Effect of Sensory Relearning on Sensory and Motor Functions of the Hand in Patients with Carpal Tunnel Syndrome: A Randomized Controlled Clinical Trial

Youssef M. Elbalawy; Ebtesam M. Fahmy; Shreen I. Taha; Abdel El- Hamied I. El Sherbini; Abdelrhman I. Abdelghany; Hager R. El-Serougy

doi:10.61841/hktdz448

Authors

Youssef M. Elbalawy Department of Physical Therapy for Neuromuscular Disorder and Its Surgery, Faculty of Physical Therapy, Cairo University, Egypt Author
Ebtesam M. Fahmy Department of Neurology, Faculty of Medicine, Cairo University, Egypt Author
Shreen I. Taha Department of Physical Therapy for Neuromuscular Disorder and Its Surgery, Faculty of Physical Therapy, Beni-Suef University, Egypt Author
Abdel El- Hamied I. El Sherbini Department of Occupational Therapy, National Institute of Longevity Elderly Sciences NILES, Beni-Suef University, Egypt Author
Abdelrhman I. Abdelghany Department of Basic Science, Faculty of Physical Therapy, Badr University in Cairo, Egypt Author
Hager R. El-Serougy Department of Physical Therapy for Neuromuscular Disorder and Its Surgery, Faculty of Physical Therapy, Misr University for Science and Technology, Egypt Author

DOI:

https://doi.org/10.61841/hktdz448

Keywords:

Carpal Tunnel Syndrome, Strength, Sensation, Sensory Relearning, Physical Therapy

Abstract

Background: Carpal tunnel syndrome (CTS) is the most common type of entrapment neuropathy caused by compression of the median nerve as it passes through the carpal tunnel. Aim: To investigate the effect of somatosensory relearning on sensory and motor functions of the hand in patients with carpal tunnel syndrome. Subjects and Methods: Thirty-two female patients with CTS, aged 20-50 years, participated in the study. They were randomly assigned to two equal groups: Group I (experimental group) received sensory relearning in addition to a standard physical therapy program, and Group II (control group) received a standard physical therapy program consisting of traditional therapeutic exercises only. Assessment was done pre- and post-treatment using the Semmes-Weinstein monofilament (SWM) test to measure the sensory threshold and a handheld dynamometer to measure grip strength of the affected hand. Results: There was a statistically significant increase in sensory threshold of the affected hand in group (I) post-treatment. In addition, there was a statistically significant increase in grip strength of the affected hand in both groups post-treatment. Comparison between groups revealed a significant difference in the measured parameters post-treatment in favor of group I. Conclusion: Sensory relearning is effective in improving sensory threshold and grip strength of the affected hand when added to the standard physical therapy program in patients with CTS.

Downloads

Download data is not yet available.

References

[1] Atroshi, I., Englund, M., Turkiewicz, A., Tägil, M., and Petersson, I. Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med. 2011; 171: 943-944.

[2] Martins, RS and Siqueira, MG. Conservative therapeutic management of carpal tunnel syndrome. Arq Neuropsiquiatr. 2017; 75(11): 819-824.

[3] Middleton SD and Anakwe RE. Carpal tunnel syndrome. BMJ. 2014; 349: 1-7.

[4] Erickson, M., Lawrence, M., Jansen, CW, Coker, D., Amadio, P., Cleary, C. Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome. J Orthop Sports Phys Ther. 2019; 49(5): 1-85.

[5] Oud T, Beelen A, Eijffinger E, Nollet F. Sensory re-education after nerve injury of the upper limb: a systematic review. Clin Rehabil. 2007; 21:483-494.

[6] Fathy sakr, Enas Elsyed, Youssef Elbalawy and Ahmed Elnagar: Comparison between neural mobilization

and carpal bone mobilization in treating carpal tunnel syndrome. Biosci. 2019; 16(3):2690-2698.

[7] Carlson, H., Colbert, A., Frydl, J., Arnall, E., Elliot, M., & Carlson, N. Current options for nonsurgical

management of carpal tunnel syndrome. Int J Clin Rheumatol. 2010 February; 5(1): 129–142.

[8] Spicher, CJ. and Clément-Favre, S. Chronic Neuropathic Pain decreases through Somatosensory

Rehabilitation. RAE: Recueil Annuel francophone belge d'Ergothérapie. 2008; 1, 25-37.

[9] Spicher, CJ, Fehlmann, P, Maihöfner, CH., Sprumont, P, Letourneau, E, Dyer, JO., Masse, J, López-Solà,

M. Maupas, E. Annoni, and JM. Management Algorithm of Spontaneous Neuropathic Pain and/or TouchNeuropathic Pain illustrated by prospective observations in clinical practice of 66 chronic

Neuropathic Pain Patients. E-News Somatosens Rehab. 2016; 13 (1): 4-32.

[10] Jerosch-Herold C. Sensory re-learning in peripheral nerve disorders of the hand: a web-based survey and

Delphi consensus method. J. Hand Ther. 2011, 24: 292-299.

