Citation Information :
Kataruka M, Haldar R. Comparative Study of Electrophysiological Improvement in Carpal Tunnel Syndrome by Local Infiltration of Steroid vs Ultrasonic Therapy. Indian J Phy Med Rehab 2017; 28 (4):122-129.
Introduction: Carpal Tunnel Syndrome (CTS) was effectively treated by lots of conservative management including splints, exercise, different types of heat modality like Ultrasound treatment (UST), steroid, etc. This is our humble attempt to explore and find out the electrophysiological improvement pattern after treatment with ultrasonic therapy and methylprednisolone injection in CTS. This analytical study was conducted at the Department of Physical Medicine and Rehabilitation (PMR), IPGME&R, SSKM Hospital, Kolkata from January 15, 2012 to July 15, 2013.
Materials and methods: After getting the institutional ethical committee clearance, patients with symptoms of nerve compression at wrist were included in the study group according to the inclusion and exclusion criteria and randomly divided into two groups. Group I received UST for 15 minutes per session for 15 days to the palmer carpal tunnel area at a frequency of 1 MHz and intensity of 1.0 W/cm2, pulsed mode, with a transducer of 5 cm2, and group II received 40 mg methylprednisolone injection. The patients were examined after intervals of 2, 4 and 8 weeks post intervention.
Results: The results of our study suggest that there was a marked improvement for all the clinical and electrophysiological parameters in both the groups, but there is no statistically significant difference between the groups.
Conclusion: Ultrasound treatment and intralesional steroid injection are both effective methods of treatment for CTS with clinical and electrophysiological improvement. This is one of the effective modalities of treatment for CTS.
Duncan KH, Lewis RC Jr, Foreman KA, Nordyke MD. Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: results of a questionnaire. J Hand Surg Am 1987 May;12(3):384-391.
Scholten RJ, de Krom MC, Bertelsmann FW, Bouter LM. Variation in the treatment of carpal tunnel syndrome. Muscle Nerve 1997;20(10):1334-1335.
Akalin E, El O, Peker O, Senocak O, Tamci S, Gülbahar S, Cakmur R, Oncel S. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil 2002 Feb;81(2):108-113.
Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther 1998 Jul-Sep;11(3):171-179.
Weiss ND, Gordon L, Bloom T, So Y, Rempel DM. Position of the wrist associated with the lowest carpal-tunnel pressure: implications for splint design. J Bone Joint Surg Am 1995 Nov;77(11):1695-1699.
Randall LB. Physical medicine and rehabilitation. 4th ed. 2011 by Saunders ELSEVIER at Philadelphia p. 518.
Brininger TL, Rogers JC, Holm MB, Baker NA, Li ZM, Goitz RJ. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome. A randomized controlled trial. Arch Phys Med Rehabil 2007 Nov;88(11):1429-1435.
Nacimiento AC, Bartels M, Loew F. Acute effects of dexamethasone on normal and on posttraumatic spinal cord polysynaptic reflex activity and axonal conduction. Surg Neurol 1986 Jul;26(1):13-16.
Qin C, Greenwood-Van Meerveld B, Myers DA. Corticosterone acts directly at the amygdala to alter spinal neuronal activity in response to colorectal distension. J Neurophysiol 2003 Mar;89(3):1343-1352.
Kisner C, Colby LA. Therapeutic exercise foundations and techniques. 5th ed. 2007 by F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 p. 375.
Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A. Comparison of three conservative treatment protocols in carpal tunnel syndrome. Int J Clin Pract 2006 Jul;60(7):820-828.
Totten PA, Hunter JM. Therapeutic techniques to enhance nerve gliding in thoracic outlet syndrome and carpal tunnel syndrome. Hand Clin 1991 Aug;7(3):505-520.
Braddom RL, Physical medicine and rehabilitation. 4th ed. 2011 by Saunders ELSEVIER at Philadelphia pp. 1084-1085.
Agarwal V, Singh R, Sachdev A, Wiclaff Shekhar S, Goel D. A prospective study of the long-term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome. Rheumatology 2005 May;44(5):647-650.
Bakhtiary AH, Rashidy-Pour A. Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aus J Physiother 2004;50(3):147-151.
Badarny S, Rawashdeh H, Meer J, Abed S, Habib G. Repeated electrophysiologic studies in patients with carpal tunnel syndrome following local corticosteroid injection using a novel approach. IMAJ 2011 Jan;13(1):25-28.
Oztas O, Turan B, Bora I, Karakaya MK. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil 1998 Dec;79(12):1540-1544.
Bilgici A, Ulosoy H, Kuru O, Cantruck F. The comparison of ultrasound and local steroid injection plus splinting in the treatment of carpal tunnel syndrome: a randomized controlled trial. Bratisl Lek Lystiy 2010;111(12):659-665.