SHORT AND LONG-TERM EFFECTS OF PULSED WAVE AND CONTINUOUS WAVE ULTRASOUND FOR THE TREATMENT OF CARPAL TUNNEL SYNDROME: A RANDOMIZED CLINICAL TRIAL
DOI:
https://doi.org/10.15621/ijphy/2020/v7i4/747Keywords:
carpal tunnel syndrome, ultrasound therapy, pulsed wave, continuous wave, ultrasound waves.Abstract
Background: Sonotherapy is used in carpal tunnel syndrome (CTS) treatment; continuous or pulsed ultrasound waves are commonly used. The aim was to assess the short and long-term effects of CTS treatment using continuous and pulsed ultrasound waves.
Methods: This study was a randomized clinical trial. Forty-eight patients with mild and moderate CTS (20 unilateral and 28 bilateral) were subjected to complex physiotherapy. Complex physiotherapy included whirlpool massage, neuromobilization, and sonotherapy (continuous wave and pulsed wave ultrasound). The patients were randomly placed in two treatment groups and were subjected to sonotherapy with continuous or pulsed ultrasound waves. Seventy-six hands were assessed before, immediately after, and one year after treatment. Outcome measures included the Boston Carpal Tunnel Questionnaire (CTS SSS & FSS), computer-measured global handgrip force, provocative and functional tests, assessments of vegetative disorders, and sensation disorders.
Results: Significant improvements in symptoms and parameters were observed after sonotherapy in both groups immediately after and one year after treatment. Long–term effects of CTS SSS & FSS for pulsed-wave amounted to p=0.0018, p=0.0001 while p=0.0003, p=0.0021 for continuous wave, respectively. Between the groups, a statistically significant difference was found in the change of muscle strength (p=0.0374) and Luthy's sign result (p=0.0262) between examination one and examination 3.
Conclusions: Short and long-term effects of continuous and pulsed ultrasound wave in CTS treatment is comparable. Effects are influenced by energy density transmitted to tissues. Pulsed wave appears more effective in the long-term in improving the condition of hand muscles.
References
Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. J Bone Joint Surg Am. 2014; 96(17):e148.
Szopiński K, Mazurczak-Pluta T, Sonographic diagnosis of carpal tunnel syndrome -diagnostic value of the triangular cross-section sign. Neurol Neurochir Pol. 2011; 45(6):556–60.
Kim LN, Kwon HK, Moon HI, Pyun SB, Lee HJ. Sonography of the median nerve in carpal tunnel syndrome with diabetic neuropathy. Am J Phys Med Rehabil. 2014; 93(10):897–907.
Cartwright MS, Walker FO, Blocker JN, Schulz MR, Arcury TA, Grzywacz JG, et al. The prevalence of carpal tunnel syndrome in Latino poultry-processing workers and other Latino manual workers. J Occup Environ Med. 2012; 54(2):198–201.
Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of
the recent literature. Open Orthop J. 2012; 6:69–76.
Thiese MS, Gerr F, Hegmann KT, Harris-Adamson C, Dale AM, Evanoff B, et al. Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort. Arch Phys Med Rehabil. 2014; 95(12):2320–6.
Deng X, Chau LP, Chiu SY, Leung KP, Hu Y, Ip WY. Diagnostic use of ultrasonography in carpal tunnel syndrome and its correlation with the Chinese version of Boston Carpal Tunnel Questionnaire. J Med Ultrasound. 2019; 27(3):124-29.
Chmielewska D, Skęczek-Urbaniak A, Kubacki J, Błaszczak E, Kwaśna K. Effectiveness of carpal tunnel syndrome rehabilitation after endoscopic versus open surgical release. Ortop Traumatol Rehabil. 2013; 15(5):417–27.
Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments–a systematic review. Arch Phys Med Rehabil. 2010; 91(7):981–1004.
Halac G, Demir S, Yucel H, Niftaliyev E, Kocaman G, Duruyen H, et al. Splinting is effective for night-only symptomatic carpal tunnel syndrome patients. J Phys Ther Sci. 2015; 27(4):993–6.
Oskouei AE, Talebi GA, Shakouri SK, Ghabili K. Effects of neuromobilization maneuver on clinical and electrophysiological measures of patients with carpal tunnel syndrome. J Phys Ther Sci. 2014; 26(7):1017–22.
Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci. 2010; 31(3):243–52.
Barbosa RI, da Silva Rodrigues EK, Tamanini G, Marcolino AM, Elui VM, de Jesus Guirro RR, et al. effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial. BMC Musculoskelet Disord. 2012; 13:248.
