Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes

• Published in: Rheumatology international 2012-10, Vol.32 (10), p.3229-3234
• Main Authors: Soyupek, Feray, Yesildag, Ahmet, Kutluhan, Suleyman, Askin, Ayhan, Ozden, Ahmet, Uslusoy, Gokcen Ay, Demirci, Seden
• Format: Article
• Language: English
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Betamethasone Valerate - administration & dosage; Carpal Tunnel Syndrome - diagnostic imaging; Carpal Tunnel Syndrome - physiopathology; Carpal Tunnel Syndrome - therapy; Diclofenac - administration & dosage; Diclofenac - analogs & derivatives; Electrodiagnosis; Female; Glucocorticoids - administration & dosage; Humans; Male; Median Nerve - diagnostic imaging; Median Nerve - physiopathology; Medicine; Medicine & Public Health; Middle Aged; Neural Conduction; Neurologic Examination; Original Article; Pain Management - methods; Pain Measurement; Phonophoresis; Predictive Value of Tests; Recovery of Function; Rheumatology; Severity of Illness Index; Splints; Surveys and Questionnaires; Time Factors; Treatment Outcome; Turkey; Ultrasonography
• ISSN: 0172-8172; 1437-160X
• DOI: 10.1007/s00296-011-2173-7

Firstly, we aimed to determine the effectiveness of various treatment modalities using ultrasonography (US), and secondly, we aimed to assess the correlations between the ultrasonographic findings and electrophysiological tests, symptom severity, functional status and physical findings. 74 hands of 47 patients with carpal tunnel syndrome (CTS) were randomly treated by applying wrist splinting alone in the neutral position (23 hands), phonophoresis with corticosteroid (PCS) (28 hands) and phonophoresis with non-steroid anti-inflamatory drug (PNSAI) (23 hands). The cross-sectional area (CSA) of the median nerve (MN) was determined by ultrasound on the initial and at the 3 months after treatment. MN conduction studies were performed on the initial visit and 3 months after treatment. The patients completed the Boston symptom severity questionnaire. For clinical evaluation, we used Phalen’s and Tinel’s signs. We could find reduction in CSA of MN in PCS group ( P   0.05) and also between ultrasonographic parameters and BQ scores ( P  > 0.05). Although there was some improvement in clinical parameters, ultrasonographic parameters did not change in P-NSAI group. Conclusion: The most effective treatment modality was P-CS according to ultrasonographic and other findings. Although there were inverse correlations between the CSA of MN and sensory and motor MN conduction velocity, no relationship was found between symptom severity, functional status and US findings or electrophysiological studies.