Yoga helps carpal tunnel syndrome
24 January 2003
Oral steroids, wrist splinting, ultrasound, yoga and carpal bone mobilisation are effective non-surgical treatments for carpal tunnel syndrome, according to the latest Cochrane review (Issue 1, 2003).
(A Cochrane review is compiled by the Cochrane Collaboration, an international organisation aimed at helping people make well-informed decisions about health care by undertaking scientific reviews of evidence for certain treatments.)
After assessing 21 trials involving 884 people, the reviewers found moderate evidence that oral steroids for 2 to 4 weeks led to a significant improvement in symptoms.
But they found only equivocal (ambiguous) evidence for the persistence of improvement after steroids were stopped.
Using a nocturnal (night-time) hand splint for 4 weeks led to a 4-fold increased chance of symptom improvement compared with not having any treatment, researchers said.
But wearing the hand splint full time did not have any advantage over nocturnal use only. And people wearing the wrist splint in a neutral position had twice as much overall and nocturnal symptom relief after 2 weeks than did patients wearing the splint in extension.
(If you start with your palm facing downward and bend your wrist so that the back of your hand moves back and upwards, rather than down and forwards, your wrist will be in extension.)
The researchers found limited evidence that 7 weeks (but not 2 weeks) of therapeutic ultrasound led to improved symptom relief or sensory perception at 6-month follow-up, but they said ultrasound for 7 weeks did not improve peripheral nerve conduction, grip or pinch strength.
Varying the intensity and frequency of ultrasound had no further effect on symptoms.
They also found yoga for 8 weeks led to better short-term pain relief and a 5-fold increased chance of improvement in Phalen's sign than wrist splinting.
(Phalen's sign is paraesthesiae ('pins and needles' and tingling) produced within 1 or 2 minutes when the wrist is held flexed.)
Yoga also provided a similar improvement to wrist splinting in nocturnal waking, Tinel's sign (paraesthesiae provoked by tapping over the median nerve at the wrist) and grip strength.
Finally, there was limited evidence that carpal bone mobilisation improved symptoms after 3 weeks, but it did not improve short-term pain, hand function, wrist motion, upper limb tension test findings or the subsequent need for surgery.
No other non-surgical treatment examined (ergonomic keyboards, NSAIDs (non-steroidal anti-inflammatory drugs), vitamin B6, diuretics, nerve and tendon gliding exercises, neurodynamic mobilisation, magnetic therapy, chiropractic, laser acupuncture and insulin injections into the carpal tunnel) produced significant improvement in symptoms.
Last Reviewed: 23 January 2003
- 1. Medical Observer Weekly 24/01/03
