Differentiating HAVS and CTS

Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome

Background

Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce.

Objective

To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status.

Methods

A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm² and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3^rd and 6^th weeks.

Results

Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group.

Conclusions

The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

Carpal tunnel syndrome and Raynaud’s phenomenon: a narrative review

Background

Raynaud’s phenomenon (RP) is a recognized symptom associated with carpal tunnel syndrome (CTS) and is also the vascular manifestation of hand arm vibration syndrome (HAVS). The symptoms of HAVS and CTS are such that there is a significant possibility of misdiagnosis and an incorrect attribution of vascular and sensory symptoms. An understanding of the relationship between RP and CTS is essential when undertaking health surveillance of vibration-exposed workers presenting with combined vascular and sensory symptoms.

Aims

To clarify the relationship between CTS and Raynaud’s phenomenon.

Methods

A systematic search was undertaken of studies that reviewed links between CTS and Raynaud’s phenomenon (RP).

Results

A total of 4170 papers were identified, with 21 articles that were then reviewed in full, including 1 meta-analysis of 8 studies. Eighteen papers, not included in the meta-analysis, were found including 3 case control studies, 9 case reports, 2 prospective studies and 4 retrospective reviews. Papers were reviewed on the basis of the diagnostic criteria used for CTS and RP. Our review of the literature confirms a substantial body of evidence of a relationship between RP and CTS.

Conclusions

It is recommended that assessment of vibration exposed individuals who report concurrent RP and separate sensory symptoms suggestive of, or compatible with CTS, should formally exclude CTS before attributing symptoms to HAVS.