The Effects of Sensory Therapy on Pain, Upper Extremity Functions and Sleep Quality in Patients with Carpal Tunnel Syndrome

Research Article

Ann Yoga Phys Ther. 2016; 1(2): 1007.

The Effects of Sensory Therapy on Pain, Upper Extremity Functions and Sleep Quality in Patients with Carpal Tunnel Syndrome

Burcu T* and Zilan B

Physiotherapy and Rehabilitation Department, Inonu University, Turkey

*Corresponding author: Burcu Talu, Inonu University Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Campus 44280, Malatya, Turkey

Received: August 08, 2016; Accepted: August 30, 2016; Published: September 01, 2016


Background: Pain, functional limitations of upper extremities and sleep disorders are important problems that affect the quality of life and daily activities. Pain is one of the most common symptoms observed in patients with Carpal Tunnel Syndrome (CTS). Because pain limits the upper extremities’ functions and adversely affects sleep quality, the daily activities of the individuals are limited, and their quality of life is impaired.

Aim: To assess pain, upper extremity functions and sleeps quality in participant with CTS.

Objectives: The purpose of this study is to determine if sensory therapy is a beneficial modality to relieves pain, improve participants’ sleep quality and upper extremity functions in patients with CTS.

Methods: Thirty volunteers (27 females and 3 males) diagnosed with CTS, ages from 33 to 68 years, and were included in the study. Demographic characteristics were noted, pain intensity, upper extremity functions and sleep quality of the subjects were assessed. Pain intensity using the Visual Analog Scale (VAS), upper extremity functions using Shoulder and Hand Disabilities of the Arm (DASH), and sleep quality were measured Pittsburgh Sleep Quality Index (PSQI).

Study type: Randomized, double-blind study.

Results: When the values before and after the sensory therapy were compared, a significant decrease (p˂0.05) was found in the pain intensity at rest, with activity, and during day and night. Additionally, differences in DASH and PSQI values showed statistically significant improvement in both upper extremity functions and sleep quality (both p˂0.05).

Conclusion: In the light of the study results, we concluded that sensory therapy improves sleep quality and upper extremity functions, and that it relieves pain symptoms in patients with CTS.

Keywords: Carpal tunnel syndrome; Sensory therapy; Sleep quality


CTS: Carpal Tunnel Syndrome; VAS: Visual Analog Scale; DASH: Disabilities of the Arm, Shoulder and Hand; PSQI: Pittsburg Sleep Quality Index; BMI: Body Mass Index; TENS: Transcutaneous Electrical Nerve Stimulation


Carpal Tunnel Syndrome (CTS) is the clinical term for the pain that occurs in association with the compression of median nerve during gliding of the nerve between carpal bones and transverse ligaments; it is the most common focal compression neuropathy of upper extremities. Clinical symptoms are nocturnal paresthesia, pain, decrease in grip strength and loss of function in the hand [1,2]. An increase in pain intensity during night and dysesthesia are observed in 80% of patients. The etiology is multifactorial; most cases are classified as idiopathic [3]. It is frequent in females aged 30–50, and occurs five times more frequently in females than in males [4].

The patients with CTS awake from sleep frequently during the night with pain and paresthesia symptoms. This is thought to be associated with increased pressure on the carpal tunnel resulting from wrong positioning of the hand [5]. Increased pain and paresthesia during the night leads to frequent sleep interruptions, an increase in duration of sleep interruptions and napping, and consequently to a decrease in sleep quality [6,7]. Impaired sleep quality is an important problem because it may adversely affect daily activities and life quality as fatigue and pain increase. One study has shown that many diseases associated with pain affect sleep quality [8].

Treatment of CTS is generally classified as conservative or surgical. Surgical treatment is preferred for severe cases (e.g., denervation of the median nerve), whereas conservative treatment is preferred for cases with mild to moderate CTS [9]. Methods such as oral steroids, local steroid injections, physiotherapy, electrotherapy, splinting and modifications in the working environment and sensory treatment are also used during conservative treatment [10,11]. The efficacy of different conservative approaches has been examined by several studies [2,9]. Sensory therapy based on the teaching of new senses and establishing the relationship with the old sense of the sensory memory. There are three phases of sensory therapy: Early Phase is focus on moving touch, continuous touch, pressure and the localization of tactile senses; Late Phase is passed when moving and continuous touch sense is return, purpose of that is to facilities tactile sense; Compensation Training. The efficacy of sensory therapy has also been shown through assessments of clinical and electro diagnostic evidence [11]. However, to our knowledge, no study investigating the effect of sensory treatment on patients’ sleep quality has been performed to date.

The purpose of this study is to subject the patients with CTS to sensory therapy and to investigate its effects on upper extremity functions and sleep quality.

