Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial

Abstract

OBJECTIVE:The aim of this placebo-controlled study was to evaluate the effects of pulsed and continuous ultrasound treatments combined with splint therapy on patients with mild and moderate idiopathic carpal tunnel syndrome.METHODS:The study included 46 carpal tunnel syndrome patients who were randomly divided into 3 groups. The first group (n = 15) received a 0 W/cm2 ultrasound treatment (placebo); the second group (n = 16) received a 1.0 W/cm2 continuous ultrasound treatment and the third group (n = 15) received a 1.0 W/cm2 1:4 pulsed ultrasound treatment 5 days a week for a total of 15 sessions. All patients also wore night splints during treatment period. Pre-treatment and post-treatment Visual Analogue Scale, Symptom Severity Scale and Functional Status Scale scores, median nerve motor conduction velocity and distal latency and sensory conduction velocities of the median nerve in the 2nd finger and palm were compared. Clinicaltrials.gov: NCT02054247.RESULTS:There were significant improvements in all groups in terms of the post-treatment Functional Status Scale score (p<0.05 for all groups), Symptom Severity Scale score (first group: p<0.05, second group: p<0.01, third group: p<0.001) and Visual Analogue Scale score (first and third groups: p<0.01, second group: p<0.001). Sensory conduction velocities improved in the second and third groups (p<0.01). Distal latency in the 2nd finger showed improvement only in the third group (p<0.01) and action potential latency in the palm improved only in the second group (p<0.05).CONCLUSION:The results of this study suggest that splinting therapy combined with placebo and pulsed or continuous ultrasound have similar effects on clinical improvement. Patients treated with continuous and pulsed ultrasound showed electrophysiological improvement; however, the results were not superior to those of the placebo.

Conservative therapeutic management of carpal tunnel syndrome

“…Because of the limited number of studies, there are still a number of doubts about the therapeutic use of ultrasound in CTS, especially with regard to the number and duration of sessions required. According to the systematic review carried out by Page et al 38 , there is poor quality evidence to recommend therapeutic ultrasound over other conservative treatments used in CTS, a conclusion also observed in another recent trial 44 . No adverse effects have been reported in the reviews by Page et al 38 , but only three reports were evaluated.…”

“…The pathophysiological premise that justifies its use as a therapeutic option in patients with CTS is still controversial 38 . Some authors argue that the effect of ultrasound is secondary to increased local temperature resulting in increased blood flow rates, metabolism and neural regeneration, while other researchers claim that the action is due to an anti-inflammatory effect 44,45 . Because of the limited number of studies, there are still a number of doubts about the therapeutic use of ultrasound in CTS, especially with regard to the number and duration of sessions required.…”

Espectro Dos Tratamentos Fisioterapêuticos Na Síndrome Do Túnel Do Carpo (Stc): Uma Revisão

“…A STC é considerada uma síndrome compressiva, ou seja, trata-se da compressão e/ou tração do nervo mediano ao nível do punho 1,6,8,10,[12][13][14][15][16][17][18] . Sir James Paget foi o primeiro a descrever a STC, em 1854, após um caso de compressão do nervo mediano decorrente de uma fratura de rádio distal.…”

“…Ocorre entre os 40 e 60 anos, sendo que afeta mais as mulheres. Estudos transversais sobre STC evidenciam prevalência de 9,2% no sexo feminino e 0,6% no sexo masculino 3,8,9,11,13,[15][16][17][21][22][23] .…”

“…Destaca-se como sinais e sintomas clínicos a dor, hipoestesia e parestesia no local de sensibilidade do nervo mediano (polegar, dedo indicador e médio, e face radial do dedo anular) podendo-se ter irradiação proximal para o braço e ombro 1,4,8,10,11,13,[16][17][18][23][24][25][26][27] . Geralmente têm-se piora das queixas no período noturno alterando a qualidade do sono 4,7,11,13,14,16,17,26,27 ; pode-se ter perda da destreza da mão como déficit de força de preensão, perda da oponência do polegar e do movimento de pinça entre o polegar e o indicador, além de achados tardios como diminuição da sensibilidade, hipotrofia da musculatura tenar, pele seca e alteração na cor da mão 1,3,7,10,11,15,16,18,[26][27][28] .…”