Comparative effectiveness of ultrasound and paraffin therapy in patients with carpal tunnel syndrome: a randomized trial

Yi-Wei Chang, Shih-Fu Hsieh, Yu-Shiow Horng, Hui-Ling Chen, Kun-Chang Lee, Yi-Shiung Horng, Yi-Wei Chang, Shih-Fu Hsieh, Yu-Shiow Horng, Hui-Ling Chen, Kun-Chang Lee, Yi-Shiung Horng

Abstract

Background: Conclusive evidence indicating an effective treatment for carpal tunnel syndrome (CTS), a common entrapment neuropathy, is lacking. Ultrasound therapy (US therapy) has long been used as one of the combination treatments for CTS. In addition, paraffin bath therapy has been applied widely as a physical modality in treating patients with hand conditions. The purpose of this randomized trial was to compare the efficacy of combining a wrist orthosis with either US therapy or paraffin bath therapy in treating CTS patients.

Methods: Patients with CTS were randomized into two groups. All patients received a wrist orthosis. Twice per week, one group underwent paraffin therapy, and the other group underwent ultrasound therapy. Each patient received a questionnaire, physical examination and nerve conduction study of the upper extremities before and after treatment for eight weeks.

Results: Sixty patients were recruited, and 47 completed the study. Statistical analysis revealed significant improvements in symptom severity scores in both groups. After adjusting for age, gender and baseline data, the analysis of covariance revealed a significant difference in the functional status score between two groups.

Conclusions: The combination of ultrasound therapy with a wrist orthosis may be more effective than paraffin therapy with a wrist orthosis.

Trial registration: Clinicaltrial.gov: NCT02278289 Oct 28, 2014.

Figures

Figure 1
Figure 1
Flowchart of patients’ recruitment.

References

    1. Bakhtiary AH, Rashidy-Pour A. Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother. 2004;50:147–151. doi: 10.1016/S0004-9514(14)60152-5.
    1. Gerritsen AAM, de Krom MCTFM, Struijs MA, Scholten RJPM, de Vet HCW, Bouter LM. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. J Neurol. 2002;249:272–280. doi: 10.1007/s004150200004.
    1. 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;60:820–828. doi: 10.1111/j.1742-1241.2006.00867.x.
    1. Horng YS, Hsieh SF, Tu YK, Lin MC, Horng YS, 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;90:435–442. doi: 10.1097/PHM.0b013e318214eaaf.
    1. Ebenbichler GR, Resch KL, Nicolakis P, Wiesinger GF, Uhl F, Ghanem AH, Fialka V. Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial. BMJ. 1998;316:731–735. doi: 10.1136/bmj.316.7133.731.
    1. Braddom RL. Physical Medicine and Rehabilitation. Philadelphia: PA:Elsevier Health Sciences; 2010.
    1. Byl NN, McKenzie AL, West JM, Whitney JD, Hunt TK, Scheuenstuhl HA. Low-dose ultrasound effects on wound healing: a controlled study with Yucatan pigs. Arch Phys Med Rehabil. 1992;73:656–664.
    1. ElHag M, Coghlan K, Christmas P, Harvey W, Harris M. The anti-inflammatory effects of dexamethasone and therapeutic ultrasound in oral surgery. Br J Oral Maxillofac Surg. 1985;23:17–23. doi: 10.1016/0266-4356(85)90074-9.
    1. Dincer U, Cakar E, Kiralp MZ, Kilac H, Dursun H. The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies. Photomed Laser Surg. 2009;27:119–125. doi: 10.1089/pho.2008.2211.
    1. Page MJ, O'Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2013;3:CD009601.
    1. Ayling J, Marks R. Efficacy of paraffin Wax baths for rheumatoid arthritic hands. Physiotherapy. 2000;86:190–201. doi: 10.1016/S0031-9406(05)60963-7.
    1. Dilek B, Gozum M, Sahin E, Baydar M, Ergor G, El O, Bircan C, Gulbahar S. Efficacy of paraffin bath therapy in hand osteoarthritis: a single-blinded randomized controlled trial. Arch Phys Med Rehabil. 2013;94:642–649. doi: 10.1016/j.apmr.2012.11.024.
    1. Prentice W. Therapeutic Modalities in Rehabilitation. 4. New York: Mcgraw-hill; 2011.
    1. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg. 1993;75:1585–1592.
    1. Phalen GS. The carpal-tunnel syndrome seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg. 1966;48:211–228.
    1. Tinel J. M Spinner, Injuries to the Major Branches of Peripheral Nerves of the Forearm. Philadelphia: Saunders; 1972. The “tingling” sign in peripheral nerve lesions. Translated by E. Kaplan; pp. 8–11.
    1. Brininger TL, Rogers JC, Holm MB, Baker NA, Li Z-M, 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;88:1429–1435. doi: 10.1016/j.apmr.2007.07.019.
    1. Medicine AAE. American academy of physical medicine and rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve. 2002;25:918–922. doi: 10.1002/mus.10185.
    1. Charles N, Vial C, Chauplannaz G, Bady B. Clinical validation of antidromic stimulation of the ring finger in early electrodiagnosis of mild carpal tunnel syndrome. Electroencephalogr Clin Neurophysiol. 1990;76:142–147. doi: 10.1016/0013-4694(90)90212-3.
    1. Kimura J. The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve. Brain. 1979;102:619–635. doi: 10.1093/brain/102.3.619.
    1. Milani P, Mondelli M, Ginanneschi F, Mazzocchio R, Rossi A. Progesterone-new therapy in mild carpal tunnel syndrome? study design of a randomized clinical trial for local therapy. J Brachial Plexus Peripher Nerv Inj. 2010;5:11.
    1. Çeliker R, Arslan S, Inanc F. Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome. Am J P M R. 2002;81:182–186. doi: 10.1097/00002060-200203000-00005.
    1. Hanley JA, Negassa A, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157:364–375. doi: 10.1093/aje/kwf215.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. London: UK: Taylor and Francis; 2013.
    1. Yildiz N, Atalay NS, Gungen GO, Sanal E, Akkaya N, Topuz O. Comparison of ultrasound and ketoprofen phonophoresis in the treatment of carpal tunnel syndrome. J Back Musculoskelet Rehabil. 2011;24:39–47.
    1. Oztas O, Turan B, Bora I, Karakaya MK. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil. 1998;79:1540–1544. doi: 10.1016/S0003-9993(98)90416-6.
    1. Raso VVM, Barbieri CH, Mazzer N, Fasan VS. Can therapeutic ultrasound influence the regeneration of peripheral nerves? J Neurosci Methods. 2005;142:185–192. doi: 10.1016/j.jneumeth.2004.08.016.
    1. Young RR, Henneman E. Reversible block of nerve conduction by ultrasound: Ultrasonic blocking of nerve fibers. Arch Neurol. 1961;4:83–89. doi: 10.1001/archneur.1961.00450070085009.
    1. Preston DC, Shapiro BE. Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations (Expert Consult - Online) Philadelphia: PA:Elsevier Health Sciences; 2012.
    1. Harris CM, Tanner E, Goldstein MN, Pettee DS. The surgical treatment of the carpal-tunnel syndrome correlated with preoperative nerve-conduction studies. J Bone Joint Surg Am. 1979;61:93–98.
    1. Wu YH, Chen WS, Luh JJ, Chong FC. Thermal effect of sonophoresis for accelerating the analgesic effect of local anesthetics on rat tail nerve. Conf Proc IEEE Eng Med Biol Soc. 2008;2008:2504–2507.
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner