Effects of diacutaneous fibrolysis in patients with mild to moderate symptomatic carpal tunnel syndrome: a randomized controlled trial

Abstract

Objective:

To compare the effects of diacutaneous fibrolysis with sham in patients with mild to moderate carpal tunnel syndrome.

Design:

Double-blind (patient and evaluator) randomized controlled trial.

Setting:

Miguel Servet University Hospital, Zaragoza, Spain.

Subjects:

A total of 52 patients (72 wrists) with carpal tunnel syndrome, 41 women and 11 men, mean age was 46.9 (8.8) years. They were divided into two groups: diacutaneous fibrolysis group and sham group.

Interventions:

Real diacutaneous fibrolysis in diacutaneous fibrolysis group and sham diacutaneous fibrolysis in sham group. Both groups received five sessions in the forearm, wrist and hand.

Main measures:

Neurophysiological parameters assessed at baseline and at the end of the treatment. Intensity of nocturnal symptoms (visual analogue scale (VAS)) and upper limb functional capacity (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) at baseline, at the end of the treatment and one month after treatment.

Results:

Diacutaneous fibrolysis group (n = 30 wrists) improved in nerve conduction distal motor latency (mean difference: –0.26, 95% confidence interval (CI): –0.49/–0.26), sensory conduction velocity (mean difference: 6.52, 95% CI: 3.52/9.51), intensity of nocturnal symptoms (mean difference: –2.24, 95% CI: –4.08/–2.04) and upper limb functional capacity (mean difference: –19, 95% CI: –26.1/–11.9) compared to the sham group (n = 30 wrists) (P < 0.02, P < 0.01, P < 0.01 and P < 0.01, respectively). At one-month follow-up, improvements in the nocturnal symptoms and upper limb functional capacity were maintained compared to the sham group (P < 0.01).

Conclusion:

Diacutaneous fibrolysis provides short-term and one-month follow-up, improvements in sensory conduction velocity, motor distal latency, symptoms and functional capacity in patients with mild to moderate carpal tunnel syndrome.

Keywords

Carpal tunnel syndrome physical therapy modalities pain and randomized controlled trial

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References

Frasca

Maggi

Padua

et al . Short-term effects of local microwave hyperthermia on pain and function in patients with mild to moderate carpal tunnel syndrome: a double blind randomized sham-controlled trial. Clin Rehabil 2011; 25(12): 1109–1118.

Brininger

Rogers

Holm

et al . Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil 2007; 88(11): 1429–1435.

Burke

FD.

Carpal tunnel syndrome: reconciling “demand management” with clinical need. J Hand Surg Br 2000; 25(2): 121–127.

Manente

Torrieri

Di Blasio

et al . An innovative hand brace for carpal tunnel syndrome: a randomized controlled trial. Muscle Nerve 2001; 24(8): 1020–1025.

Harirforoosh

Asghar

Jamali

Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci 2013; 16(5): 821–847.

Liu

Ahmet

Ward

et al . A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol 2013; 9(1): 30.

Kuschner

Brien

Johnson

et al . Complications associated with carpal tunnel release. Orthop Rev 1991; 20(4): 346–352.

Braun

Rechnic

Fowler

Complications related to carpal tunnel release. Hand Clin 2002; 18(2): 347–357.

Ebenbichler

Resch

Nicolakis

et al . Ultrasound treatment for treating the carpal tunnel syndrome: randomized “sham” controlled trial. BMJ 1998; 316(7133): 731–735.

10.

Carlson

Colbert

Frydl

et al . Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol 2010; 5(1): 129–142.

11.

Graham

Nonsurgical treatment of carpal tunnel syndrome. J Hand Surg Am 2009; 34(3): 531–534.

12.

Huisstede

Friden

Coert

et al . 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): 2253–2263.

13.

Kim

SD.

Efficacy of tendon and nerve gliding exercises for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Phys Ther Sci 2015; 27(8): 2645–2648.

14.

O’Connor

Marshall

Massy-Westropp

Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003; 1: CD00321.

15.

Page

O’Connor

Pitt

et al . Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev 2013; 283: CD009601.

16.

Bakhtiary

Rashidy-Pour

Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother 2004; 50(3): 147–151.

17.

Oztas

Turan

Bora

et al . Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil 1998; 79(12): 1540–1544.

18.

Burke

Buchberger

Carey-Loghmani

et al . A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther 2007; 30(1): 50–61.

19.

Fernández-de-las-Peñas

Cleland

Palacios-Ceña

et al . The effectiveness of manual therapy versus surgery on self-reported function, cervical range of motion, and pinch grip force in carpal tunnel syndrome: a randomized clinical trial. J Orthop Sports Phys Ther 2017; 47(3): 151–161.

20.

Schuind

Ventura

Pasteels

Idiopathic carpal tunnel syndrome: histologic study of flexor tendon synovium. J Hand Surg Am 1990; 15(3): 497–503.

21.

Allampallam

Chakraborty

Bose

et al . Explant culture, immunofluorescence and electron-microscopic study of flexor retinaculum in carpal tunnel syndrome. J Occup Environ Med 1996; 38(3): 264–271.

22.

