Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial

BMJ 1998;316:731-735 ( 7 March )

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Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial

Gerold R Ebenbichler, assistant doctor, ^a Karl L Resch, senior lecturer, ^b Peter Nicolakis, assistant doctor, ^a Günther F Wiesinger, assistant doctor, ^a Frank Uhl, professor, ^c Abdel-Halim Ghanem, assistant doctor, ^a Veronika Fialka, head of department. ^a

^a Department of Physical Medicine and Rehabilitation, University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria, ^b Department of Complementary Medicine, University of Exeter, Exeter, ^c Department of Neurology, University of Vienna

Correspondence to: Dr Ebenbichler

Objective: To assess the efficacy of ultrasound treatment for mild to moderate idiopathic carpal tunnel syndrome.
Design: Randomised, double blind, "sham" controlled trial with assessments at baseline, after 2 weeks' and 7 weeks'treatment, and at a follow up assessment 6 months later (8 monthsafter baseline evaluation).
Setting: Outpatient clinic of a university department of physical medicine and rehabilitation in Vienna.
Subjects: 45 patients with mild to moderate bilateral carpal tunnel syndrome as verified by electroneurography.
Intervention: 20 sessions of ultrasound (active) treatment (1 MHz, 1.0 W/cm², pulsed mode 1:4, 15 minutes per session) applied to the areaover the carpal tunnel of one wrist, and indistinguishable shamultrasound treatment applied to the other. The first 10 treatmentswere performed daily (5 sessions/week); 10 further treatmentswere twice weekly for 5 weeks.
Main outcome measures: Score of subjective symptom ratings assessed by visual analogue scale; electroneurographic measures(for example, motor distal latency and sensory antidromic nerveconduction velocity).
Results: Improvement was significantly more pronounced in actively treated than in sham treated wrists for both subjectivesymptoms (P<0.001, paired t test) and electroneurographic variables(motor distal latency P<0.001, paired t test; sensory antidromicnerve conduction velocity P<0.001, paired t test). Effects weresustained at 6 months' follow up.
Conclusion: Results suggest there are satisfying short to medium term effects due to ultrasound treatment in patientswith mild to moderate idiopathic carpal tunnel syndrome. Findingsneed to be confirmed, and ultrasound treatment will have to becompared with standard conservative and invasive treatment options.

Key messages

Chronic entrapment of the median nerve at the wrist (the carpal tunnel syndrome) is probably the most common peripheral nerve lesion
No satisfactory conservative treatment is available at present
Twenty sessions of ultrasound treatment show good short and medium term efficacy in patients with bilateral, mild to moderate forms of the carpal tunnel syndrome
Optimal treatment schedules of ultrasound treatment alone or in combination with other non-surgical treatments await
elucidation

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