European Journal of Physical and Rehabilitation Medicine, Vol. 53
By Marco Pintucci, Marta Imamura, Aurore Thibaut, Lucas M. de Exel Nunes, Mylene Mayumi Nagato, Helena H. Kaziyama, Satiko Tomikawa Imamura, Antonio Stecco, Felipe Fregni, Linamara Rizzo Battistella.
Carpal tunnel syndrome (CTS ) is the most common nerve compression syndrome, accounting for 90% of all compressive neuropathies. Despite its high incidence, CTS remains challenging to treat. Fascial manipulation (FM) 2 involves deep friction over specific points, namely the center of coordination (CC) and the center of fusion (CF ), i.e., where the vector forces of the myofascial expansions of synergic muscles occur (Figure 1). This technique has demonstrated to reduce pain symptoms in others musculoskeletal conditions such as painful shoulder syndrome,3 patellar tendinopathy 4 or post traumatic neck pain.5 A recent study comparing FM to conventional laser therapy in CTS showed that FM had better effects than laser therapy on pain relief and disability of the upper limb.6 However, there was no sham comparator, and therefore we cannot disentangle the effects of the intervention from a placebo effect. In the present pilot study, we aimed to assess the efficacy of FM applied over the CC s and CF s compared to a sham intervention that looks like FM but applied over other areas of the skin, in patients with CTS . The study was approved by the Ethics Committee of the Institute
of Physical Medicine and Rehabilitation, Sao Paulo, Brazil. Patients signed an informed consent according the Declaration of Helsinki. Registration number: NCT 02495298. Fourteen women (age: 18-65 years old) were enrolled and completed the trial. Before starting the treatment, all patients received an educational program regarding appropriate behaviors to avoid upper limbs overuse or incorrect movements during daily activities together with an exercise program to complete at home. Medication was kept unchanged during the study protocol. Patients allocated to the FM group received 5 sessions of 30-45 minutes, 1 session per week for 5 weeks. The most dysfunctional CC ’s and CF ’s, in the hand, forearm, arm, chest, and neck, were submitted to a comparative palpation following the FM guidelines.2 After the selection of the points, friction was applied for 2 to 4 minutes.7 Patients allocated to the sham group received the exact same protocol except that the frictions were applied outside the points used in the FM method. Duration of treatment was equal in both groups.
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