Carpal Tunnel Syndrome – More Than Just a Wrist Problem

Carpal tunnel syndrome (CTS) is a common condition that affects around 6-12% of the population and can result in significant pain and disability. The financial costs associated with CTS can be staggering – ranging from $45,000 to $89,000 per patient over a six-year period when productivity loses are taken into account.

Historically, doctors and researchers have described CTS as the result of compression of the median nerve as it travels through the bony carpal tunnel at the wrist. However, there is recent evidence that CTS is a more complex pain syndrome with multiple studies showing women with CTS exhibit widespread pressure pain hypersensitivity, thermal pain increases, and what’s called “enhanced wind-up in extra-median nerve territories.” In other words, the central nervous system seems to be involved, affecting the whole body, not just the wrist and hand.

Traditionally, the management of CTS has included conservative interventions primarily focused on relieving wrist and hand symptoms using splints, manual therapies, modalities (ultrasound, laser), and exercise—with surgery recommended if the patient fails to respond treatment. In looking at CTS as a product of the central nervous system (CNS), therapies that target desensitizing the nervous system may be more effective.

A 2017 randomized clinical trial compared manual therapy with surgery for improving BOTH pain and central sensitization (“nociceptive gain”) in CTS patients. Here, researchers randomly assigned 100 women to either a manual therapy group who received one session per week for three weeks including “desensitizing manoeuvres of the CNS” or a surgical intervention group (50 in each group). The research team evaluated pressure pain thresholds (PPT), thermal pain thresholds (hot or cold – HPT or CPT), and pain intensity at baseline, three, six, nine, and twelve month intervals following the intervention.

After one year, those in the manual therapy group experienced higher increases in PPT over the carpal tunnel at three, six, and nine months and greater decreases in pain intensity at three-months than those who underwent a surgical procedure. Otherwise, the outcome measurements were similar for both groups.

The significance of this study supports that a non-surgical, manual therapy approach (in which neuromuscular/trigger point massage specializes) is more effective in the short term and equally effective in the long term as surgery for BOTH pain and central sensitization (PPT only – not HPT/CPT for either group).


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