Terapia manual en el síndrome del túnel carpiano.
DOI:
https://doi.org/10.37536/RIECS.2017.2.1.19Resumen
El síndrome del túnel carpiano (STC) es la neuropatía periférica más común y supone el 90% de todas las neuropatías por atrapamiento. Actualmente El objetivo de la presente revisión es determinar la eficacia de la terapia manual (TM) en el tratamiento del STC. Para ello, se realizó una búsqueda bibliográfica en las bases de datos PubMed, PEDro, Cochrane, Scopus, Web of Knowledge y Scielo de ensayos clínicos aleatorizados (ECA) publicados hasta diciembre de 2016. Las palabras clave empleadas fueron “carpal tunnel syndrome”, “nerve gliding”, “neural mobilization”, “neurodynamic”, “manual therapy”, “musculoskeletal manipulation”, “massage therapy” y “myofascial release”. Acorde a los criterios de inclusión, fueron seleccionados 10 ECA en los que se determinó el análisis de los resultados a través de escalas validadas como el cuestionario de Boston para STC, la escala visual analógica o medidas secundarias como el test de Phalen y Tinel, electroneurografía, discriminación de 2 puntos, fuerza de agarre y pinza. Los estudios se clasificaron según las técnicas empleadas para el tratamiento. Estas se dividieron en técnicas de neurodinamia y masoterapia. Dichas técnicas fueron empleadas solas, combinadas entre ellas o con diferentes intervenciones convencionales como ultrasonido, ortesis, laser o parafina. Los resultados obtenidos sugieren que el empleo de terapia manual en el manejo clínico del STC produce efectos favorables en comparación con el tratamiento convencional, obteniendo siempre mejores resultados tras la aplicación combinada entre las diferentes técnicas analizadas.
Citas
Moscony AMB. Common peripheral nerve problems. Cooper C, ed. Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. Philadelphia: Mosby Elsevier; 2007:201-250.
Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008; 77: 6-17.
Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J 2012; 6: 69-76.
Mashoof AA, Levy HJ, Soifer TB, Miller-Soifer F, Bryk E, Vigorita V. Neural anatomy of the transverse carpal ligament. Clin Orthop Relat Res 2001; (386): 218-221.
García AM, Gadea R. Estimación de la mortalidad y morbilidad por enfermedades laborales en España. Arch Prev Riesgos Labor 2004; 7 (1): 3-8.
Dawson D, Feske SK. Degenerative and compressive structural disorders. Textbook of clinical neurology. Philadelphia: WB Saunders; 1999.
Atroshi I, Gummesson C, Jonson R, Sprinchorn A. Symptoms, Disability and quality of life in patients with carpal tunnel syndrome. J Hand Surg [Am] 1999; 24: 398-404.
Ortega-Santiago R, De-la-Llave-Rincón AI, Laguarta-Val S, Martínez-Pérez A, Pareja JA, Fernández-de-las-Peñas C. Avances neurofisiológicos en el síndrome del túnel del carpo: proceso de sensibilización central o neuropatía local. Rev Neurol 2012; 54: 490-6.
Sunderland S. Nerves and nerve injury. 2 ed. London: Churchill Livingstone; 1978.
Hansson P. Difficulties in stratifying neuropathic pain by mechanisms. Eur J Pain 2003; 7: 353-7.
Chacur M, Milligan ED, Gazda LS, Armstrong C, Wang H, Tracey K. A new model of sciatic inflammatory neuritis: induction of unilateral and bilateral mechanical allodynia following acute unilateral perisciatic immune activation in rats. Pain 2001; 94: 231-44.
Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 2000; 288: 1765.
Ettema AM, Zhao C, Amadio PC, O’Byrne MM, An KN. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study. Clin Anat. 2007;20:292-299.
Xavier AV, Farrell CE, McDanal J, Kissin I. Does antidromic activation of nociceptors play a role in sciatic radicular pain?. Pain. 1990 Jan;40(1):77-9.
Nee RJ, Butler D. Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence. Physical Therapy in Sport 7, (2), May 2006, Pages 110-111.
Sunshine, W., Field, T., Quintino, O., et al.,. Massage therapy and transcutaneous electrical stimulation effects on fibromyalgia. Journal of Clinical Rheumatology 2, 18–22. 1996.
Hernandez-Reif, M., Field, T., Krasnegor, J., Theakston, H., 2001. Lower back pain is reduced and range of motion increased after massage therapy. International Journal of Neuroscience 106, 131–145.
Naliboff, B., Tachiki, X., 1991. Autonomic and skeletal muscle responses to nonelectrical cutaneous stimulation. Perceptual Motor Skills 72, 575–584.
