The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Data Sources and Searchers
- P (population)—cubital tunnel syndrome;
- I (intervention)—physiotherapy treatment;
- C (comparator)—control group, placebo group, and sham therapy;
- O (outcomes)—nerve conduction study, discrimination and threshold sensation, functional assessment, and ultrasound imaging measurements (Supplementary Material S1).
2.2. Study Selection
2.3. Data Extraction
2.4. Methodological Quality Assessment
2.5. Data Synthesis and Analysis
3. Results
3.1. Study Selection
3.2. Randomised Controlled Trials
3.2.1. Participants
3.2.2. Outcome Measures
3.2.3. Interventions
3.2.4. Risk of Bias
3.2.5. Synthesis of the Results
3.3. Case Studies
3.3.1. Outcome Measures
3.3.2. Interventions
3.3.3. Therapeutic Effect
3.3.4. Risk of Bias
4. Discussion
4.1. Limitations
4.2. Implications for Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Participants | Outcome Measures | Control/ Comparison | Intervention | Results |
---|---|---|---|---|---|
Svernlov et al. [13] | n = 70 Sex: 39 female; 31 male Age: 17–72 | Measurement at baseline and 6-month follow-up; Activities scale (COPM); Grip strength (JAMAR dynamometer); Pain (VAS); Neurophysiological examination (NCS, electromyography). | Three groups | Group A—elbow orthosis (3-month treatment); Group B—nerve gliding exercises (3-month treatment); Group C—information (exercise modification). | There was a significant improvement in each group after the applied therapy. There were no between-group differences. |
Badur et al. [29] | n = 61 Sex: 32 female; 29 male Age: 16–79 | Measurement at baseline, after treatment, and 1- and 3-month follow-up; Pain (VAS); Upper-extremity disability and symptoms (DASH); Overall health (SF-36 questionnaire); Grip strength (dynamometer). | Two groups | Group 1—continuous shortwave diathermy (10 treatments); Group 2—placebo shortwave diathermy (10 treatments). | There were no changes in the assessed parameters in both groups after the applied therapy. |
Ozkan et al. [30] | n = 32 Sex: 16 female; 16 male Age: mean = 43.5 | Measurement at baseline, after treatment, and 1- and 3-month follow-up; Pain (VAS); Grip strength (dynamometer); Sensory threshold (Semmes–Weinstein monofilament test; Neurophysiological examination (NCS); patient satisfaction scale. | Two groups | Group 1—low-level laser therapy (10 treatments); Group 2—ultrasound therapy (10 treatments). | There was a significant improvement in both groups after the applied therapy. There were no between-group. |
Study | Participants | Outcome Measures | Control/ Comparison | Intervention | Results |
---|---|---|---|---|---|
Kearns and Wang [20] | n = 1 Sex: female Age: 45 | Measured at baseline and 4 weeks post-treatment; Tissue tension (STTT); range of motion (goniometer); symptom provocation (ULTT, elbow flexion test); structural dysfunction (PAM); pain (NPRS). | No | Thrust manipulation (humeroulnar joint 2 treatments, radiocarpal joint 1 treatment). | After 3 treatment sessions, pain and paraesthesia were resolved; all other tests were negative. |
Oskay et al. [21] | n = 7 Sex: not specified Age range: 35–70 | Measured at baseline, after treatment, and 12-month follow-up; Symptom provocation (elbow flexion test); palmar gripping and grasping (pinchmeter and grip dynamometer); pain (VAS); loss of sensation (Semmes–Weinstein monofilaments); upper-extremity disability and symptoms (DASH). | No | Cold application; pulsed ultrasound (10 treatments); nerve mobilisation techniques (10 treatments); strengthening exercises; postural adaptations; education; ergonomic modifications. | Pain, Tinel’s sign, and Disability of Arm, Shoulder, and Hand Index scores were decreased; grip and pinch strength increased during the observation period. |
Shen et al. [22] | n = 7 Sex: not specified Age: 35–71 | Measured at baseline and 4-, 8-, and 12-week follow-up; Severity of paraesthesia/dysaesthesia (VAS); upper-extremity disability and symptoms (DASH). | No | Extracorporeal shock wave therapy (3 treatments). | The VAS and Quick DASH scores demonstrated improvements at all follow-up time points in all treated elbows. |
Anandkumar and Manivasagam [23] | n = 3 Sex: 2 male; 1 female Age: 35,45,50 | Measured at baseline, beginning of each treatment session, and at 6-month follow-up; Pain (NPRS); function limitation (PSFS); pain-free grip strength (JAMAR dynamometer); self-reported outcome measure (GROC). | No | Dry needling (4 treatments, twice a week). | All patients achieved complete pain reduction and full recovery of function; the strength of the pain-free grip also improved; all self-reported significant improvement after therapy; the effect lasted 6 months after the therapy. |
Illes and Johnson [31] | n = 1 Sex: female Age: 41 | Measured at baseline and after treatment; Severity of numbness (VAS); Symptom provocation (EAST, Tinel sign); Grip strength (Blood pressure cuff); | No | Chiropractic manipulative therapy; myofascial therapy (11 treatments); elastic therapeutic taping (no number specified); home exercises (8 treatments). | After 11 treatment sessions, symptoms resolved completely. |
