Comparison of the efficiencies of occlusion steroid phonophoresis and ultrasound treatments in carpal tunnel syndrome

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which occurs as a result of the compression of the median nerve in the carpal tunnel in the wrist. CTS is diagnosed with clinical findings, clinical examination and electrophysiological studies. In this study, we aimed to investigate the effects of steroid phonophoresis performed with and without occlusion therapy on electroneurophysiological and clinical parameters in patients with idiopathic CTS and, whether these effects have a superiority to performing ultrasound (US) alone.Material and Method: 45 patients who were diagnosed as idiopathic CTS, were enrolled in the study (all female, 81 hands). The patients were randomly grouped as occlusion (n=30 hands), phonophoresis (n=25 hands) and US (n=26 hands) groups. Continuous mode US treatments were delivered 5 min/day, 5 days a week, 3 weeks (15 sessions) at an intensity of 1 W/cm2, 3 MHz frequency over the carpal tunnel in all study groups.In the occlusion group, 0.7 mg 0.1% dexamethasone pomade (Maxidex, Alcon) was applied to the skin and occluded with a dressing for 30 minutes before the ultrasound.In the phonophoresis group, US treatment was delivered by using 0.7 mg 0.1% dexamethasone pomade (Maxidex, Alcon) as the conductor agent.In the ultrasound group, only US treatment was delivered by using aquasonic gel as the conductor agent.The patients attending in all three groups were instructed to use night splints, which keep the wrist in neutral position. The patients were evaluated according to electrophysiological parameters (median nerve motor and sensory distal latency and sensory nerve conduction velocities), clinical parameters (visual analogous scales (VAS), grip strengths and pinch strengths ) and Boston Scale (the severity of the symptoms and the functional capacity) before, after and at the third month of the treatment.Results: There was no significant difference between the three groups in terms of improvement in clinical evaluation parameters. A significant improvement was observed in only palmar pinch strength at the third month after the treatment in the US group. In electrophysiological evaluation, a significant improvement was observed in median motor distal latency parameter after treatment compared to before treatment in the US group.Conclusion: As the effects of occlusion phonophoresis, phonophoresis and US treatments used in the conservative treatment of CTS, were compared, it was shown that all of the three treatments provided favorable effects in the short and long term (3 months) clinical outcomes. It was also observed that these treatment methods improved clinical outcomes of CTS more than the electrophysiological outcomes of CTS in our study group. However, we recommend randomized controlled studies including larger numbers of patients are needed to evaluate these treatment methods with controversial efficiencies at the present time.