Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome, a pilot project

Participants

• Numbers: 9 people (6 female and 3 male, mean age 48.6 years)

• Criteria of inclusion: volunteers contacted through e-mail or telephone; symptoms compatible with carpal tunnel syndrome involving at least one arm (hand numbness, tingling, pain, weakness or nocturnal symptoms exacerbation); electrophysiologic evidence of median nerve dysfunction typical in carpal tunnel syndrome in least one arm (median sensory nerve conduction velocity < < 43m/s or distal motor latency >>4.3ms); no evidence of: peripheral neuropathy, cervical radiculopathy, brachial plexopathy, proximal median neuropathy, ulnar and radial neuropathy, a history of carpal tunnel release surgery or intracarpal tunnel corticosteroid injection in the previous 6 months.

• Groups of study: 1 group only

Group 1: OMT, 9 people
• some of the participants were also considered as control:
• if a person only had one arm affected with carpal tunnel syndrome, this arm was treated
• if a person had both arms affected with carpal tunnel syndrome, only one of them was treated while the other one functioned as a control (whichever of them was chosen by the patient)
• an average symptom duration of 8.6 years
• 3 participants used wrist splints and 1 was taking anti-inflammatory drugs

Interventions and evaluations

• Assessment of symptoms and function at the beginning of the study and after the last treatment using BCTQ
• Evaluation using sensory symptomatic diagram (representation on the body of the perceptions felt, ie, pain, numbness and tingling, over the previous 7 days) and patient estimate of overall change at the beginning of the study and after the last treatment
• Evaluation of the median nerve (nerve and motor conduction velocity and proximal to distal action potentials amplitude ratio) using electrophysiological testing and ultrasonic images of the median nerve and transverse carpal ligaments, at the beginning of the study, after the first intervention session and after the last treatment
• The people managing the carpal tunnel syndrome with wrist splints and non steroidal anti-inflammatory drugs could continue to use these measures during the study
• 6 weekly OMT sessions
• OMT:
  • standing postural evaluation to assess curves and compensations, palpatory examination of the spine, ribs, treated arm and the anterior Chapman point at the third rib
  • ligamentous tension balancing, membranous tension balancing of the interosseous membranes, high-velocity low-amplitude, and extension and release of the transverse carpal ligament techniques
• OMT performed by an osteopathic physician and her student

Results

• Primary outcomes: People reported a statistically significant reduction in symptoms measured by both BCTQ and sensory symptomatic diagram in the arm treated with OMT. The BCTQ assessment also showed a statistically significant improvement in arm function, as well as a lowering of the symptoms and function to levels similar to those of the untreated arms. However, on an estimated level, people reported a statistically significant improvement only in symptoms and not in functionality. With regard to electrophysiological analysis, despite a tendency to a higher velocity of sensory and motor conduction, no statistically significant results have emerged. Also the ultrasound analyses did not relieve any particular changes: only the length of the transverse carpal ligament resulted statistically significantly increased at the end of the study, but there was no difference between treated and untreated arms.

• Further analyses: somatic dysfunction and tenderness at the Chapman point persisted throughout the study. Only during the last intervention the tenderness at the Chapman point did not induce any more pain.

Discussion

OMT proved to be able to improve the symptomatology and functionality of arms affected by carpal tunnel. However, from an objective point of view, there were no electrophysiological or anatomical changes in the carpal tunnel in this study.

Potentially, OMT may have therefore acted independently from the carpal tunnel decompression, for example through an opioid release. Or, the objective evaluation may have been carried out too early: several studies report that it takes several weeks after a carpal tunnel decompression to detect changes in myelination or nerve function.

Studies on larger samples and over a longer-term are needed to better assess objective changes. In addition, individual techniques could be evaluated to understand which ones would be most useful.