Diacutaneous Fibrolysis for Carpal Tunnel Syndrome
Affecting approximately 3 to 6 percent of the general adult population, carpal tunnel syndrome is one of the most common neuropathies of the hand [1]. Symptoms consist of numbness, weakness, tingling, and pain in the hand and fingers, triggered by compression of the median nerve within a passage of tendons, nerves, bones, and ligaments in the wrist known as the carpal tunnel [2, 3]. Causes of the syndrome include repetitive movements such as typing or hammering, trauma, pregnancy, or underlying conditions like arthritis and tenosynovitis [1, 2]. Splints, physical therapy, pain medications, and cortisone injections are among the initial treatments for carpal tunnel syndrome, but surgery to relieve nerve compression by widening the carpal tunnel may become necessitated when symptoms are not improved by first-line treatments [2]. However, another non-invasive treatment known as diacutaneous fibrolysis has been shown to improve symptoms of carpal tunnel syndrome, prompting providers to prescribe this treatment to reduce symptoms and avoid surgery [4].
Unlike other treatments for carpal tunnel syndrome, diacutaneous fibrolysis (DF) is a form of manual therapy performed by a physiotherapist [5]. A type of soft-tissue mobilization treatment, DF is accomplished with the use of metal tools to enable deep penetration and precision. Using a stainless steel hook with a beveled end, the physiotherapist targets the affected area with the goal of easing mechanical pain by relieving the pressure between the muscles, scar tissue, and the layer of collagen build-up due to fibrosis [4]. Patients with carpal tunnel syndrome typically have fibrosis between nerves and connective tissues, which worsens the compression of the median nerve [4]. For these patients, the hook end of the instrument is applied as proximal as the elbow and then pulled across the skin in a sweeping motion [4]. The theory behind this treatment is that the destruction of scar tissue and fibrosis will reduce the pressure in the carpal tunnel, decreasing the compression of the median nerve and therefore the severity of symptoms [4, 6]; however, the efficacy of this therapeutic technique in treating carpal tunnel syndrome had not been assessed in clinical trials until recently.
Beginning in 2010, clinical studies tested the efficacy of DF in alleviating symptoms of numerous musculoskeletal conditions, including shoulder pain, epicondylalgia (“tennis elbow”), and patellofemoral pain syndrome [7-9]. Because skeptics argued that the empirical efficacy of DF could have been caused by the placebo effect, these clinical trials were overwhelmingly randomized and placebo-controlled, and often double-blind. Despite this initial doubt, studies presented evidence in favor of DF, with many concluding that the therapeutic technique was a safe, effective, non-invasive treatment option with the power to reduce symptom severity, increase range of motion, reinstate muscle function, and improve nerve conduction [7-9]. Studies examining the efficacy of DF on carpal tunnel syndrome also showed significant symptom improvement, as well as improved function, mechanosensitivity, and nerve conduction, after just 5 treatment sessions [4]. Thus, due to its efficacy, lack of side effects, and non-invasive nature, DF is an excellent treatment option for carpal tunnel syndrome.
References
1: LeBlanc, E. and Cestia, W. (2011). Carpal tunnel syndrome. American Family Physician, vol. 83. URL: https://www.aafp.org/afp/2011/0415/p952.html.
2: Genova, A., Dix, O., Saefan, A., Thakur, M., and Hassan, A. (2020). Carpal tunnel syndrome: a review of literature. Cureus, vol. 12. DOI: 10.7759.cureus.7333.
3: Presazzi, A., Bortolotto, C., Zacchino, M., Madonia, L., and Draghi, F. (2011). Carpal tunnel: normal anatomy, anatomical variants and ultrasound technique. Journal of Ultrasound, vol. 14. DOI: 10.1016/j.jus.2011.01.006.
4: Del Barrio, S., Ceballos-Laita, L., Bueno-Gracia, E., Rodriguez-Marco, S., Haddad-Garay, M., and Estebanez-de-Miguel, E. (2020). Effects of diacutaneous fibrolysis on mechanosensitivity, disability, and nerve conduction studies in mild to moderate carpal tunnel syndrome: secondary analysis of a randomized controlled trial. Physical Therapy and Rehabilitation Journal, vol. 101. DOI: 10.1093/ptj.pzaa222.
5: Lopez-de-Celis, C., Perez-Bellmunt, A., Byeno-Gracia, E., Fanlo-Mazas, P., Zarate-Tejero, C., Llurda-Almuzaar, L., Arroniz, A., and Rodriguez-Rubio, P. (2020). Effects of diacutaneous fibrolysis on the muscular properties of gastrocnemius muscle. Public Library of Science, vol. 15. DOI: 0.1371/journal.pone.0243225.
6: Agud, M., Del Barrio, S., Moreno, M., Garcia, C., Guillen, S., Barea, S., Marco, S., Laita, L., Aguilella, P., and Perez, J. (2016). Effectiveness of physiotherapy treatment through diacutaneous fibrolysis in patients with carpal tunnel syndrome: 12 case series. Manual Therapy, vol. 25. DOI: 10.1016/j.math.2016.05.238.
7: Cadellans-Arroniz, A., Llurda-Almuazara, L., Campos-Laredo, B., Cabanas-Valdes, R., Garcia-Sutil, A., and Lopez-de-Celis, C. (2021). The effectiveness of diacutaneous fibrolysis on pain, range of motion and functionality in musculoskeletal disorders: a systematic review and meta-analysis. Clinical Rehabilitation, vol. 35. DOI: 10.1177/0269215520968056.
8: Barra, M., Lopez, C., Fernandez, G., Murillo, E., Villar, E., and Raya, L. (2011). The immediate effects of diacutaneous fibrolysis on pain and mobility in patients suffering from painful shoulder: a randomized placebo-controlled pilot study. Clinical Rehabilitation, vol. 25. DOI: 10.1177/0269215510385480.
9: Lopez-de-Celis, C., Barra-Lopez, M., Gonzalez-Rueda, V., Bueno-Gracia, E., Rodriguez-Rubio, P., and Tricas-Moreno, J. (2018). Effectiveness of diacutaneous fibrolysis for the treatment of lateral epicondylalgia: a randomized clinical trial. Clinical Rehabilitation, vol. 32. DOI: 10.1177/0269215517738114