Therapeutic ultrasound for carpal tunnel syndrome
Matthew J Page, Denise O'Connor, Veronica Pitt, Nicola Massy-Westropp, Matthew J Page, Denise O'Connor, Veronica Pitt, Nicola Massy-Westropp
Abstract
Background: Therapeutic ultrasound may be offered to people experiencing mild to moderate symptoms of carpal tunnel syndrome (CTS). The effectiveness and duration of benefit of this non-surgical intervention remain unclear.
Objectives: To review the effects of therapeutic ultrasound compared with no treatment, placebo or another non-surgical intervention in people with CTS.
Search methods: On 27 November 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL (2012, Issue 11 in The Cochrane Library), MEDLINE (January 1966 to November 2012), EMBASE (January 1980 to November 2012), CINAHL Plus (January 1937 to November 2012), and AMED (January 1985 to November 2012).
Selection criteria: Randomised controlled trials (RCTs) comparing any regimen of therapeutic ultrasound with no treatment, a placebo or another non-surgical intervention in people with CTS.
Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias in the included studies. We calculated risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs) for primary and secondary outcomes. We pooled results of clinically homogenous trials in a meta-analysis using a random-effects model, where possible, to provide estimates of the effect.
Main results: We included 11 studies including 414 participants in the review. Two trials compared therapeutic ultrasound with placebo, two compared one ultrasound regimen with another, two compared ultrasound with another non-surgical intervention, and six compared ultrasound as part of a multi-component intervention with another non-surgical intervention (for example, exercises and splint). The risk of bias was low in some studies and unclear or high in other studies, with only two reporting that the allocation sequence was concealed and six reporting that participants were blinded. Overall, there is insufficient evidence that one therapeutic ultrasound regimen is more efficacious than another. Only two studies reported the primary outcome of interest, short-term overall improvement (any measure in which patients indicate the intensity of their complaints compared with baseline, for example, global rating of improvement, satisfaction with treatment, within three months post-treatment). One low quality trial with 68 participants found that when compared with placebo, therapeutic ultrasound may increase the chance of experiencing short-term overall improvement at the end of seven weeks treatment (RR 2.36; 95% CI 1.40 to 3.98), although losses to follow-up and failure to adjust for the correlation between wrists in participants with bilateral CTS in this study suggest that this data should be interpreted with caution. Another low quality trial with 60 participants found that at three months post-treatment therapeutic ultrasound plus splint increased the chance of short-term overall improvement (patient satisfaction) when compared with splint alone (RR 3.02; 95% CI 1.36 to 6.72), but decreased the chance of short-term overall improvement when compared with low-level laser therapy plus splint (RR 0.87; 95% CI 0.57 to 1.33), though participants were not blinded to treatment, it was unclear if the random allocation sequence was adequately concealed, and there was a potential unit of analysis error. Differences between groups receiving different frequencies and intensities of ultrasound, and between ultrasound as part of a multi-component intervention versus other non-surgical interventions, were generally small and not statistically significant for symptoms, function, and neurophysiologic parameters. No studies reported any adverse effects of therapeutic ultrasound, but this outcome was only measured in three studies. More adverse effects data are required before any firm conclusions on the safety of therapeutic ultrasound can be made.
Authors' conclusions: There is only poor quality evidence from very limited data to suggest that therapeutic ultrasound may be more effective than placebo for either short- or long-term symptom improvement in people with CTS. There is insufficient evidence to support the greater benefit of one type of therapeutic ultrasound regimen over another or to support the use of therapeutic ultrasound as a treatment with greater efficacy compared to other non-surgical interventions for CTS, such as splinting, exercises, and oral drugs. More methodologically rigorous studies are needed to determine the effectiveness and safety of therapeutic ultrasound for CTS.
Conflict of interest statement
None known.
Figures
Study flow diagram.
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 1 Short‐term overall improvement (number of participants with good to excellent improvement) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 2 Short‐term improvement in CTS symptoms (number of participants with complete remission of subjective symptoms) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 3 Short‐term improvement in CTS symptoms (VAS pain score) (2 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 4 Short‐term improvement in CTS symptoms (pain and/or paraesthesia) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 5 Short‐term improvement in CTS symptoms (sensory loss) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 6 Short‐term improvement in CTS symptoms (nocturnal waking) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 7 Short‐term improvement in functional ability (hand grip strength) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 8 Short‐term improvement in functional ability (pinch strength) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 9 Short‐term improvement in motor distal latency (ms) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 10 Short‐term improvement in motor nerve conduction velocity (m/s) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 11 Short‐term improvement in sensory distal latency (ms) (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 12 Short‐term improvement in sensory nerve conduction velocity (3 months or less).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 13 Long‐term improvement in CTS symptoms (>3 months) (number of participants who did not have an overall unsatisfactory outcome).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 14 Long‐term improvement in CTS symptoms (number of participants with complete remission of subjective symptoms) (>3 months).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 15 Long‐term improvement in CTS symptoms (pain and/or paraesthesia) (>3 months).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 16 Long‐term improvement in CTS symptoms (sensory loss) (>3 months).
