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Ultrasound and Carpal tunnel syndrome

I have heard mixed reports regarding the effectiveness of ultrasound therapy in the conservative management of (mild/moderate) carpal tunnel syndrome. Has anyone had success in clinical practice and if so what was the dose and frequency? Thanks in advance

Leanne Topcuoglu

2 months ago

Back to General Electrotherapy

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Prof Tim Watson
Prof Tim Watson

There have been a number of interesting studies with ultrasound and carpal tunnel. There was a reasonably recent RCT from a group in Taiwan [Chang et al. (2014). "Comparative effectiveness of ultrasound and paraffin therapy in patients with carpal tunnel syndrome: a randomized trial." BMC Musculoskelet Disord 15(1): 399] which gave good results (especially for pain and function) using ultrasound 2 x weekly at a fairly typical dose of 1MHz, 1.0 W cm^2 Pulse 1:4, 5 mins. The US treatment was compared with paraffin wax therapy and the US came out more effective.

lancashirehandtherapy173
lancashirehandtherapy173

Thanks Prof Gad Alon and Cliff Eaton for you replies and useful article links. Its the first time I've requested help through this forum and appreciate the replies. Thank you, Leanne Topcuoglu

Prof Gad Alon
Prof Gad Alon

correction of typo: "much higher dose"

Prof Gad Alon
Prof Gad Alon

correction of typo: "much higher dose"

Cliff Eaton
Cliff Eaton

Totally agree with Gad. This would not be my choice of modality to treat CTS. rather I would choose Radial Shockwave, supported by this clinical study and my own clinical experiences: Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial. Wu YT, Ke MJ, Chou YC, Chang CY, Lin CY, Li TY, Shih FM, Chen LC (2016) Journal of Orthopaedic Research Key message: Significant improvement of pain and disability in CTS patients with rESWT treatment versus placebo. Cliff

Prof Gad Alon
Prof Gad Alon

To the best of my limited knowledge only 1 study with much higher than typical dosage showed significant clinical and electrophysiological benefits

Ebenbichler, G. R. Resch, K. L. Nicolakis, P. Wiesinger, G. F. Uhl, F. Ghanem, A. H. Fialka, V. Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial. BMJ 1998;316:731-735.

All other studies question the benefit over placebo. Typical example:

Armagan, O. Bakilan, F. Ozgen, M. Mehmetoglu, O. Oner, S. Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial. Clinics (Sao Paulo) 2014;69: 524-528.

One can speculate that we need much higher does for example longer session time (20-30 min?) and more sessions (20-30?)

Dr. Alon

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