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

ABSTRACT: 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.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.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.The combination of ultrasound therapy with a wrist orthosis may be more effective than paraffin therapy with a wrist orthosis.Clinicaltrial.gov: NCT02278289 Oct 28, 2014.

SUBMITTER: Chang YW

PROVIDER: S-EPMC4256823 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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

Chang Yi-Wei YW Hsieh Shih-Fu SF Horng Yu-Shiow YS Chen Hui-Ling HL Lee Kun-Chang KC Horng Yi-Shiung YS

BMC musculoskeletal disorders 20141126

<h4>Background</h4>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 paraff ...[more]

PMID: 25428566

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Project description:Background: Despite the wide use of corticosteroid hydrodissection for carpal tunnel syndrome (CTS), there is insufficient evidence to confirm its efficacy. This study aimed to compare the effectiveness of corticosteroid hydrodissection vs. corticosteroid perineural injection alone on clinical and electrophysiological parameters in patients with CTS. Method: This prospective randomized controlled trial (RCT) was conducted in a tertiary care center with a follow-up period of 12 weeks. Subjects were randomly assigned to either ultrasound-guided hydrodissection with a mixture of 1 mL of triamcinolone acetonide (10 mg/mL), 1 mL of 2% lidocaine, and 8 mL normal saline or ultrasound-guided perineural injection with 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of 2% lidocaine. The primary outcome measure was the symptom severity subscale (SSS) of Boston Carpal Tunnel Questionnaire (BCTQ) scores at baseline and at 6 and 12 weeks' post-treatment. The secondary outcomes included the functional status subscale (FSS) of BCTQ and the distal motor latency and sensory nerve conduction velocity of the median nerve. The effect of interventions on the designated outcome was analyzed using a 3 × 2 repeated measures analysis of variance. The within-subject and among-subject factors were differences in time (before the intervention, and 6 and 12 weeks after injection) and intervention types (with or without hydrodissection), respectively. Results: Sixty-four patients diagnosed with CTS were enrolled. Both groups experienced improvement in the SSS and FSS of BCTQ and median nerve distal motor latency and sensory nerve conduction velocity. However, group-by-time interactions were not significant in any outcome measurements. No serious adverse events were reported in either group, except for two patients in the hydrodissection group who reported minor post-injection pain on the first day after the intervention, which resolved spontaneously without the need for additional treatments. Conclusion: Hydrodissection did not provide an additional benefit compared to corticosteroid perineural injection alone. More prospective studies are needed to investigate the long-term effectiveness of corticosteroid hydrodissection, as well as its influence on median nerve mobility.

Project description:Ultrasound-guided perineural dextrose injection (PDI) has been reported effective for carpal tunnel syndrome (CTS). Higher volume of injectate may reduce adhesion of median nerve from other tissues, but volume-dependent effects of PDI in CTS remain unknown. We aimed to investigate whether PDI with different injectate volumes had different effects for CTS participants. In this randomized, double-blinded, three-arm trial, 63 wrists diagnosed with CTS were randomized into three groups that received ultrasound-guided PDI with either 1, 2 or 4 ml of 5% dextrose water. All participants finished this study. Primary outcome as visual analog scale (VAS) and secondary outcomes including Boston Carpal Tunnel Questionnaire (BCTQ), Disability of the Arm, Shoulder and Hand score (QuickDASH), electrophysiological studies and cross-sectional area (CSA) of the median nerve at carpal tunnel inlet were assessed before and after PDI at the 1st, 4th, 12th and 24th weeks. For within-group analysis, all three groups (21 participants, each) revealed significant improvement from baseline in VAS, BCTQ and QuickDASH at the 1st, 4th, 12th and 24th weeks. For between-group analysis, 4 ml-group yielded better VAS reduction at the 4th and 12th weeks as well as improvement of BCTQ and QuickDASH at the 1st, 4th, and 12th weeks, compared to other groups. No significant between-group differences were observed in electrophysiological studies or median nerve CSA at any follow-up time points. There were no severe complications in this trial, and transient minor adverse effects occurred equally in the three groups. In conclusion, ultrasound-guided PDI with 4 ml of 5% dextrose provided better efficacy than with 1 and 2 ml based on symptom relief and functional improvement for CTS at the 1st, 4th, and 12th week post-injection, with no reports of severe adverse effects. There was no significant difference between the three groups at the 24th-week post-injection follow-up. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03598322.

Dataset Information

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

Publications

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

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