Physical Therapy for Carpal Tunnel Syndrome

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Brooke Army Medical Center

Disqualifiers: Radiculopathy, Bilateral CTS, Hand surgery, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

The diagnosis of carpal tunnel syndrome (CTS) is typically based on clinical findings and confirmatory electrodiagnostic testing. However, electrodiagnostic testing can only assess large A-alpha and A-beta nerve fibers. Quantitative sensory testing (QST) is a series of tests used to assess small nerve fiber changes in the A-delta, c-fibers, and A-beta nerve fibers as well. Previous studies have used QST to assess small nerve fiber changes related to carpal tunnel syndrome and found changes compared to controls. This study will utilize a course of standard physical therapy care and assess for any changes to small nerve fiber activity and how those changes may or may not relate to patient outcomes.

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 data supports the effectiveness of the treatment Physical Therapy for Carpal Tunnel Syndrome?

Research shows that physical therapy, including education, manual therapy, and exercises, is widely used for carpal tunnel syndrome and can improve symptoms and hand function. A study also found that a conservative treatment program, which may include physical therapy, led to significant improvements in symptom severity and functional status. ^{1 2 3 4 5}

Is physical therapy safe for treating carpal tunnel syndrome?

Physical therapy is generally considered a safe treatment option for carpal tunnel syndrome, with a low risk of side effects. ^{1 6 7 8 9}

How does physical therapy differ from other treatments for carpal tunnel syndrome?

Physical therapy for carpal tunnel syndrome is unique because it is non-invasive, relatively inexpensive, and easy to apply compared to surgical options. It involves exercises and methods that help improve nerve function and reduce symptoms without the risks associated with surgery. ^{1 4 10 11 12}

Research Team

Eligibility Criteria

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.

Trial Timeline

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

Treatment Details

Interventions

• Physical Therapy (Behavioural Intervention)

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.

Participant Groups

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+

Col. Mark Stackle

Brooke Army Medical Center

Chief Executive Officer since 2024

MD

Col. Sean Hipp

Brooke Army Medical Center

Chief Medical Officer since 2024

MD

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials. [2019]

2. United States 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. [2013]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Carpal Tunnel Syndrome: A National Survey to Monitor Knowledge and Operating Methods. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Physical Therapy and Rehabilitation Approaches in Patients with Carpal Tunnel Syndrome. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Clinical Course and Prognostic Factors in Conservatively Managed Carpal Tunnel Syndrome: A Systematic Review. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Clinical management of carpal tunnel syndrome: a 12-year review of outcomes. [2019]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Effectiveness of Conservative Treatment According to Severity and Systemic Disease in Carpal Tunnel Syndrome: A Systematic Review. [2021]

8. Netherlands 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. [2023]

9. Germany pubmed.ncbi.nlm.nih.gov

[Physiotherapy and sports therapeutic interventions for treatment of carpal tunnel syndrome : A systematic review]. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Conservative interventions for carpal tunnel syndrome. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

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

12. United States pubmed.ncbi.nlm.nih.gov

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