Conservative therapeutic management of carpal tunnel syndrome

Roberto Sérgio Martins; Mário Gilberto Siqueira

doi:10.1590/0004-282X20170152

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(11): 819-824
DOI: 10.1590/0004-282X20170152

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Conservative therapeutic management of carpal tunnel syndrome

Manejo terapêutico conservador da síndrome do túnel do carpo

Roberto Sérgio Martins

¹Universidade de São Paulo, Faculdade de Medicina, Unidade de Cirurgia do Nervo Periférico, Divisão de Neurocirurgia Funcional, Instituto de Psiquiatria, São Paulo SP Brasil.

,

Mário Gilberto Siqueira

¹Universidade de São Paulo, Faculdade de Medicina, Unidade de Cirurgia do Nervo Periférico, Divisão de Neurocirurgia Funcional, Instituto de Psiquiatria, São Paulo SP Brasil.

› Author Affiliations

Abstract

ABSTRACT

Carpal tunnel syndrome is the most prevalent nerve compression and can be clinically or surgically treated. In most cases, the first therapeutic alternative is conservative treatment but there is still much controversy regarding the most effective modality of this treatment. In this study, we critically evaluated the options of conservative treatment for carpal tunnel syndrome, aiming to guide the reader through the conventional options used in this therapy.

RESUMO

A síndrome do túnel do carpo é a compressão de nervo mais prevalente e seu tratamento pode ser clínico ou cirúrgico. Na maioria dos casos o tratamento conservador é a primeira alternativa terapêutica mas ainda há muitas controvérsias a respeito do tratamento mais eficaz. Neste estudo avaliamos de forma crítica as opções de tratamento conservador da síndrome do túnel do carpo, objetivando guiar o leitor no uso racional deste tipo de terapêutica.

Keywords:

carpal tunnel syndrome - median nerve - conservative treatment

Palavras-chave:

