Multilevel median nerve compression: diagnosis and non-pharmacological treatment

Objective. To compare the efficacy of two options for manual treatment of stage I carpal tunnel syndrome: correction of somatic dysfunctions along the entire course of the median nerve and the treatment confined to the wrist region. Material and methods. A prospective active-controlled comparative trial was performed from September 2023 to May 2026 at “Harmony Clinic” LLC (Irkutsk) and “Angara” Clinical Resort” JSC. 38 patients with stage I carpal tunnel syndrome (CPS) were examined; the CTS was confirmed clinically and by electroneuromyography (ENMG) data. Both groups received identical basic treatment – night wrist orthosis in neutral position and activity modification as well as an equal number of manual sessions differing in target only: somatic dysfunctions (SD) of the carpal tunnel and thenar region in group 1 (n = 18) versus SD along the whole course of the median nerve in group 2 (n = 20). Four sessions were given at 5-day intervals. The patients were examined twice: before treatment and after 1 month. The efficacy indicator was the Boston Carpal Tunnel Questionnaire symptom severity scale (SSS), functional status scale (FSS), the intensity of pain was assessed using the visual analog scale (VAS 10 points), and the ENMG results (residual latency, the sensory response amplitude, and conduction velocity in motor and sensory fibers) were also evaluated. Results. The groups were comparable at all baseline indicators. At 1 month the SSS score fell by 1.06 in group 2 versus 0.32 in group 1 (difference is 0.74; 95% CI 0.51-0.97; p < 0.001), the FSS score fell by 0.35 versus 0.06 (difference is 0.29; 95% CI 0.23-0.35; p < 0.001), and pain intensity on the VAS fell by 3.0 versus 1.0 points (difference is 2.0; 95% CI 1.30-2.70; p < 0.001). Residual latency decreased in both groups with an advantage in group 2 (difference is 0.08 ms; 95 % CI 0.03-0.13; p = 0.003), and sensory response amplitude rose by 2.0 and 1.0 µV respectively (difference is 1.0 µV; 95 % CI 0.56-1.44; p < 0.001). Differences in conduction velocity in sensory (p = 0.14) and motor (p = 0.84) fibers were not significant. All p values have been corrected for multiplicity. Conclusion. In stage I CTS, manual correction covering the whole course of the median nerve produced greater clinical and electrophysiological improvement at 1 month than the treatment confined to the wrist, with identical basic therapy and an equal number of sessions.