Comparing the Effectiveness of Different Treatment Methods on Pain, Symptoms, Function, Quality of Life, and Hand–Forearm Muscle Strength in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial

Abstract

Background: The most used conservative treatments for carpal tunnel syndrome (CTS) are splints, tendon/nerve gliding exercises (TNGEs), and local corticosteroid injections (LSIs). Objective: The aim of this study was to evaluate the effect of different conservative treatments such as splint, TNGE, and LSI on clinical status, pain, symptoms, signs, function, quality of life, and hand and forearm muscle strengths in mild and moderate CTS. Population: Patients who had clinical findings during routine examinations in the physical therapy outpatient clinic and were diagnosed with mild to moderate CTS with electrophysiological nerve conduction studies. Methods: Sixty subjects consisting of female patients with CTS were randomly assigned to 3 groups (n = 20). Group S was only applied to splint. Group SE underwent TNGE and splint. Group SI received LSI and splint. Hand grip and forearm muscle strengths during flexion/extension, radial/ulnar deviation, and supination/pronation movements were tested at different angular velocities by isokinetic test system. Pain with Visual Analog Scale (VAS), symptoms and functions with Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), and Quality of life with SF-36 were evaluated before and after 8 weeks of treatment. Results: Significant improvements in VAS, SF-36, BCTQ, and DASH scores, as well as hand grip strength, were observed at the endpoint of treatment period in all groups (p < 0.05). Group SI had significantly lower DASH total scores than the other groups after treatment and showed greater improvement in Boston Functional Capacity Scale (BFCS) scores than Group S (p < 0.05). There was no significant difference in hand grip and forearm muscle strengths between the groups; however, Group SI showed greater increases in forearm muscle strengths in different directions and angular speeds at the end of the treatment. Conclusions: Steroid injection provided superior improvements in functional outcomes, particularly in DASH and Boston Functional Capacity scores, compared with other groups. Although hand grip and forearm muscle strength did not differ significantly, greater increases were observed in forearm muscle strength across multiple directions and angular speeds in the steroid group. The results suggest that adding steroid injections to the treatment of CTS may enhance functional recovery. Trial Registration: ClinicalTrials.gov identifier: NCT05475808.