síndrome do túnel do carpo - nervo mediano - tratamento conservador

Full Text

References

References
1 Middleton SD, Anakwe RE. Carpal tunnel syndrome. BMJ. 2014;6;349:g6437. https://doi.org/10.1136/bmj.g6437.
2 Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992;45(4):373-6. https://doi.org/10.1016/0895-4356(92)90038-O
3 Huisstede BM, Fridén J, Coert JH, Hoogvliet P, European HANDGUIDE Group. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline-results from the European Handguide Study. Arch Phys Med Rehabil. 2014;95(12):2253-63. https://doi.org/10.1016/j.apmr.2014.06.022
4 Ashworth NL. Carpal tunnel syndrome. Am Fam Physician. 2016;94(10):830-1.
5 O’Gradaigh D, Merry P. Corticosteroid injection for the treatment of carpal tunnel syndrome. Ann Rheum Dis. 2000;59(11):918-9. https://doi.org/10.1136/ard.59.11.918
6 Armstrong T, Devor W, Borschel L, Contreras R. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome. Muscle Nerve. 2004;29(1):82-8. https://doi.org/10.1002/mus.10512
7 Breuer B, Sperber K, Wallenstein S, Kiprovski K, Calapa A, Snow B et al. Clinically significant placebo analgesic response in a pilot trial of botulinum B in patients with hand pain and carpal tunnel syndrome. Pain Med. 2006;7(1):16-24. https://doi.org/10.1111/j.1526-4637.2006.00084.x
8 Dammers JW, Veering MM, Vermeulen M. Injection with methylprednisolone proximal to the carpal tunnel: randomized double blind trial. BMJ. 1999;319(7214):884-6. https://doi.org/10.1136/bmj.319.7214.884
9 Gökoğlu F, Fındıkoğlu G, Yorgancoğlu ZR, Okumuş M, Ceceli E, Kocaoğlu S. Evaluation of iontophoresis and local corticosteroid injection in the treatment of carpal tunnel syndrome. Am J Phys Med Rehabil. 2005;84(2):92-6. https://doi.org/10.1097/01.PHM.0000151942.49031.DD
10 Nalamachu S, Crockett RS, Mathur D. Lidocaine patch 5% for carpal tunnel syndrome: how it compares with injections: a pilot study. J Fam Pract. 2006;55(3):209-14.
11 Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007;21(4):299-314. https://doi.org/10.1177/0269215507077294
12 Wong SM, Hui AC, Tang A, Ho PC, Hung LK, Wong KS et al. Local vs. systemic corticosteroids in the treatment of carpal tunnel syndrome. Neurology. 2001;56(11):1565-7. https://doi.org/10.1212/WNL.56.11.1565
13 Wong SM, Hui ACF, Lo SK, Chiu JH, Poon WF, Wong L. Single vs. two steroid injections for carpal tunnel syndrome: a randomised clinical trial. Int J Clin Pract. 2005;59(12):1417-21. https://doi.org/10.1111/j.1368-5031.2005.00696.x
14 Marshall S, Tardif G, Ashworth N. Local corticosteroid injection or carpal tunnel syndrome. Cochrane Database Syst Rev. 2007(2):CD001554.
15 Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E et al. Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome. Neurol Sci. 2004;25(2):48-52. https://doi.org/10.1007/s10072-004-0229-0
16 Amadio PC. Pyridoxine as an adjunct in the treatment of carpal tunnel syndrome. J Hand Surg Am. 1985;10(2):237-41. https://doi.org/10.1016/S0363-5023(85)80112-X
17 Ryan-Harshman M, Aldoori W. Carpal tunnel syndrome and vitamin B6. Can Fam Physician. 2007;53(7):1161-2.
18 O’Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003(1):CD003219. https://doi.org/10.1002/14651858.CD003219
19 Horng YS, Hsieh SF, Lin MC, Chang YW, Lee KC, Liang HW. Ultrasonographic median nerve changes under tendon gliding exercise in patients with carpal tunnel syndrome and healthy controls. J Hand Ther. 2014;27(4):317-23. https://doi.org/10.1016/j.jht.2014.07.007
20 Szabo RM, Bay BK, Sharkey NA, Gaut C. Median nerve displacement through the carpal canal. J Hand Surg Am. 1994;19(6):901-6. https://doi.org/10.1016/0363-5023(94)90087-6
21 Wright WT, Glowczewskie F, Wheeler D, Miller G, Cowin D. Excursion and strain of the median nerve. J Bone Joint Surg Am. 1996;78(12):1897-903. https://doi.org/10.2106/00004623-199612000-00013
22 Yoshii Y, Villarraga HR, Henderson J, Zhao C, An KN, Amadio PC. Ultrasound assessment of the displacement and deformation of the median nerve in the human carpal tunnel with active finger motion. J Bone Joint Surg (Am). 2009;91(12):2922-30. https://doi.org/10.2106/JBJS.H.01653
23 Akalin E, El O, Peker O, Senocak O, Tamci S, Gulbahar S et al. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil. 2002;81(2):108-13. https://doi.org/10.1097/00002060-200202000-00006
