in CTS.

4. jospt.org jospt.org/doi/10.2519/jospt.2017.7090

The Effectiveness of Manual Therapy Versus Surgery on ... In women with carpal tunnel syndrome, 3 sessions of manual therapy provided superior improvements in self-reported function and pinch-tip grip ...

5. bmcmusculoskeletdisord.biomedcentral.com bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06778-z

The effectiveness of biophysical agents in the treatment of ... The evidence was inconclusive for the effectiveness of Low-level Laser therapy and favorable for the short-term efficacy of non-thermal ultrasound.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12085949/

Assessment of the Impact of Specialized Physical Therapy ... Statistical analysis showed a statistically significant improvement in all assessed parameters in both groups of patients two months after CTR.

7. jospt.org jospt.org/doi/10.2519/jospt.2019.0301

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome The overall lifetime prevalence of self-reported and physician-diagnosed carpal tunnel syndrome (CTS), regardless of work status, is 8.0%.

8. jhrlmc.com jhrlmc.com/index.php/home/article/view/309

Long-Term Outcomes of Non-surgical versus ... The study indicates that surgical treatment for CTS may be more effective in reducing symptom severity and improving patient satisfaction compared to non- ...

9. aaos.org aaos.org/globalassets/quality-and-practice-resources/carpal-tunnel/carpal-tunnel-2024/cts-cpg.pdf

Management of Carpal Tunnel Syndrome One high-quality article (Logli 2018) demonstrated no difference in patient reported or clinical outcomes at any follow up period to 12 months ...

10. clinicaltrials.gov clinicaltrials.gov/study/NCT01789645

Physical Therapy in Carpal Tunnel Syndrome Scientific evidence for the management of CTS has exhibited conflicting results. The Cochrane review concluded that surgical treatment relieves symptoms ...