Dr. Margreet Meems, Prof. dr. Victor Pop
Carpal Tunnel Syndrome (CTS) is a prevalent neurological condition: around 5% of the population suffers from it. (1) In CTS patients the median nerve is compressed around the carpal tunnel, which leads to symptoms of numbness, tingling and sometimes pain in the hand(s). (2) CTS is usually treated conservatively when the symptoms have arisen recently or are mild. The most-used conservative treatments are a wrist splint or steroid injection into the carpal tunnel. Both treatment options are effective in the short term, but there is very little evidence for long-term effectiveness. (3) A CTS operation, in which the carpal ligament is cut, is the only treatment that is effective in the long term. However, it is an invasive method and 25% of patients experience persistent symptoms, operative complications or their symptoms return. (4) Mechanical traction exerted on the wrist using the Phystrac is a very promising, conservative treatment option for CTS.
We conducted a randomised controlled trial in which the effect of mechanical traction of the wrist, as a non-invasive treatment for CTS, was researched in CTS patients from a Neurology outpatients clinic at the VieCuri Medical Centre in Venlo/Venray. In total, 181 adult CTS patients (average age 58.1 (13.0) years, 67% women) were included. All patients had a clinical CTS diagnosis, which was confirmed using an electrophysiological examination. Participants were randomised into one of two groups: intervention (mechanical traction) or the control group (usual care). Patients in the intervention group received 12 treatments with mechanical traction over six weeks. During this treatment, the Phystrac traction device repeatedly exerted traction force on the wrist using a weight. If the traction was not effective after 12 treatments, patients then received the usual care. In the control group, patients received the usual care immediately. In most cases this meant a wrist splint, steroid injection or an operation, or, if the symptoms were not yet severe enough, a wait-and-see approach was used. Participants in both groups filled out questionnaires at the start of the investigation and after 3 and 6 months, including the Boston Carpal Tunnel Questionnaire (BCTQ). The BTCQ measures the severity of the symptoms and the level of functional restriction in CTS patients. (5)
After 6 months, the average BCTQ score had reduced significantly compared to the start of the study in both groups (p <001), but there was no difference between the groups. Patients in the control group however, were more likely to have an operation: After 6 months, 28% of the patients in the intervention group had had an operation, compared to 43% in the control group (χ2 (1, N = 181) = 4.40, p = .036).
Treatment of CTS using mechanical traction, resulted in significantly fewer operations after 6 months. Mechanical traction has a number of advantages. It is non-invasive: in general, patients experience no pain or discomfort from the treatment and can continue to perform their daily activities. Patients with bilateral symptoms can be treated on both hands during the same session and the treatment can be adapted to the needs of individual patients through the weights and the number of sessions. If mechanical traction is not effective, an operation is still an option.
In the Netherlands, around 25% of patients with a clinical CTS diagnosis are referred to a neurology outpatients’ clinic by their GP. (6) The remaining patients are treated by their GP or do not receive treatment. Mechanical traction could be suitable for these patients because it is non-invasive and low risk. Operative treatment is seen as the most effective option, but some patients prefer a conservative treatment initially, which could also be more cost-effective.
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