Carpal tunnel syndrome: does physiotherapy help as well as surgery?

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Tingling, painful, and later dysfunctional hands - this is how the carpal tunnel syndrome manifests itself. Often an operation is then carried out. The doctor uses the scalpel to free the constricted nerve in the wrist that is causing the symptoms. However, the procedure could often be unnecessary. Because physiotherapy apparently achieves just as good results - even with hands that are already restricted in their function.

Three major nerves allow the hands to move. They run through a bottleneck in the wrist. If the middle one becomes too narrow due to pathological changes, a carpal tunnel syndrome develops with tingling, numbness, pain and finally paralysis.

Physiotherapy versus surgery

Researchers led by César Fernández from the Spanish Universidad Alcorcón have examined how well physiotherapeutic treatment can improve symptoms compared to surgery.

The doctors accompanied 100 women with carpal tunnel syndrome over a period of twelve months. Half received a 30-minute manual treatment once a week that targeted the middle hand nerve, but also the neck, where it originated. They also did stretching exercises at home every day. The other half of the patients underwent an operation.

Physio works faster

After a month, the symptoms of the participants from the physio group had even improved significantly than that of the operated women. The function of her hands in everyday situations recovered faster, as did their grip strength. After three, six and twelve months, both groups were on par on all points - also with regard to the improvement in pain.

The current guidelines for the treatment of carpal tunnel syndrome recommend an operation in the event of persistent pain and abnormal sensations as well as paralysis and functional restrictions. On the basis of his results, research leader Fernández suggests checking whether the first treatment option for carpal tunnel syndrome should not be physiotherapy.

However, further investigations are necessary for a final assessment. On the one hand, because all the patients were treated in the same clinic. On the other hand, because only women were examined as part of the study. The long-term effects of the two treatment options have not yet been compared either.

Multiple causes, common syndrome

Carpal tunnel syndrome is a common phenomenon. Doctors estimate that up to ten percent of the population develop corresponding symptoms - but by no means all of them to a degree that requires treatment.

The causes of the bottleneck in the wrist are diverse. Injuries, rheumatic and thyroid diseases are just as much a part of it as pregnancy, but also work-related stress. Vibrations in particular seem to promote the syndrome - for example, working on the jackhammer. But every second cleaner also develops corresponding complaints over the years.

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