Bilateral Idiopathic Carpal Tunnel Syndrome: Clinical-Functional Characterization and Efficacy of Two Combined Postoperative Physiotherapeutic Treatments

OBJECTIVE

To evaluate the efficacy of combined association instrument myofascial mobilization (IASTM) and stretching in patients with idiopathic bilateral carpal tunnel syndrome (CTS) operated on one hand and to analyze the response of the operated (OH) and non-operated (NH) hand according to the sequence of therapies. Research on these parameters has not yet been found in the literature.

METHODS

Randomized controlled crossover study with 43 participants using the objective and subjective outcome variables. Patients were randomly assigned to two groups: starting with stretching followed by IASTM and starting with IASTM followed by stretching. Then patients underwent surgery on the hand with more severe involvement and physical therapy rehabilitation was started 30 days after for a period of 4 weeks. After the 1-week interval the participants who started with stretching were referred to IASTM and vice versa, following the same previous patterns. The outpatient reassessments took place at 3 to 6 months. Crossover ANOVA and effect sizes were used as analysis methods.

RESULTS

Time was the most significant outcome for all variables both during therapies and at 6-month follow-up. Regarding response to the combined therapies between OH and NH, there were differences for both OH and NH, with the greatest impact on NH for the palmar grip and VAS variables. The treatment sequences were significant for pain on the NH and mental SF-12, suggesting that starting with IASTM followed by stretching had a superior outcome for these outcomes.

CONCLUSION

The combination of IASTM with stretching, used in the postoperative period of bilateral idiopathic CTS, proved to be supplementary, with significant results and large effect sizes for most of the outcomes assessed, both during the time of application of the therapies and in the 6-month follow-up for both hands, and may constitute a viable therapeutic alternative for this population.

Sensory Nerve Conduction Velocity Predicts Improvement of Hand Function with Nerve Gliding Exercise Following Carpal Tunnel Release Surgery

This study aims to investigate the effects of nerve gliding exercise following carpal tunnel release surgery (NGE-CTRS) and the probing factors affecting the effect of NGE-CTRS on hand function. A total of 86 patients after CTRS participated. Grip strength (grip-s), pinch strength (pinch-s), Semmes-Weinstein monofilament test (SWMT), two-point discrimination (2PD), numbness, pain, and Phalen test (Phalen) were measured and compared between pre- and post-NGE-CTRS. The results showed that the combination of surgery and NGE significantly improved the postoperative grip-s, pinch-s, SWMT, 2PD, numbness, and Phalen; however, no improvement was observed in pain. Background factors that influenced the improved grip-s and pinch-s included gender and preoperative sensory nerve conduction velocity (SCV). Additionally, numbness and Phalen were not affected by age, gender, fault side, bilateral, trigger finger, dialysis, thenar eminence atrophy, motor nerve conduction velocity, SCV, the start of treatment, and occupational therapy intervention. In conclusion, the combination of surgical procedures and NGE showed a high improvement. SCV and time-to-start treatment of intervention for carpal tunnel syndrome may be useful in predicting the function after the intervention.