Ten to 15 minutes of manual therapy twice a week for three weeks resulted in significant improvements in the signs and symptoms of carpal tunnel syndrome, and those improvements remained stable after 24 weeks, according to recent research.

The study, “A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study,” involved 22 people with carpal tunnel syndrome. Three of these people had unilateral symptoms, and the other 19 had bilateral symptoms. The mean age of the subjects was about 65 years, and the mean duration of their symptoms was about one year.

The main outcome measures for this study included hand sensitivity, paresthesia, hand strength, hand and forearm pain, night awakening, Boston Carpal Tunnel Questionnaire Symptom Severity Scale and Functional Status Scale. All subjects were assessed using these and other outcome measures before the manual therapy intervention began.

The manual therapy consisted of two sessions per week for three weeks. During the first session, which lasted 10 minutes, the manual therapist focused on the “most thickened tissues of hand palmar surface and wrist and forearm volar side,” using deep transverse massage to improve elasticity “by detachment maneuvers performed in the cranio-caudal direction.”

During the second and third sessions, each of which lasted 15 minutes and were conducted with the hand maintained in traction, the manual therapist performed “passive mobilizations of the radio-carpal and radio-ulnar joints, and opening of the palmar surface of the metacarpal-phalangeal joints were added.”

During the fourth, fifth and sixth sessions, each of which lasted 15 minutes, a further joint mobilization of the wrist was added to the protocol performed in sessions two and three.

“The wrist, maintained in traction, was treated with passive flexo-extension and transversal movements in order to improve the range of motion of the joints and the elasticity of the flexo-extensor and prono-supinator muscles,” state the study’s authors. “Also, the palmar aponeurosis and the pollical and the first palmar interosseous muscles were treated, working on the hand that was maintained open and extended.”

Immediately after the end of the three-week manual therapy intervention period, the subjects were once again evaluated using the outcome measures, and a follow-up evaluation took place 24 weeks later.

Results of the research revealed a significant improvement on both the Symptom Severity Scale and Functional Status Scale of the Boston Carpal Tunnel Questionnaire immediately after the three-week intervention, as compared to the baseline assessment. These same significant improvements were maintained at the 24-week follow-up evaluation.

The study also showed that the number of patients reporting paresthesia, pain, night awakening and hand sensitivity decreased significantly after manual therapy as compared to the baseline assessment.

“Patients improved significantly in hand symptoms and function, as assessed by [Boston Carpal Tunnel Questionnaire] and by the reductions in prevalence of paresthesias, hand pain and sensitivity, and night awakening,” state the study’s authors. “The improvements obtained by the intervention were maintained at the follow-up.”


Authors: Susanna Maddali Bongi, Massimo Signorini, Massimo Bassetti, Angela Del Rosso, Martina Orlandi and Giusseppe De Scisciolo.

Sources: Division of Rheumatology, Department of Biomedicine, Denothe Centre, Carregi Hospital, University of Florence, Italy; Center of Manual Therapy, Florence, Italy; and Neurophysiology Unit, Department of Neurology and Psychiatry, Careggi Hospital, Florence, Italy. Originally published in October 2012 in Rheumatology International.