Coppieters et al. [32] | n = 1 Sex: female Age: 17 | Measured at baseline, beginning of each treatment session, and at 6- and 10-month follow-up; Pain (VAS); range of motion (goniometer); clinical tests (neural provocation test, elbow flexion test, Tinel’s sign); functional status (NPQ). | No | Neurodynamic mobilisation (5 treatments); Elbow mobilisation (4 treatments); home exercises—active ulnar nerve-sliding (5 treatments); high-velocity distraction/rotation thrust (3 treatments); education (1 instruction). | After the applied therapy, in each of the tests used, the symptoms were eliminated; The effect lasted 10 months after the therapy. |
Kwak et al. [33] | n = 2 Sex: male Age: 39 and 40 | Measured at baseline, after treatment, and at 1, 2, 3, and 6 months post-treatment; Pain (NPRS); NCS; elbow imaging (MRI). | No | PRF (1 treatment). | After 1 treatment session, the pain was completely relieved. At the 1-, 2-, 3-, and 6-month follow-up assessments after the procedure, the previously reported pain had not recurred. |
Fernández-de-Las-Peñas al. [34] | n = 1 Sex: male Age: 48 | Measured at baseline and at 1, 3, 6, and 12 months post-treatment; Upper-extremity disability and symptoms (DASH); neuropathic pain (S-LANSS); self-reported outcome measure (GROC). | No | PENS of the ulnar nerve (3 treatments); self-neural glides as a home program (2–3 weeks). | After three treatment sessions, there was an elimination of pain and symptoms and an improvement in functional status; the effect lasted 12 months after the therapy. |
Study | Domain 1 Risk of Bias Arising from the Randomisation Process | Domain 2 Risk of Bias Due to Deviations from the Intended Interventions | Domain 3 Missing Outcome Data | Domain 4 Risk of Bias in Measurement of the Outcome | Domain 5 Risk of Bias in Selection of the Reported Result | Overall Risk of Bias |
---|---|---|---|---|---|---|
Svernlov et al. [13] | Low | Some concerns | Low | High | Low | High |
Badur et al. [29] | Low | Some concerns | Low | Low | Low | Some concerns |
Ozkan et al. [30] | Low | Some concerns | Low | Low | Low | Some concerns |
Critical Appraisal Checklist | Kearns and Wang [20] | Oskay et al. [21] | Shen et al. [22] | Anandkumar and Manivasagam [23] | Illes and Johnson [31] | Coppieters et al. [32] | Kwak et al. [33] | Fernández-de-Las-Peñas et al. [34] |
---|---|---|---|---|---|---|---|---|
1. Were the patient’s demographic characteristics clearly described? | Yes | Unclear | Yes | Yes | Yes | Yes | Yes | Yes |
2. Was the patient’s history clearly described and presented as a timeline? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
3. Was the current clinical condition of the patient on presentation clearly described? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
4. Were diagnostic tests or assessment methods and the results clearly described? | Unclear | Yes | Yes | Unclear | Unclear | Unclear | Yes | Unclear |
5. Was the intervention(s) or treatment procedure(s) clearly described? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
6. Was the post-intervention clinical condition clearly described? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
7. Were adverse events (harms) or unanticipated events identified and described? | No | Unclear | Unclear | Unclear | No | Unclear | Unclear | No |
8. Does the case report provide takeaway lessons? | No | Yes | Yes | Yes | No | No | Yes | Unclear |
Study | Bias Due to Confounding | Bias in Selection of Participants in the Study | Bias in Classification of Interventions | Bias Due to Deviations from Intended Interventions | Bias Due to Missing Data | Bias in Measurement of Outcomes | Bias in Selection of the Reported Result | Overall Bias |
---|---|---|---|---|---|---|---|---|
Kearns and Wang [20] | Serious | Moderate | Serious | Serious | Moderate | Serious | Moderate | Serious |
Oskay et al. [21] | Serious | Moderate | Serious | Serious | Moderate | Serious | Moderate | Serious |
Shen et al. [22] | Moderate | Low | Moderate | Moderate | Low | Moderate | Moderate | Moderate |
Anandkumar and Manivasagam [23] | Moderate | Low | Moderate | Moderate | Low | Moderate | Moderate | Moderate |
Illes and Johnson [31] | Serious | Moderate | Serious | Serious | Moderate | Serious | Moderate | Serious |
Coppieters et al. [32] | Serious | Moderate | Serious | Serious | Moderate | Serious | Moderate | Serious |
Kwak et al. [33] | Moderate | Low | Moderate | Moderate | Low | Moderate | Moderate | Moderate |
Fernández-de-Las-Peñas et al. [34] | Serious | Moderate | Serious | Serious | Moderate | Serious | Moderate | Serious |
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Wolny, T.; Fernández-de-las Peñas, C.; Buczek, T.; Domin, M.; Granek, A.; Linek, P. The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review. J. Clin. Med. 2022, 11, 4247. https://doi.org/10.3390/jcm11144247
Wolny T, Fernández-de-las Peñas C, Buczek T, Domin M, Granek A, Linek P. The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review. Journal of Clinical Medicine. 2022; 11(14):4247. https://doi.org/10.3390/jcm11144247
Chicago/Turabian StyleWolny, Tomasz, César Fernández-de-las Peñas, Tomasz Buczek, Magdalena Domin, Arkadiusz Granek, and Paweł Linek. 2022. "The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review" Journal of Clinical Medicine 11, no. 14: 4247. https://doi.org/10.3390/jcm11144247
APA StyleWolny, T., Fernández-de-las Peñas, C., Buczek, T., Domin, M., Granek, A., & Linek, P. (2022). The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review. Journal of Clinical Medicine, 11(14), 4247. https://doi.org/10.3390/jcm11144247