Effectiveness of Phonophoresis Treatment in Carpal Tunnel Syndrome: A Randomized Double‐blind, Controlled Trial

• Published in: PM&R
• Main Authors: Boonhong, Jariya, Thienkul, Worakan
• Other Authors: King Chulalongkorn Memorial Hospital
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2019
• Subjects: DML
• Online Access: http://dx.doi.org/10.1002/pmrj.12171; https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fpmrj.12171; https://onlinelibrary.wiley.com/doi/pdf/10.1002/pmrj.12171; https://onlinelibrary.wiley.com/doi/full-xml/10.1002/pmrj.12171

Objective To determine the effects of phonophoresis of piroxicam (PH‐P) and phonophoresis of dexamethasone sodium phosphate (PH‐Dex) on mild to moderate carpal tunnel syndrome (CTS), and to compare each of them with the control group of nondrug ultrasound (US) therapy. Design A randomized, double‐blind controlled trial. Setting Department of rehabilitation medicine, university hospital. Participants Patients with clinical signs and symptoms of CTS underwent an electrophysiological study to confirm the diagnosis of CTS and severity grading. Thirty‐three patients, 50 hands (52% of the patients had bilateral CTS, n = 17) with mild to moderate CTS were randomly allocated into three study groups: PH‐P, PH‐Dex, or US. Intervention All three groups received 10 sessions of 1‐MHz frequency, 1.0 w/cm 2 intensity ultrasound wave with stroking technique, continuous mode, at the palm side of the hand over the carpal tunnel area—10 minutes per session, two to three times per week for 4 weeks, for a total of 10 sessions. During each session, the patients received 15 cm 3 of study gel according to the study groups. The PH‐P group received 0.5% piroxicam gel mixture (equivalence of 20 mg of piroxicam). The PH‐Dex group received 0.4% dexamethasone sodium phosphate gel mixture (equivalence 60 mg of dexamethasone). The US group received nondrug gel. Main Outcome Measurements Boston Carpal Tunnel Questionnaire for symptom severity (BCTQ SYMPT), Boston Carpal Tunnel Questionnaire for functional status (BCTQ FUNCT) and electrophysiological parameters of the median nerve including distal sensory latency (DSL) and distal motor latency (DML) were evaluated before the first treatment and after the last treatment. Results After treatment, all treatment groups (PH‐P, PH‐Dex, and US) showed significant improvements of the BCTQ SYMPT ( P < .001, −0.74 ± 0.73 [−1.12, −0.37], −0.91 ± 0.96 [−1.41, −0.42], and − 0.68 ± 0.71 [−1.05, −0.30], respectively) and the BCTQ FUNCT ( P < .001, −0.68 ± 0.89 [−1.14, −0.22], −0.74 ± 0.84 [−1.17, ‐0.30], ...