Piravej K, Boonhong J. Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome. J Med Assoc Thai. 2004; 87 (Suppl 2):100-6.
Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007; 21(4):299-314.
Mitragotri S. Healing sound: the use of ultrasound in drug delivery and other therapeutic applications. Nat Rev Drug Discov. 2005; 4(3):255-60.
Bartkowiak Z, Zgorzalewicz-Stachowiak M, Nowicka A. Skuteczność wybranych technik fizjoterapeutycznych w leczeniu zespołu kanału nadgarstka. Zastosowanie ultradźwięków w oparciu o przegląd piśmiennictwa. Physiotheraphy. 2012; 20(3):57-70.
Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2013; 28(3):CD009601.
Robertson VJ, Baker KG. A review of therapeutic ultrasound: effectiveness studies. Phys Ther. 2001; 81(7):1339-50.
Jothi KP, Bland JDP. Ultrasound therapy adds no benefit to splinting in carpal tunnel syndrome. Muscle Nerve. 2019; 60(5):538-43.
Yildiz N, Atalay NSF, 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(1):39–47.
ter Haar G. Therapeutic applications of ultrasound. Prog Biophys Mol Biol. 2007; 93(1-3):111-29.
Wong RA, Schumann B, Townsend R, Phelps CA. A survey of therapeutic ultrasound use by physical therapists who are orthopaedic certified specialists. Phys Ther. 2007; 87(8):986-94.
Padua L, Padua R, Lo Monaco M, Aprile I, Paciello N, Nazzaro M. Natural history of carpal tunnel syndrome according to the neurophysiological classification. Ital J Neurol Sci. 1998; 19(6): 357-61.
Jansen MC, van der Oest MJ, Slijper HP, Porsius JT, Selles RW. Item reduction of the Boston Carpal Tunnel Questionnaire using decision tree modeling. Arch Phys Med Rehabil. 2019; 100(12):2308-13.
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 Am. 1993;75(11):1585-92.
Meirelles LM, Santos JB, Santos LL, Branco MA, Faloppa F, Leite VM, Fernandes CH. Evaluation of Boston Questionnaire applied at late-post operative period of carpal tunnel syndromeoperated with the paine retinaculatome through palmar port. Acta Ortop Bras. 2006; 14(3):126-132.
Klaus Buckup. Johannes Buckup. Clinical Tests for the Musculoskeletal System: Examinations- Signs- Phenomena. 3rd ed; Frankfurt:Thieme 2016.
Demidaś A, Ratajczak B, Pisula-Lewandowska A. The influence of the hydro-massage on the sense of touch in the upper extremities. Acta Bio-Optica Inform Medica. 2010; 16(3):212-4.
Wilson JK, Sevier TL. A review of treatment for carpal tunnel syndrome. Disabil Rehabil. 2003; 25(3):113-9.
Watson T. Ultrasound in contemporary physiotherapy practice. Ultrasonics. 2008; 48(4):321-9.
Ebenbichler GR, Resch KL, Nicolakis P, Wiesinger GF, Uhl F, Ghanem AH, et al. Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial. BMJ. 1998; 316(7133):731-5.
Viera AJ. Management of carpal tunnel syndrome. Am Fam Physician. 2003; 68(2):265-72.
Alexander LD, Gilman DRD, Brown DR, Brown JL, Houghton PE. Exposure to low amounts of ultrasound energy does not improve soft tissue shoulder pathology:
a systematic review. Phys Ther. 2010; 90(1):14-25.
Speed CA. Therapeutic ultrasound in soft tissue lesions. Rheumatology (Oxford). 2001; 40(12):1331-6.
Santamato A, Solfrizzi V, Panza F, Tondi G, Frisardi V, Leggin BG, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther. 2009; 89(7):643-52.
Bakhsh H, Ibrahim I, Khan WS et al.: Assessment of validity, reliability, responsiveness and bias of three commonly used patient-reported outcome measures in carpal tunnel syndrome. Ortop Traumatol Rehabil. 2012; 14(4):335-40.
Sezgin M, Arinci Incel C, Sevim S, Handan C, Ҫamdeviren H, As I, Erdoğan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: Reliability and validity of the Turkish version of the Boston Questionnaire. Disabil Rehabil. 2006; 20:1281-5.
De Kleermaeker FGCM, Levels M, Verhagen WIM, Meulstee J. Validation of the Dutch version of the Boston Carpal Tunnel Questionnaire. Front Neurol. 2019; 10(7):1154.
Published
How to Cite
Issue
Section
Copyright © Author(s) retain the copyright of this article.
This work is licensed under a