[11] Miller L, Chester R, Jerosch-Herold C. Effects of sensory reeducation programs on functional hand

Sensibility after median and ulnar nerve repair: a systematic review. J Hand Ther. 2012, 25: 297-307.

[12] American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic

Studies in Carpal Tunnel Syndrome: Summary Statement. Muscle Nerve, 1993; 16: 1390-1391.

[13] Flondell, M., Rosén, B., Andersson, G., Schyman, T., Dahlin, L.B., Björkman, A. Vibration thresholds in

Carpal tunnel syndrome assessed by multiple frequency vibrometry: a case-control study. J Occup Med

Toxicol. 2017; 12, 34.

[14] Bakhtiary, AH, Rashidy-Pour A. Ultrasound and laser therapy in the treatment of carpal tunnel syndrome.

Aust J Physiother. 2004; 50(3): 147–151.

[15] Hsu, HY, Kuo, LC, Chiu, HY. Functional sensibility assessment. Part II: Effects of sensory improvement

on precise pinch force modulation after transverse carpal tunnel release. J Orthop Res. 2009; 27: 1534–

1539

[16] Paula, M., Barbosa, R., Marcolino, A., Elui, V., Rosén, B., & Fonseca, M. Early sensory re-education of the hand

After peripheral nerve repair based on mirror therapy: a randomized controlled trial. Braz J Phys Ther.

2016; 20(1): 58-65.

[17] Sella, GE. The hand grip: gender, dominance, and age considerations. Europa medicophysica. 2001, 37 (3):

161-170.

[18] Wilson, JK, and Sevier, TL. A review of treatment for carpal tunnel syndrome. Disabil Rehabil. 2003; 4;

25(3): 113-119.

[19] Kruger, V., Kraft, G., Deitz, J., Ameis, A., and Polissar, L. Carpal tunnel syndrome: objective measures and splint use. Arch Phys Med Rehabil. 1991; 72:517-520.

[20] Niki, Y., Kanai, A., Hishi, K. Okamoto, H. Immediate analgesic effect of 8% lidocaine applied to the oral mucosa in patients with trigeminal neuralgia. Pain Med. 2014; 15: 826-831.

[21] Kanai, A., Kumaki, C., Niki, Y., Suzuki, A., Tazawa, T., & Okamoto, H. Efficacy of a metered-dose 8% lidocaine pump spray for patients with post-herpetic neuralgia. Pain Med. 2009; 10: 902-909.

[22] Chu, M., Chan, R., Leung, Y., and Fung, Y. Desensitization of fingertip injury. Tech Hand Upper Extrem Surg. 2001; 5(1): 63-70.

[23] Adler, SS, Beckers, D, Buck, M. (2014). PNF in practice: An illustrated guide. Heidelberg: Springer

Medizin Verlag.

[24] Warren, H. Carpal Tunnel Exercises that Work. Dynamic Chiropractic 2001, 19(14).

[25] Novak CB, von der Heyde RL. Evidence and techniques in rehabilitation following nerve injuries. Hand

Clin. 2013; 29(3):383-92.

[26] Jerosch-Herold C, Houghton J, Miller L, Shepstone L. Does sensory relearning improve tactile function

after carpal tunnel decompression? A pragmatic, assessor-blinded, randomized clinical trial. J Hand Surg

Eur Vol. 2016; 41(9): 948‐956.

[27] Rosén B, Bjorkman A, Boeckstyns M. Differential recovery of touch thresholds and discriminative touch

following nerve repair with a focus on time dynamics. Hand Ther. 2014; 19(3):59-63.

[28] Rosén, B, Vikström, P, Turner, S, McGrouther, DA, Selles, RW, Schreuders, TA, Björkman, A. Enhanced

early sensory outcome after nerve repair as a result of immediate post-operative re-learning: a randomized

controlled trial. J Hand Surg Eur Vol. 2015; 40(6): 598-606

[29] Vikström, P, Rosén, B, Carlsson, IK, Björkman, A. The effect of early relearning on sensory recovery 4 to

9 years after nerve repair: a report of a randomized controlled study. J Hand Surg Eur Vol. 2018;

43(6):626-630.

[30] Manoli, T., Schiefer, J. L., Schulz, L., Fuchsberger, T., & Schaller, H. E. Influence of immobilization and sensory re-education on the sensory recovery after reconstruction of digital nerves with direct suture ore-in-vein conduits. Neural Regen Res. 2016; 11(2): 338-344.

[31] Abdel-fattah MS, Sharaf MA, EL-Gendy AM. Correlation between handgrip strength and nerve conduction velocity in diabetic patients. Jokull Journal, 2014, (64): 177-185.

[32] Challoner T, Power DM, Beale S, Nijran A. Pathogenesis, Clinical Evaluation, and Nonsurgical Management of Symptomatic Neuromas: A Literature Review. Journal of Musculoskeletal Surgery and Research. 2020; 3:15-21.