A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome.

STUDY DESIGN Randomized clinical trial. OBJECTIVE The aim of this study was to evaluate the effect of ischemic compression therapy in the treatment of chronic carpal tunnel syndrome. METHOD Fifty-five patients suffering from carpal tunnel syndrome were randomized to two groups. Thirty-seven patients received 15 experimental treatments which consisted of ischemic compressions at trigger points located in the axilla of the shoulder, the length of the biceps muscle, at the bicipital aponeurosis and at the pronator teres muscle in the hollow of the elbow. Eighteen patients received the control treatment involving ischemic compression on trigger points located in the deltoid muscle, supraspinatus muscle and infraspinatus muscle. Of the 18 patients forming the control group, 13 agreed to receive the experimental treatments after the 15 control treatments. Outcome measures included a validated 18-question questionnaire to assess the severity of symptoms and functional status in carpal tunnel syndrome, and a quantification of the patients' perceived improvement, using a scale from 0% to 100%. Outcome measures evaluations were completed at baseline, after 15 treatments, 30 days following the last treatment, and 6 months later. RESULTS For the disability questionnaire, a significant reduction of symptoms was noted only in the experimental group. In the experimental group the outcome at baseline was 33.5 (SD, 10.3); after 15 treatments it was 18.6 (SD, 7.0). The control group outcome at baseline was 36.3 (SD, 15.2); after 15 treatments it was 26.4 (SD, 9.9) and after the crossover (15 control treatments plus 15 experimental treatments) 20.2 (SD, 12.2). A significant between group difference (P < 0.021) was noted in the patients' perceived improvement after 15 treatments: 67 (SD, 26) percent and 50 (SD, 25) percent respectively for the experimental and control groups. CONCLUSION This practice-based clinical trial suggests that myofascial therapy using ischemic compression the length of the biceps, at the bicipital aponeurosis, at the pronator teres and at the subscapularis muscles could be a useful approach to reduce symptoms associated with the carpal tunnel syndrome. Patients' perceived improvement in functional capacities persisted over a 6-month period.