Comparison 1 Therapeutic ultrasound versus placebo, Outcome 17 Long‐term improvement in functional ability (grip and pinch strength) (>3 months).
Comparison 2 Therapeutic ultrasound (varying frequency), Outcome 1 Short‐term improvement in CTS symptoms (pain) (3 months or less).
Comparison 2 Therapeutic ultrasound (varying frequency), Outcome 2 Short‐term improvement in CTS symptoms (paraesthesia) (3 months or less).
Comparison 2 Therapeutic ultrasound (varying frequency), Outcome 3 Short‐term improvement in CTS symptoms (superficial sensation) (3 months or less).
Comparison 2 Therapeutic ultrasound (varying frequency), Outcome 4 Short‐term improvement in CTS symptoms (Tinel's sign) (3 months or less).
Comparison 2 Therapeutic ultrasound (varying frequency), Outcome 5 Short‐term improvement in CTS symptoms (Phalen's sign) (3 months or less).
Comparison 2 Therapeutic ultrasound (varying frequency), Outcome 6 Short‐term improvement in functional ability (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 1 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 2 Short‐term improvement in functional ability (hand grip strength, N) (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 3 Short‐term improvement in functional ability (pinch strength, N) (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 4 Short‐term improvement in motor distal latency (ms) (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 5 Short‐term improvement in compound muscle action potential (CMAP) amplitude (mV) (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 6 Short‐term improvement in thumb sensory latency (ms) (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 7 Short‐term improvement in thumb sensory action potential (SAP) amplitude (µV) (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 8 Short‐term improvement in index sensory latency (ms) (3 months or less).
Comparison 3 Therapeutic ultrasound (single intervention) versus low‐level laser therapy, Outcome 9 Short‐term improvement in index sensory action potential (SAP) amplitude (µV) (3 months or less).
Comparison 4 Therapeutic ultrasound (varying intensity), Outcome 1 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 4 Therapeutic ultrasound (varying intensity), Outcome 2 Short‐term improvement in CTS symptoms (night pain / paraesthesia) (3 months or less).
Comparison 4 Therapeutic ultrasound (varying intensity), Outcome 3 Short‐term improvement in CTS symptoms (nocturnal awakening) (3 months or less).
Comparison 4 Therapeutic ultrasound (varying intensity), Outcome 4 Short‐term improvement in motor distal latency (ms) (3 months or less).
Comparison 4 Therapeutic ultrasound (varying intensity), Outcome 5 Short‐term improvement in motor nerve conduction velocity (m/s) (3 months or less).
Comparison 4 Therapeutic ultrasound (varying intensity), Outcome 6 Short‐term improvement in sensory distal latency (ms) (3 months or less).
Comparison 4 Therapeutic ultrasound (varying intensity), Outcome 7 Short‐term improvement in sensory nerve conduction velocity (3 months or less).
Comparison 5 Therapeutic ultrasound (single intervention) versus local corticosteroid injection plus splint, Outcome 1 Short‐term improvement in CTS symptoms (symptom severity score) (3 months or less).
Comparison 5 Therapeutic ultrasound (single intervention) versus local corticosteroid injection plus splint, Outcome 2 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 5 Therapeutic ultrasound (single intervention) versus local corticosteroid injection plus splint, Outcome 3 Short‐term improvement in functional ability (functional status score) (3 months or less).
Comparison 5 Therapeutic ultrasound (single intervention) versus local corticosteroid injection plus splint, Outcome 4 Short‐term improvement in functional ability (grip strength) (3 months or less).
Comparison 5 Therapeutic ultrasound (single intervention) versus local corticosteroid injection plus splint, Outcome 5 Short‐term improvement in median nerve motor distal latency (3 months or less).
Comparison 5 Therapeutic ultrasound (single intervention) versus local corticosteroid injection plus splint, Outcome 6 Short‐term improvement in median sensory nerve conduction velocity (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 1 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 2 Short‐term improvement in CTS symptoms (Levine) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 3 Short‐term improvement in CTS symptoms (Phalen sign) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 4 Short‐term improvement in CTS symptoms (Tinel sign) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 5 Short‐term improvement in functional ability (Levine) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 6 Short‐term improvement in functional ability (hand grip strength) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 7 Short‐term improvement in functional ability (pinch strength) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 8 Short‐term improvement in motor distal latency (ms) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 9 Short‐term improvement in sensory distal latency (ms) (3 months or less).