Yesil

Bacakaoglu

Dogan

Are myofibroblasts activated in idiopathic carpal tunnel syndrome? An immunohistochemical study. Eklem Hastalik Cerrahisi 2014; 25(3): 133–140.

23.

Barra

Lopez

Fernandez

et al . The immediate effects of diacutaneous fibrolysis on pain and mobility in patients suffering from painful shoulder: a randomized placebo-controlled pilot study. Clin Rehabil 2011; 25(4): 339–348.

24.

Barra López

López de Celis

Fernández Jentsch

et al . Effectiveness of diacutaneous fibrolysis for the treatment of subacromial impingement syndrome: a randomized controlled trial. Man Ther 2013; 18(5): 418–424.

25.

Veszely

Guissard

Duchateau

Contribution à l’étude des effects de la fibrolyse diacutanée sur le triceps sural. Ann Kinésithér 2000; 2(27): 54–59.

26.

Lévénez

Timmermans

Duchateau

Effet du crochetage myo-aponévrotique du triceps sural sur la tension passive et l’architecture musculaire à l’étirement. Thérapie Man Chev Pied 2009; 9(92–93): 56–61.

27.

Jablecki

Andary

Floeter

et al . Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002; 58(11): 1589–1592.

28.

Bland

JD.

A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000; 23(8): 1280–1283.

29.

Jensen

Turner

Romano

et al . Comparative reliability and validity of chronic pain intensity measures. Pain 1999; 83(2): 157–162.

30.

Hervas

Navarro Collado

Peiro

et al . Spanish version of the DASH questionnaire. Cross-cultural adaptation, reliability, validity and responsiveness. Med Clin 2006; 127(12): 441–447.

31.

Jester

Harth

Wind

et al . Disabilities of the arm, shoulder and hand (DASH) questionnaire: determining functional activity profiles in patients with upper extremity disorders. J Hand Surg Br 2005; 30(1): 23–28.

32.

Karadas

Tok

Akarsu

et al . Triamcinolone acetonide vs procaine hydrochloride injection in the management of carpal tunnel syndrome: randomized placebo-controlled study. J Rehabil Med 2012; 44(7): 601–604.

33.

Celiker

Arslan

Inanici

Corticosteroid injection vs nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome. Am J Phys Med Rehabil 2002; 81(3): 182–186.

34.

Yang

Hsieh

Wang

et al . Acupuncture in patients with carpal tunnel syndrome: a randomized controlled trial. Clin J Pain 2009; 25(4): 327–333.

35.

Joe-Air

Wen-Dien

Jih-Huah

et al . Low-level laser treatment relieves pain and neurological symptoms in patients with carpal tunnel syndrome. J Phys Ther Sci 2011; 23(4): 661–665.

36.

Günay BALPA. The effectiveness of carpal bone mobilization accompanied by night splinting in idiopathic carpal tunnel syndrome. Turkish J Phys Med Rehabil 2015; 61(1): 45.

37.

Elliott

Burkett

Massage therapy as an effective treatment for carpal tunnel syndrome. J Bodyw Mov Ther 2013; 17(3): 332–338.

38.

Jain

Hudak

Bowen

CVA

. Validity of health status measures in patients with ulnar wrist disorders. J Hand Ther 2001; 14(2): 147–153.

39.

Franchignoni

Vercelli

Giordano

et al . Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014; 44(1): 30–39.

40.

Lundquist

Døssing

Christiansen

DH.

Responsiveness of a Danish version of the disabilities of the arm, shoulder and hand (DASH) questionnaire. Dan Med J 2014; 61(4): A4813.

41.

Yagci

Elmas

Akcan

et al . Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome. Clin Rheumatol 2009; 28(9): 1059–1065.

42.

Horng

Hsieh

et al . 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): 435–442.

43.

Akalin

Peker

et al . Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil 2002; 81(2): 108–113.

44.

Kanatani

Fujioka

Kurosaka

et al . Delayed electrophysiological recovery after carpal tunnel release for advanced carpal tunnel syndrome: a two-year follow-up study. J Clin Neurophysiol 2013; 30(1): 95–97.

45.

Chang

Ger

Hsieh

et al . A randomized clinical trial of oral steroids in the treatment of carpal tunnel syndrome: a long term follow up. J Neurol Neurosurg Psychiatry 2002; 73(6): 710–714.

46.

Casale

Damiani

Maestri

et al . Pain and electrophysiological parameters are improved by combined 830-1064 high-intensity LASER in symptomatic carpal tunnel syndrome versus transcutaneous electrical nerve stimulation. A randomized controlled study. Eur J Phys Rehabil Med 2013; 49(2): 205–211.

47.

Maddali Bongi

Signorini

Bassetti

et al . A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study. Rheumatol Int 2013; 33(5): 1233–1241.

48.

Guimberteau

J-C

. Le système multifibrillaire par son organization fractale et irrégulière introduit à des notions non lineaires. Entrée matière vivante 2012; 57(5): 515–516.

49.

Engber

DW.

Myofibroblasts and the carpal tunnel syndrome. Iowa Orthop J 1984; 4: 57–59.

50.

Yoshii

Zhao

et al . The effect of wrist position on the relative motion of tendon, nerve, and subsynovial connective tissue within the carpal tunnel in a human cadaver model. J Orthop Res 2008; 26(8): 1153–1158.

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