{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:18:18Z","timestamp":1784823498322,"version":"3.55.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T00:00:00Z","timestamp":1596672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Health Institute Carlos III","award":["FIS PI11\/01223"],"award-info":[{"award-number":["FIS PI11\/01223"]}]},{"name":"Spanish government"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>No study to our knowledge has investigated the effects longer than 1 year of manual therapy in carpal tunnel syndrome (CTS). The purpose of this study was to investigate the effects of manual therapy versus surgery at 4-year follow-up and to compare the post-study surgery rate in CTS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This randomized controlled trial was conducted in a tertiary public hospital and included 120 women with CTS who were randomly allocated to manual therapy or surgery. The participants received 3 sessions of physical therapy, including desensitization maneuvers of the central nervous system or carpal tunnel release combined with a tendon\/nerve gliding exercise program at home. Primary outcome was pain intensity (mean and the worst pain). Secondary outcomes included functional status, symptom severity, and self-perceived improvement measured using a global rating of change scale. Outcomes for this analysis were assessed at baseline, 1\u00a0year, and 4\u00a0years. The rate of surgical intervention received by each group was assessed throughout the study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At 4\u00a0years, 97 (81%) women completed the study. Between-group changes for all outcomes were not significantly different at 1\u00a0year (mean pain: mean difference [MD]\u00a0=\u00a0\u22120.3, 95% CI\u00a0=\u00a0\u22120.9 to 0.3; worst pain: MD\u00a0=\u00a0\u22121.2, 95% CI\u00a0=\u00a0\u22123.6 to 1.2; function: MD\u00a0=\u00a0\u22120.1, 95% CI\u00a0=\u00a0\u22120.4 to 0.2; symptom severity: MD\u00a0=\u00a0\u22120.1, 95% CI\u00a0=\u00a0\u22120.3 to 0.1) and 4\u00a0years (mean pain: MD\u00a0=\u00a00.1, 95% CI\u00a0=\u00a0\u22120.2 to 0.4; worst pain: MD\u00a0=\u00a00.2, 95% CI\u00a0=\u00a0\u22120.8 to 1.2; function: MD\u00a0=\u00a00.1, 95% CI\u00a0=\u00a0\u22120.1 to 0.3; symptom severity: MD\u00a0=\u00a00.2, 95% CI\u00a0=\u00a0\u22120.2 to 0.6). Self-perceived improvement was also similar in both groups. No between-group differences (15% physical therapy vs 13% surgery) in surgery rate were observed during the 4 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In the long term, manual therapy, including desensitization maneuvers of the central nervous system, resulted in similar outcomes and similar surgery rates compared with surgery in women with CTS. Both interventions were combined with a tendon\/nerve gliding exercise program at home.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact<\/jats:title>\n                  <jats:p>This is the first study to our knowledge to report clinical outcomes and surgical rates during a 4-year follow-up and will inform decisions regarding surgical versus conservative management of CTS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Lay summary<\/jats:title>\n                  <jats:p>Women with CTS may receive similar benefit from a more conservative treatment\u2014manual therapy\u2014as they would from surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzaa150","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T11:20:13Z","timestamp":1596194413000},"page":"1987-1996","source":"Crossref","is-referenced-by-count":31,"title":["Manual Therapy Versus Surgery for Carpal Tunnel Syndrome: 4-Year Follow-Up From a Randomized Controlled Trial"],"prefix":"10.1093","volume":"100","author":[{"given":"C\u00e9sar","family":"Fern\u00e1ndez-de-las-Pe\u00f1as","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos , Avenida de Atenas s\/n, Alcorc\u00f3n, Madrid, Spain 28922, and C\u00e1tedra Institucional en Docencia, Cl\u00ednica e Investigaci\u00f3n en Fisioterapia Terapia Manual, Punci\u00f3n Seca y Ejercicio Terap\u00e9utico, Universidad Rey Juan Carlos"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 L","family":"Arias-Bur\u00eda","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos and C\u00e1tedra Institucional en Docencia , Cl\u00ednica e Investigaci\u00f3n en Fisioterapia Terapia Manual, Punci\u00f3n Seca y Ejercicio Terap\u00e9utico, Universidad Rey Juan Carlos"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua A","family":"Cleland","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy Program , Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan A","family":"Pareja","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurophysiology , , Alcorc\u00f3n, Madrid, Spain"},{"name":"Hospital Universitario Fundaci\u00f3n , , Alcorc\u00f3n, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Plaza-Manzano","sequence":"additional","affiliation":[{"name":"Department of Radiology, Rehabilitation and Physiotherapy , , Madrid, Spain; and Instituto de Investigaci\u00f3n Sanitaria del Hospital Clinico San Carlos, Madrid, Spain"},{"name":"Universidad Complutense de Madrid , , Madrid, Spain; and Instituto de Investigaci\u00f3n Sanitaria del Hospital Clinico San Carlos, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Ortega-Santiago","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos and C\u00e1tedra Institucional en Docencia , Cl\u00ednica e Investigaci\u00f3n en Fisioterapia Terapia Manual, Punci\u00f3n Seca y Ejercicio Terap\u00e9utico, Universidad Rey Juan Carlos"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,6]]},"reference":[{"key":"2023011806021212100_ref1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1212\/01.wnl.0000338533.88960.b9","article-title":"Long-term trends in carpal tunnel syndrome","volume":"72","author":"Gelfman","year":"2009","journal-title":"Neurology"},{"key":"2023011806021212100_ref2","doi-asserted-by":"crossref","first-page":"2320","DOI":"10.1016\/j.apmr.2014.08.004","article-title":"Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort","volume":"95","author":"Thiese","year":"2014","journal-title":"Arch Phys Med Rehabil"},{"key":"2023011806021212100_ref3","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1111\/j.1445-2197.2006.03770.x","article-title":"Occupation and carpal tunnel syndrome","volume":"76","author":"Stapelton","year":"2006","journal-title":"ANZ J Surg"},{"key":"2023011806021212100_ref4","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1016\/j.apmr.2014.06.022","article-title":"European HANDGUIDE group. 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