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Effect of OMT on Myofascial Somatic Dysfunction and Objective Parameters of Severity in Patients with Carpal Tunnel Syndrome

Journal: The Journal of the American Osteopathic Association Date: 2006/08, 106(8):Pages: 477. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2006.106.8.471/html)

Keywords:

balanced ligamentous tension [7]
carpal tunnel syndrome [27]
median nerve [10]
myofascial release [45]
randomized controlled trial [766]
wrist [12]

Abstract:

Background: Carpal Tunnel Syndrome (CTS) is a common entrapment neuropathy. Current conservative treatments are NSAIDs, wrist splints, and exercises. Myofascial trigger points (MTrPs), painful hyperirritable areas in skeletal muscles that can refer pain, decrease range of motion, and cause altered neural-vascular-lymphatic function, have been associated with CTS. In numerous studies, osteopathic manipulative treatment (OMT) has improved pain and Phalen's test measures. OMT has also been linked to decreased median nerve swelling and to trends in nerve conduction study (NCS) improvement. Methods: Patients with mild-to-moderate CTS diagnosed by NCS were randomized into OMT (n=14 wrists) or sham laser (n=14 wrists) groups. Ultrasound measurements of the median nerve were obtained from all subjects. The subjects were provided 8 weekly treatments of pan-corporeal OMT (myofascial release/balanced ligamentous tension) or forearm sham laser. All patients were provided wrist splints, hand exercises, and ibuprofen if not contraindicated. At the time of the NCS, MTrPs common in CTS were recorded and scored (0=none; 1=inactive; 2=latent MTrP; 3=active MTrP) at baseline and 1 week after final treatment. Survey data on pain level, NSAIDs and splint use and exercises were recorded weekly throughout. Results: There were 29 hands with a positive NCS (14 in OMT group, 14 in sham group, 1 excluded for severe CTS rating). There were also 12 symptomatic hands with negative NCS. There was no difference in total MTrP load in subjects with (n=29) or without (n=12) a positive NCS (P=0.23). A statistically significant reduction in total MTrP load was achieved in the OMT group (P<0.01). Conversely, conservative+sham care resulted in more myofascial dysfunction with “no myofascial activity” shifting towards more inactive (P=0.01) and latent (P=0.001) MTrPs. The adductor pollicis is the most abundant MTrP (P<0.01). Individual patient analysis was highly suggestive (P=0.06) of a trend towards MTrP reduction in those treated with OMT compared to the individual treated with sham laser. Conclusion: OMT is successful in reducing MTrP load while those receiving standard care alone got significantly worse. This study suggests addition of OMT would benefit standard conservative care for mild-to-moderate CTS.


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