Comparison 6 Therapeutic ultrasound plus splint versus exercises plus splint, Outcome 10 Long‐term improvement in CTS symptoms (>3 months).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 1 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 2 Short‐term improvement in CTS symptoms (Levine) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 3 Short‐term improvement in CTS symptoms (Phalen sign) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 4 Short‐term improvement in CTS symptoms (Tinel sign) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 5 Short‐term improvement in functional ability (Levine) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 6 Short‐term improvement in functional ability (hand grip strength) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 7 Short‐term improvement in functional ability (pinch strength) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 8 Short‐term improvement in motor distal latency (ms) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 9 Short‐term improvement in sensory distal latency (ms) (3 months or less).
Comparison 7 Therapeutic ultrasound plus exercises plus splint versus exercises plus splint, Outcome 10 Long‐term improvement in CTS symptom (>3 months).
Comparison 8 Therapeutic ultrasound plus splint versus splint, Outcome 1 Short‐term overall improvement (completely normal hands based on electroneuromyography) (3 months or less).
Comparison 8 Therapeutic ultrasound plus splint versus splint, Outcome 2 Short‐term overall improvement (patient satisfaction) (3 months or less).
Comparison 8 Therapeutic ultrasound plus splint versus splint, Outcome 3 Short‐term improvement in CTS symptoms (symptom severity score) (3 months or less).
Comparison 8 Therapeutic ultrasound plus splint versus splint, Outcome 4 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 8 Therapeutic ultrasound plus splint versus splint, Outcome 5 Short‐term improvement in functional ability (functional status score) (3 months or less).
Comparison 8 Therapeutic ultrasound plus splint versus splint, Outcome 6 Short‐term improvement in median nerve motor distal latency (3 months or less).
Comparison 8 Therapeutic ultrasound plus splint versus splint, Outcome 7 Short‐term improvement in second digit‐wrist median nerve sensory velocity (3 months or less).
Comparison 9 Therapeutic ultrasound plus splint versus low‐level laser therapy plus splint, Outcome 1 Short‐term overall improvement (completely normal hands based on electroneuromyography) (3 months or less).
Comparison 9 Therapeutic ultrasound plus splint versus low‐level laser therapy plus splint, Outcome 2 Short‐term overall improvement (patient satisfaction) (3 months or less).
Comparison 9 Therapeutic ultrasound plus splint versus low‐level laser therapy plus splint, Outcome 3 Short‐term improvement in CTS symptoms (symptom severity score) (3 months or less).
Comparison 9 Therapeutic ultrasound plus splint versus low‐level laser therapy plus splint, Outcome 4 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 9 Therapeutic ultrasound plus splint versus low‐level laser therapy plus splint, Outcome 5 Short‐term improvement in functional ability (functional status score) (3 months or less).
Comparison 9 Therapeutic ultrasound plus splint versus low‐level laser therapy plus splint, Outcome 6 Short‐term improvement in median nerve motor distal latency (3 months or less).
Comparison 9 Therapeutic ultrasound plus splint versus low‐level laser therapy plus splint, Outcome 7 Short‐term improvement in second digit‐wrist median nerve sensory velocity (3 months or less).
Comparison 10 Therapeutic ultrasound plus nerve and tendon gliding exercises plus night splint plus activity modification versus dexamethasone iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 1 Short‐term improvement in CTS symptoms (BCTQ symptom severity score) (3 months or less).
Comparison 10 Therapeutic ultrasound plus nerve and tendon gliding exercises plus night splint plus activity modification versus dexamethasone iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 2 Short‐term improvement in CTS symptoms (VAS pain on movement) (3 months or less).
Comparison 10 Therapeutic ultrasound plus nerve and tendon gliding exercises plus night splint plus activity modification versus dexamethasone iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 3 Short‐term improvement in CTS symptoms (VAS pain at rest) (3 months or less).
Comparison 10 Therapeutic ultrasound plus nerve and tendon gliding exercises plus night splint plus activity modification versus dexamethasone iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 4 Short‐term improvement in CTS symptoms (VAS pain at night) (3 months or less).
Comparison 10 Therapeutic ultrasound plus nerve and tendon gliding exercises plus night splint plus activity modification versus dexamethasone iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 5 Short‐term improvement in functional ability (BCTQ functional status score) (3 months or less).
Comparison 10 Therapeutic ultrasound plus nerve and tendon gliding exercises plus night splint plus activity modification versus dexamethasone iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 6 Short‐term improvement in functional ability (Health Assessment Questionnaire) (3 months or less).
Comparison 11 Therapeutic ultrasound plus nerve and tendon gliding exercise plus night splint plus activity modification versus placebo iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 1 Short‐term improvement in CTS symptoms (BCTQ symptom severity score) (3 months or less).
