Noninvasive management of carpal tunnel syndrome and changing treatment patterns over a 15-year time span. A practice survey among Australian hand therapists

Background: Numerous conservative treatment options are available to manage carpal tunnel syndrome (CTS). It is unclear how hand therapists currently manage CTS and whether practice patterns have changed over time. Purpose: This study aimed to (1) document how hand therapists manage CTS and (2) identify possible changes in treatment patterns over a 15-year window. Study Design: Cross-sectional. Methods: An online survey was distributed among all members of the Australian Hand Therapy Association. Findings were compared with a nearly identical survey conducted 15 years earlier, and with clinical guidelines, and recent clinical trials and reviews. Results: The 10 most commonly used noninvasive management options were explanation and advice, splinting, home exercise prescription, nerve gliding exercises involving proximal joints (ie, elbow, shoulder, or neck) and distal joints (ie, hand and wrist), ergonomic advice, advice regarding sitting and standing posture, tendon gliding exercises, and active wrist and finger exercises. Although these interventions also constituted the 10 most common interventions in the previous survey, meaningful differences were observed. Compared to 15 years ago, the main changes included an increase in the use of neurodynamic exercises involving proximal joints (+19.9 %pt) and distal joints (+10.7 %pt), and heat (+10.7 %pt), whereas tendon gliding exercises (−8.5 %pt) and therapeutic ultrasound (−6.2 %pt) were the main modalities that were performed less frequently. Apart from ergonomic and postural advice, commonly performed interventions (eg, explanation and advice, splinting, and neurodynamic exercises) were in line with the literature. Overall, Australian hand therapists often used a more active (exercise-based) approach compared with the guidelines and an approach that typically involved the arm rather than only the hand and wrist. Conclusions: Australian hand therapists use a wide range of interventions to manage CTS, with some noteworthy changes in treatment patterns over the preceding 15 years. Their approach is mostly supported by the literature.