Materials and Methods

This experimental research study was conducted on participants with CTS applied to Physiotherapy and Rehabilitation Department of Beydagi State Hospital (Malatya, Turkey). It is a randomised, doubleblind study. The randomised, double-blind study is an experimental procedure in which neither the subjects of the experiment nor the persons administering the experiment know the critical aspects of the experiment nor the people participating in the trial are randomly allocated. The sample of the study consisted of patients with CTS who applied to the Physiotherapy and Rehabilitation Department of Beydağı State Hospital (Malatya, Turkey). The participants who were included in the study were selected out of the sample that who volunteered and fulfilled the inclusion criteria of the study was included in accordance with the random improbable sampling method. The power analysis that was conducted using the software NCSS PASS suggested that a sample number of 30 achieves a statistical power of 80% at 5% level of significance with a 95% confidence interval. Thirty-five persons diagnosed with CTS, ages 33 to 68 years, were enrolled in the study. Two participants was quitted the treatment for decrease in pain and paresthesia, and did not attend the control in the third week, two participants was withdrew and did not attend in the third week without any explanation, one participant was do local steroid injection while the treatment continued after five of the original participants withdrew from the study, the total sample number was 30 (27 females and 3 males).

Selection criteria

The criteria for inclusion in the study were: not having any cognitive, mental, psychological or neurological problems; no medical record of diabetes mellitus; having a positive score on at least one of the CTS-specific tests (Phalen, Reverse Phalen, Tinel’s and Carpal Compression Tests); and not having been subjected to any medical treatment, steroid injection or surgical treatment in relation to CTS.


Prior to the study, all participants in the study were informed verbally and in writing about the purpose and duration of the study; the forms used for assessment and the assessment process itself; then, the patient’s approval was obtained. Demographical details of the participants such as age, height, weight, body mass index (BMI) and dominant hand were recorded. The side of the CTS and CTSrelated symptoms were recorded, and the pain intensity, anomalies and functionality of upper extremities and sleep quality were assessed before and after the therapy. The Visual Analog Scale (VAS), used for assessment of the pain intensity, is a scaled measurement of 10 cm in length where there are two extremes, with zero corresponding to no pain and ten corresponding to an unbearable amount of pain [12]. The participants are asked to mark the pain intensity on the scale, and the length of the interval between the mark and zero point corresponds to the pain intensity of the patient.

The Disabilities of the Arm, Shoulder and Hand (DASH) was used to assess anomalies and upper extremity functions. DASH assesses changes in functionality due to wounding of upper extremities, anomalies, limitations in activities, workforce effects and extracurricular activities [13,14]. DASH has been shown to be a valid and reliable method to assess upper extremity entrapment neuropathies, and the reliability and validity of the questionnaire for a Turkish population has been tested previously [15,16]. The questionnaire, which consists of three sections and 38 questions in total, was filled out by each participating patient: they were asked to mark the most appropriate answer (1: no difficulty, 2: mild difficulty, 3: moderate difficulty, 4: severe difficulty and 5: unable). The survey yields a score of 0 to 100, and the higher the score, the more severe the disability.

The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Using 19 questions, PSQI measures seven components, including subjective sleep quality over the last month, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction. Each component has a range of 0 to 3 points, and the global score is calculated by summing the scores of each component. A global score ≤5 is indicative of good sleep quality, whereas a score >5 is indicative of poor sleep quality [17]. The validity and reliability of this test was tested for a Turkish population, and its coefficient of internal consistency was reported to be 0.80 [18].

The sensory therapy was applied to the participants for 30 minutes five days per week and continued for three weeks and after three weeks pain intensity, upper extremity functions, sleep quality of the subjects were assessed again (Figure 1). The therapy was performed using different objects sequentially. Spiky balls were used for massaging in all directions during 2 min to apply pressure on paresthesia areas on the hand and to stimulate the sense of touch. Various parts of the hand were tapped. Rougher and softer sides of a sponge, as well as a material made up of a soft metal, were sequentially slid over various parts of the hand. A brush was used for massaging that followed sliding a piece of cotton over various parts of hands. The hands were dipped into a bowl filled with sand and macaroni. The participants touched surfaces covered with different types of fabrics. The length of the duration of the treatments with each object was two minutes. Lastly, conventional Transcutaneous Electrical Nerve Stimulation (TENS) was performed with Chattanooga (ELSA Corp.), each with four rounds, carbon-impregnated rubber electrodes 4 cm in diameter. The participants were received conventional TENS (pulse frequency 100 Hz, pulse amplitude 100 mA, pulse duration 100 μs and pulse pattern continuous) once a day for 4 minute periods for three weeks.