(1) Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and moderate idiopathic CTS. However, severe CTS and systemic conditions were an exclusion criterion from the studies. The aim of this study is to review the effectiveness of conservative treatment in patients with CTS regardless of the level of severity and the presence or not of systemic diseases in the last ten years. (2) Methods: Randomized controlled clinical trials that compared the effect of conservative treatment on the Boston questionnaire and pain were selected. PubMed, PEDro, Scopus, Cochrane, and Web of Science databases were used. PRISMA statement checklist was performed. (3) Results: 876 studies were recorded, 29 were selected. Pharmacology, Electrotherapy and Manual Therapy had benefits for CTS. Electrotherapy and manual therapy could be effective for severe CTS patients with a systemic condition in the short term, but there was a low percentage of these patients included in the studies. (4) Conclusion: Some pharmacological treatments, manual therapy and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown. It would be necessary to include patients with systemic conditions in the selection criteria for future studies.

Background: Carpal tunnel syndrome (CTS) presents a high burden on the healthcare system. However, no alternative treatments are provided during the waiting period. In addition, the incidence of severe patients with comorbidities is underestimated. The aim of this study was to determine whether nerve mechanical interface treatment improves the symptoms, function, and quality of life in pre-surgical CTS patients. Methods: A randomized controlled trial and intention-to-treat analysis were carried out. Forty-two patients with an electrodiagnosis of carpal tunnel syndrome, included on the surgery waiting list of a public healthcare system, were analyzed. The intervention group (n = 20) received a 45 min session/per week of instrument-assisted manual therapy (diacutaneous fibrolysis) for 3 weeks. The Boston Carpal Tunnel Questionnaire (BCTQ) was the primary outcome. The symptoms, mechanical threshold, grip strength, mechanosensitivity of the median nerve, quality of life, and patient satisfaction were included as secondary outcomes. The control group (n = 22) remained on the waiting list. Results: The intervention seems to be beneficial for the BCTQ score (function and symptoms scale), pain, and mechanosensitivity after treatment, at the 3 and 6 months follow-up (p < 0.05). Kinesiophobia was improved at 6 months (p = 0.043; η² = 0.10) and the mechanical threshold at the 3-month follow-up (p = 0.048; η² = 0.10). No differences were identified for grip strength. At 6 months, the intervention group patients were satisfied (100%), as opposed to the controls, who felt that they had experienced a worsening of their condition (50.1%). Conclusions: Nerve mechanical interface treatment improved the symptoms, function, and quality of life in pre-surgical CTS patients. One hundred percent of the treated patients, characterized as moderate and severe CTS with associated comorbidities, were satisfied.

(1) Background: Neurodynamic tests are recommended for the diagnosis of entrapment neuropathies such as carpal tunnel syndrome (CTS). However, their association with clinical variables in severe patients or patients with associated comorbidities is poorly documented. This study aims to analyze the association between the mechanosensitivity of the median nerve and symptoms, function and psycho-social variables in moderate and severe carpal tunnel syndrome patients with comorbidities; (2) Methods: Correlational study. In total, 42 pre-surgical patients (24 females; 59.1 ± 12.7 years) included in the Spanish Public Healthcare System with an electrodiagnostic of CTS were selected. Sociodemographic variables and clinical features (symptoms, function, sensitivity and quality of life evaluated with the 36-item Short Form Survey (SF-36) and the Medical Outcomes Study Sleep Scale (MOS-sleep) were recorded. Upper Limb Neurodynamic Test 1 was used to evaluate neural mechanosensitivity; (3) Results: The 81% had a severe CTS and 78.6% had some comorbidity. The average time from the first medical visit to the surgeon’s visit was 365.5 days. Median nerve mechanosensitivity correlated weakly with the SF-36 subscale, General Health, (Spearman’s rho = 0.367) and MOS sleep scale, Awaken Short of Breath or with headache dimension (Spearman’s rho = −0.353) and moderately with SF-36 subscale, Social Functioning (Spearman’s rho = 0.553); (4) Conclusions: No associations were observed for median nerve mechanosensitivity, except for quality of life and sleep. Both social determinants and clinical variables should be considered when examining and treating these patients.

Carpal Tunnel Syndrome (CTS) is a prevalent upper limb mononeuropathy that often leads to delayed surgical intervention, resulting in prolonged symptoms and reduced quality of life. To describe the effect of a three-session treatment involving nerve mechanical interface mobilization and self-mobilization combined with education in hand function, symptoms, and quality of life of pre-surgical CTS patients at 3 and 6-months follow-ups; 3) A randomized clinical trial was performed in 42 preoperative CTS patients. Patients were randomized into an experimental group, receiving a three-session intervention of education, diacutaneous fibrolysis, and self-mobilization, or a control group receiving standard care. Primary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, while secondary outcomes assessed paresthesia, mechanosensitivity of the median nerve, mechanical threshold with the Semmes Weinstein monofilament, pinch strength, and quality of life, with the short-form-36 & EuroQol-5D. The cohort were predominantly severe CTS patients with associated comorbidities. Statistical improvements were shown for experimental group compared to control group in DASH at 6-month follow-up (p = 0.035; η² = 0.12). Paraesthesia intensity, mechanosensitivity, and quality of life were also significantly improved in the experimental group compared to control group at both 3- and 6-months (p < 0.05). The same occurred for pinch strength at 6 months (p < 0.05). No significant differences were found in mechanical threshold (p > 0.05); 5) The treatment effectively improved hand function, symptoms, and quality of life in preoperative CTS patients, offering a viable alternative during delays in surgical procedures. Nerve mechanical interface treatment could not only help mild to severe CTS patients but might be relevant for severe CTS patients with associated comorbidities.

Carpal tunnel syndrome (CTS) patients experience a wide range of sleep complaints. However, little evidence exists on how conservative treatment can improve sleep quality in these patients. To determine the effectiveness of a multimodal physiotherapy approach based on sleep symptoms and quality in patients suffering from CTS included in a surgery waiting list. A randomized controlled trial. CTS patients included in surgical waiting list of Spanish Public Health System were recruited. Patients were randomized into an education, diacutaneous fibrolysis, and self-mobilization treatment over 3 weeks (n = 20) or a control group (n = 22). Nocturnal symptoms, Medical Outcome Study Sleep Scale, Boston Carpal Tunnel Questionnaire, and sensitivity of the hand were assessed after treatment, at 3- and 6-months follow-up. A general linear model of repeated measures was performed. Nocturnal symptoms (p < 0.1; d = 1.0-1.5) and Boston Carpal Tunnel Questionnaire (p = 0.01; d = 1.0-1.1) were improved in favor of intervention group at each follow-up. Also, sensitivity of the first three fingers showed better results for intervention group at 3- (p = 0.021; d = 0.5) and 6-months (p = 0.036; d = 0.8) follow-up. Five of the eight items in the Medical Outcome Study Sleep Scale reported significant differences at 6-month against the control group (p < 0.1). There was a significant increase in the amount of sleep in the intervention group (p = 0.006; d = 0.7). Finally, physical activity and splint influenced the results of nocturnal symptoms and awaken short of breath and headache. Education, diacutaneous fibrolysis, and self-mobilization may improve night-time symptoms and sleep quality in CTS patients awaiting surgery. Patients included were mainly severe, had associated comorbidities, and under-represented patients in conservative treatment studies.