The relative effectiveness of wrist joint manipulation versus ultrasound in the management of carpal tunnel syndrome

Abstract

Carpal Tunnel Syndrome is defined as a median nerve entrapment beneath the flexor retinaculum in the carpal canal such that it produces symptoms in the hand, wrist and upper extremity. A review of related literature suggests that statistics on the incidence of Carpal Tunnel Syndrome in South Africa are unavailable. In the U. s. A, Carpal Tunnel Syndrome occurs in 1% of the population and is the most frequently diagnosed peripheral neuropathy. Several studies investigating the use of conservative care in managing Carpal Tunnel Syndrome have been performed, but none have compared the effect of wrist joint manipulation and ultrasound in the management of Carpal Tunnel Syndrome, The purpose of this study was to investigate the effectiveness of wrist joint manipulation compared to ultrasound in the management of Carpal Tunnel Syndrome. This randomized controlled clinical trial consisted of a study population offorty patients. The patients were randomly allocated to two groups of twenty each. One group received wrist joint manipulation while the other received ultrasound application to the palmar-radial aspect of the wrist. Both groups received four treatments over a two week period. Subjective measures included the Numerical Rating Scale-I 0 1 Questionnaire and the Carpal Tunnel Pain and Disability Form and objective measures consisted of the grip strength reading and goniometer readings for wrist flexion and extension. Both the subjective and objective measures were taken before the first and third visit and at the fifth follow- up consultation which took place during the following week. Inter-group analysis was done using the Mann- Whitney U test. Friedman's T test was used for intra-group analysis. ct was set at the 0.05 level of significance. The results were illustrated by means of tables and bar- charts. The results indicated that for intragroup analysis, a statistically significant difference existed for both groups, warranting the use of a multiple comparison procedure (Dunn' s procedure) to determine at which stage the treatment made a significant difference. For all the measures except the wrist extension reading in the ultrasound group, most improvement occurred between the first and fifth consultations. For inter-group analysis, no significant difference for any of the measures, except the wrist extension readings, was present between the two groups indicating that both wrist joint manipulation and ultrasound were equally effective in treating Carpal Tunnel Syndrome. The improvement in wrist extension, in the wrist joint manipulation group was significantly better than that in the ultrasound group. Although this study was limited by its single researcher design and could not clarify which treatment protocol was more effective, it supports the existing body of evidence in favour of both wrist joint manipulation and therapeutic ultrasound application in the management of Carpal Tunnel Syndrome