Comparison 11 Therapeutic ultrasound plus nerve and tendon gliding exercise plus night splint plus activity modification versus placebo iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 2 Short‐term improvement in CTS symptoms (VAS pain on movement) (3 months or less).
Comparison 11 Therapeutic ultrasound plus nerve and tendon gliding exercise plus night splint plus activity modification versus placebo iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 3 Short‐term improvement in CTS symptoms (VAS pain at rest) (3 months or less).
Comparison 11 Therapeutic ultrasound plus nerve and tendon gliding exercise plus night splint plus activity modification versus placebo iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 4 Short‐term improvement in CTS symptoms (VAS pain at night) (3 months or less).
Comparison 11 Therapeutic ultrasound plus nerve and tendon gliding exercise plus night splint plus activity modification versus placebo iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 5 Short‐term improvement in functional ability (BCTQ functional status score) (3 months or less).
Comparison 11 Therapeutic ultrasound plus nerve and tendon gliding exercise plus night splint plus activity modification versus placebo iontophoresis plus nerve and tendon gliding exercises plus night splint plus activity modification, Outcome 6 Short‐term improvement in functional ability (Health Assessment Questionnaire) (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 1 Short‐term improvement in CTS symptoms (Tinel's sign) (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 2 Short‐term improvement in CTS symptoms (Phalen's sign) (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 3 Short‐term improvement in CTS symptoms (symptom severity score) (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 4 Short‐term improvement in functional ability (functional status score) (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 5 Short‐term improvement in functional ability (grip strength) (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 6 Short‐term improvement in motor distal latency (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 7 Short‐term improvement in motor nerve conduction velocity (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 8 Short‐term improvement in sensory distal latency (3 months or less).
Comparison 12 Therapeutic ultrasound plus splint versus placebo ultrasound plus splint, Outcome 9 Short‐term improvement in palm‐wrist conduction velocity (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 1 Short‐term improvement in CTS symptoms (pain and/or paraesthesia) (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 2 Short‐term improvement in CTS symptoms (frequency of awakening) (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 3 Short‐term improvement in median nerve sensory distal latency (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 4 Short‐term improvement in sensory nerve action potential (SNAP) (endpoint) (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 5 Short‐term improvement in sensory nerve action potential (SNAP) (change from baseline) (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 6 Short‐term improvement in median nerve motor distal latency (change from baseline) (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 7 Short‐term improvement in compound muscle action potential (CMAP) (endpoint) (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 8 Short‐term improvement in compound muscle action potential (CMAP) (change from baseline) (3 months or less).
Comparison 13 Therapeutic ultrasound plus placebo versus sham ultrasound plus NSAID, Outcome 9 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 14 Therapeutic ultrasound plus splint versus sham ultrasound plus splint, Outcome 1 Adverse events.
Comparison 14 Therapeutic ultrasound plus splint versus sham ultrasound plus splint, Outcome 2 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 14 Therapeutic ultrasound plus splint versus sham ultrasound plus splint, Outcome 3 Short‐term improvement in CTS symptoms (symptom severity score) (3 months or less).
Comparison 14 Therapeutic ultrasound plus splint versus sham ultrasound plus splint, Outcome 4 Short‐term improvement in functional ability (functional status score) (3 months or less).
Comparison 14 Therapeutic ultrasound plus splint versus sham ultrasound plus splint, Outcome 5 Short‐term improvement in median nerve motor distal latency (3 months or less).
Comparison 14 Therapeutic ultrasound plus splint versus sham ultrasound plus splint, Outcome 6 Short‐term improvement in median nerve sensory distal latency (3 months or less).
Comparison 15 Therapeutic ultrasound plus splint versus therapeutic ultrasound plus splint plus ketoprofen phonophoresis, Outcome 1 Adverse events.
Comparison 15 Therapeutic ultrasound plus splint versus therapeutic ultrasound plus splint plus ketoprofen phonophoresis, Outcome 2 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
Comparison 15 Therapeutic ultrasound plus splint versus therapeutic ultrasound plus splint plus ketoprofen phonophoresis, Outcome 3 Short‐term improvement in CTS symptoms (symptom severity score) (3 months or less).
Comparison 15 Therapeutic ultrasound plus splint versus therapeutic ultrasound plus splint plus ketoprofen phonophoresis, Outcome 4 Short‐term improvement in functional ability (functional status score) (3 months or less).
Comparison 15 Therapeutic ultrasound plus splint versus therapeutic ultrasound plus splint plus ketoprofen phonophoresis, Outcome 5 Short‐term improvement in median nerve motor distal latency (3 months or less).
Comparison 15 Therapeutic ultrasound plus splint versus therapeutic ultrasound plus splint plus ketoprofen phonophoresis, Outcome 6 Short‐term improvement in median nerve sensory distal latency (3 months or less).
Source: PubMed