24 Heebner ML, Roddey TS. The effects of neural mobilization in addition to standard care in persons with carpal tunnel syndrome from a community hospital. J Hand Ther. 2008;21(3):229-40. https://doi.org/10.1197/j.jht.2007.12.001
25 Pinar L, Enhos A, Ada S, Güngör N. Can we use nerve gliding exercises in women with carpal tunnel syndrome? Adv Ther. 2005;22(5):467-75. https://doi.org/10.1007/BF02849867
26 Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998;11(3):171-9. https://doi.org/10.1016/S0894-1130(98)80035-5
27 Wehbé MA, Hunter JM. Flexor tendon gliding in the hand. Part II. Differential gliding. J Hand Surg Am. 1985;10(4):575-9. https://doi.org/10.1016/S0363-5023(85)80086-1
28 Horng YS, Hsieh SF, Tu YK, Lin MC, Horng YS, Wang JD. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial. Am J Phys Med Rehabil. 2011;90(6):435-42. https://doi.org/10.1097/PHM.0b013e318214eaaf
29 Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;13(6):CD009899. https://doi.org/10.1002/14651858.CD009899
30 Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments: a systematic review. Arch Phys Med Rehabil. 2010;91(7):981-1004. https://doi.org/10.1016/j.apmr.2010.03.022
31 Manente G, Torrieri F, Di Blasio F, Staniscia T, Romano F, Uncini A. An innovative hand brace for carpal tunnel syndrome: a randomized controlled trial. Muscle Nerve. 2001;24(8):1020-5. https://doi.org/10.1002/mus.1105
32 Schmid AB, Elliott JM, Strudwick MW, Little M, Coppieters MW. Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome: an MRI study to reveal therapeutic mechanisms. J Orthop Res. 2012;30(8):1343-50. https://doi.org/10.1002/jor.22064
33 De Angelis MV, Pierfelice F, Di Giovanni P, Staniscia T, Uncini A. Efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome: a randomized controlled study. Acta Neurol Scand. 2009;119(1):68-74. https://doi.org/10.1111/j.1600-0404.2008.01072.x
34 Burke DT, Burke MM, Stewart GW, Cambré A. Splinting for carpal tunnel syndrome: in search of the optimal angle. Arch Phys Med Rehabil. 1994;75(11):1241-4. https://doi.org/10.1016/0003-9993(94)90012-4
35 Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;11(7):CD010003. https://doi.org/10.1002/14651858.CD010003
36 Roll SC, Hardison ME. Effectiveness of occupational therapy interventions for adults with musculoskeletal conditions of the forearm, wrist, and hand: a systematic review. Am J Occup Ther. 2017;71(1):7101180010p1-12. https://doi.org/10.5014/ajot.2017.023234
37 Hall B, Lee HC, Fitzgerald H, Byrne B, Barton A, Lee AH. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial. Am J Occup Ther. 2013;67(4):448-59. https://doi.org/10.5014/ajot.2013.006031
38 Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2013;3(3):CD009601. https://doi.org/10.1002/14651858.CD009601
39 Chang WD, Wu JH, Jiang JA, Yeh CY, Tsai CT. Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament. Photomed Laser Surg. 2008;26(6):551-7. https://doi.org/10.1089/pho.2007.2234
40 Yagci I, Elmas O, Akcan E, Ustun I, Gunduz OH, Guven Z. Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome. Clin Rheumatol 2009;28(9):1059-65. https://doi.org/10.1007/s10067-009-1213-0
41 Naeser MA, Hahn KA, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. Arch Phys Med Rehabil. 2002;83(7):978-88. https://doi.org/10.1053/apmr.2002.33096
42 Gigo-Benato D, Geuna S, de Castro Rodrigues A, Tos P Fornaro M, Boux E et al. Low-power laser biostimulation enhances nerve repair after end-to-side neurorrhaphy: a double-blind randomized study in the rat median nerve model. Lasers Med Sci. 2004;19(1):57-65. https://doi.org/10.1007/s10103-004-0300-3
43 Oliveira FB, Pereira VM, Trindade AP, Shimano AC, Gabriel RE, Borges AP Action of therapeutic laser and ultrasound in peripheral nerve regeneration. Acta Ortop Bras. 2012;20(2):98-103. https://doi.org/10.1590/S1413-78522012000200008
44 Armagan O, Bakilan F, Ozgen M, Mehmetoglu O, Oner S. Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial. Clinics (São Paulo). 2014;69(8):524-8. https://doi.org/10.6061/clinics/2014(08)04
45 Oztas O, Turan B, Bora I, Karakaya MK. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil. 1998;79(12):1540-4. https://doi.org/10.1016/S0003-9993(98)90416-6