Ironson G et al. Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. Int J Neurosci. 1996 Feb;84(1-4):205-17.
Hoving JL et al. A critical appraisal of review articles on the effectiveness of conservative treatment for neck pain. Spine (Phila Pa 1976). 2001 Jan 15;26(2):196-205.
Haraldsson BG et al. Massage for mechanical neck disorders. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004871.
Meneses Echavez JF, Morales-Osorio MA. Evidencia de la efectividad del deslizamiento del nervio mediano en el tratamiento del síndrome del túnel carpiano: una revisión sistemática. Fisioterapia. 2013;35(3):126-135.
Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother. 2002;48(1):43-9.
Huskisson EC. Measurement of pain. Lancet. 1974 Nov 9;2(7889):1127-31.
Giannini F, Cioni R, Mondelli M, Padua R, Gregori B, D'Amico P, Padua L. A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment. Clin Neurophysiol. 2002 Jan;113(1):71-7.
Totten PA, Hunter JM. Therapeutic techniques to enhance nerve gliding in thoracic outlet syndrome and carpal tunnel syndrome. Hand Clin. 1991 Aug;7(3):505-20.
Shacklock M. Neurodinámica clínica. Madrid: Elsevier; 2005.
Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A. Comparison of three conservative treatment protocols in carpal tunnel syndrome. Int J Clin Pract. 2006 Jul;60(7):820-8.
Bardak AN, Alp M, Erhan B, Paker N, Kaya B, Onal AE. Evaluation of the clinical efficacy of conservative treatment in the management of carpal tunnel syndrome. Adv Ther. 2009;26:107-16.
Brininger TL, Rogers JC, Holm MB, Baker NA, Li ZM, Goitz RJ. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2007;88(11):1429-1435.
Akalin E, El O, Peker O, et al. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil. 2002;81(2):108-113.
Horng YS, Hsieh SF, Tu YK, Lin MC, Wang JD. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial. Am J Phys Med Rehabil. 2011;90(6):435-442.
Wehbe MA, Hunter JM: Flexor tendon gliding in the hand. Part II. Differential gliding. J Hand Surg Am. 1985 Jul;10(4):575-9.
Oskouei AE, Talebi GA, Shakouri SK, Ghabili K. Effects of neuromobilization maneuver on clinical and electrophysiological measures of patients with carpal tunnel syndrome. J Phys Ther Sci. 2014 Jul;26(7):1017-22.
Bialosky JE, Bishop MD, Price DD, Robinson ME, Vincent KR, George SZ. A randomized sham-controlled trial of a neurody- namic technique in the treatment of carpal tunnel syndrome. J Orthop Sports Phys Ther. 2009;39:709-23.
Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty EP, Greco SD, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007 Jan;30(1):50-61.
Sevier TL, Gehlsen GM, Wilson JK, Stover SA, Helfst RH. Traditional physical therapy vs Graston augmented soft tissue mobilization in treatment of lateral epicondylitis. Med Sci Sports Exerc 1995;27(Suppl 5):S52.
Madenci E, Altindag O, Koca I, Yilmaz M, Gur A. Reliability and efficacy of the new massage technique on the treatment in the patients with carpal tunnel syndrome. Rheumatol Int 2012;32(10):3171–9.
Pratelli E, Pintucci M, Cultrera P, Baldini E, Stecco A, Petrocelli A, Pasquetti P. Conservative treatment of carpal tunnel syndrome: comparison between laser therapy and Fascial Manipulation(®). J Bodyw Mov Ther. 2015 Jan;19(1):113-8.
Ercole B, Antonio S, Julie Ann D, Stecco C. How much time is required to modify a fascial fibrosis?. J Bodyw Mov Ther. 2010 Oct;14(4):318-25.
Myers RR, Murakami H, Powell HC. Reduced nerve blood flow in edematous neuropathies: a biomechanical mechanism. Microvasc Res. 1986 Sep;32(2):145-51.
Moscony AMB. Common peripheral nerve problems, Cooper, ed. Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. Philadelphia: Mosby Elsevier; 2007:201-250.
Souvilis T, Vicenzino B. Efectos analgésicos de la terapia manual en la columna cervical. En Torres Cueco R. La columna cervical: evaluación clínica y aproximaciones terapéuticas. Vol. 1. Madrid: Médica Panamericana; 2008; p. 303-18.
De-la-Llave-Rincon AI, Ortega-Santiago R, Ambite-Quesada S, Gil-Crujera A, Puentedura EJ, Valenza MC, Fernández-de-las-Peñas C. Response of pain intensity to soft tissue mobilization and neurodynamic technique: a series of 18 patients with chronic carpal tunnel syndrome. J Manipulative Physiol Ther. 2012 Jul;35(6):420-7.
