Study: Physical therapy may work as well or better than surgery for carpal tunnel syndrome

Study: Physical therapy may work as well or better than surgery for carpal tunnel syndrome

Carpal tunnel syndrome can be painful and debilitating for people who suffer from it. Traditionally, doctors have recommended surgery to provide relief from the pain and symptoms of the disorder.

A recent study showed that manual physical therapy can be equally effective for the treatment of carpal tunnel syndrome, and as a non-invasive option, it may be preferable for those who have developed it.

Incidence of carpal tunnel syndrome in the U.S.

Carpal tunnel syndrome is fairly common in the U.S. It has a reported prevalence of between 6 and 11 percent annually. Over a six-year period, people who suffer from CTS have total income losses per person that range from $45,000 to $89,000.

The study: Manual physical therapy vs. surgery for carpal tunnel syndrome

Carpal tunnel syndrome can happen when people regularly perform repetitive motions with their hands and wrists as routine parts of their jobs. The condition happens because of a narrowing of the carpal canal in the wrist, which then places pressure on the nerve that runs through it. Researchers in Spain were interested in learning about whether or not manual physical therapy may be a good treatment alternative to surgery, which is normally used to improve hand function and to alleviate pain.

The researchers randomly assigned 120 women either to a group that received surgery or a group that received manual physical therapy. The women who were in the group receiving physical therapy attended three 30-minute weekly sessions of physical therapy. At the appointments, the women received treatment to stabilize their soft tissues.

They also performed tendon and nerve gliding exercises that were focused on the areas of their wrists where their median nerves were believed to be entrapped. The women in both groups reported back for follow-up appointments at one, three, six and 12 months following the completion of their treatment. The researchers used the following to assess the women’s improvement at each appointment:

  • 11-point scale for rating pain
  • Boston Carpal Tunnel Syndrome Questionnaire
  • Patient self-reports


Women in both groups reported similar pain relief and functional improvement at their six-month and 12-month follow-up appointments. At the one-month and three-month follow-up appointments, however, the women who had received manual physical therapy instead of surgery reported greater functional improvements and pain relief as compared to those who received surgery.

The researchers recommend that manual physical therapy should be chosen as the first option for the treatment of carpal tunnel syndrome. They also reported that people prefer to receive more conservative treatment such as physical therapy because it has lower risks than those that are associated with surgery.

They also stated that additional research should be performed with men to see if they have similar outcomes as the women in the study did. The trial was reported in the “Journal of Pain,” which is a peer-reviewed journal that is published by the American Pain Society.

As the study’s results indicate, people who are suffering from CTS may want to ask their doctors about using manual physical therapy instead of surgery as their first treatment options. If the physical therapy works, they may then be able to avoid having to undergo surgery.

Research at NYDNRehab

Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018)At: Paris, France
Conference: 22nd European Congress of Physical and Rehabilitation Medicine (ESPRM 2020)At: Belgrade, Serbia

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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