Effects of diacutaneous fibrolysis in patients with mild to moderate symptomatic carpal tunnel syndrome: a randomized controlled trial

Abstract

Objective: To compare the effects of diacutaneous fibrolysis with sham in patients with mild to moderate carpal tunnel syndrome. Design: Double-blind (patient and evaluator) randomized controlled trial. Setting: Miguel Servet University Hospital, Zaragoza, Spain. Subjects: A total of 52 patients (72 wrists) with carpal tunnel syndrome, 41 women and 11 men, mean age was 46.9 (8.8) years. They were divided into two groups: diacutaneous fibrolysis group and sham group. Interventions: Real diacutaneous fibrolysis in diacutaneous fibrolysis group and sham diacutaneous fibrolysis in sham group. Both groups received five sessions in the forearm, wrist and hand. Main measures: Neurophysiological parameters assessed at baseline and at the end of the treatment. Intensity of nocturnal symptoms (visual analogue scale (VAS)) and upper limb functional capacity (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) at baseline, at the end of the treatment and one month after treatment. Results: Diacutaneous fibrolysis group (n = 30 wrists) improved in nerve conduction distal motor latency (mean difference: –0.26, 95% confidence interval (CI): –0.49/–0.26), sensory conduction velocity (mean difference: 6.52, 95% CI: 3.52/9.51), intensity of nocturnal symptoms (mean difference: –2.24, 95% CI: –4.08/–2.04) and upper limb functional capacity (mean difference: –19, 95% CI: –26.1/–11.9) compared to the sham group (n = 30 wrists) (P < 0.02, P < 0.01, P < 0.01 and P < 0.01, respectively). At one-month follow-up, improvements in the nocturnal symptoms and upper limb functional capacity were maintained compared to the sham group (P < 0.01). Conclusion: Diacutaneous fibrolysis provides short-term and one-month follow-up, improvements in sensory conduction velocity, motor distal latency, symptoms and functional capacity in patients with mild to moderate carpal tunnel syndrome.