Efficacy of night splinting and ultrasound in Carpal Tunnel Syndrome. A randomized controlled clinical trial

DOI: https://doi.org/10.15417/issn.1852-7434.2020.85.4.982
Keywords: Carpal Tunnel Syndrome, therapeutics, splints, ultrasound therapy

Abstract

Objective: To compare the efficacy of night wrist immobilization using an ulnar splint in neutral angle versus the use of ultrasound (US) in patients with mild and moderate Carpal Tunnel Syndrome (CTS). Materials and Methods: Study population included over 18 years of age that were treated for electromyography-confirmed CTS between October 2007 and March 2010 at a Buenos Aires hospital. A sex- and age-stratified randomization was performed by using randomly permuted blocks, allocating patients into the experimental group (EG) and control group (CG). Pulsed US therapy was administered for 15 minutes to all patients three times a week for six weeks at a frequency of 1 MHz. In addition, EG patients were also prescribed night splint. Pain and paresthesia were evaluated using a 100mm Visual Analogue Scale (VAS), the Patient Specific Functional Scale (PSFS), and the Moberg pickup test (MPUT) at baseline, at 3 and 6 weeks, and follow-up at 1, 3 and 6 months after treatment by a blinded investigator. Results: Study population consisted of 85 cases (65 patients) that were randomly allocated to CG (n=42) or EG (n=43). Twenty were eliminated, so 32 in the CG and 33 in EG were analyzed. Improvement of all the variables was observed at the end of treatment in both groups, with a 1.64 (95% CI: 0.38-2.91, P=0.012) statistically significant difference in means for pain in favor of the EG at 3 weeks of treatment, but without a significant clinical difference. No adverse effects were observed. Conclusion: The efficacy of combined night splint and US therapy is not superior to the US alone treatment in CTS patients. Key words: Key words: Carpal Tunnel Syndrome; therapeutics; splints; ultrasound therapy.Level of Evidence: II

Downloads

Download data is not yet available.

Author Biographies

Daniel Hernandez, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Esteban Terpolilli, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Daniel Héctor Verdecchia, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Valeria Leiva, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Laura Ventos, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Romina Rodríguez, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Anabella Gamboa, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
María Belén Spath, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Jimena Steimberg, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Martín Sanz, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Erica Williams, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Sabrina Mohr, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Paola Colesnik, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Tai Lo Chen, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Silvina Dell' Era, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Mariana Dimaro, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Romina Díaz, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Bruno Baldo, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)
Matías Accoce, Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand” (Buenos Aires, Argentina)
Physical Therapy Unit, Hospital General de Agudos “Dr. Carlos G. Durand”(Buenos Aires, Argentina)

References

Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008;77(1):6-17. PMID: 18269111

Burke FD, Ellis J, McKenna H, Bradley MJ. Primary care management of carpal tunnel syndrome. Postgrad Med J

;79(934):433-7. https://doi.org/10.1136/pmj.79.934.433

Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, et al. Practice parameter:

Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic

Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation.

Neurology 2002;58(11):1589-92. https://doi.org/10.1212/wnl.58.11.1589

Currier DP, Greathouse D, Swift T. Sensory nerve conduction: effect of ultrasound. Arch Phys Med Rehabil

;59(4):181-5. PMID: 646607

Kramer JF. Effect of therapeutic ultrasound intensity on subcutaneous tissue temperature and ulnar nerve conduction velocity. Am J Phys Med 1985;64(1):1-9. PMID: 3970155

Ebenbichler GR, Resch KL, Nicolakis P, Wiesinger GF, Uhl F, Ghanem AH, et al. Ultrasound treatment for treating the carpal tunnel syndrome: randomised “sham” controlled trial. BMJ 1998;316(7133):731-5.

https://doi.org/10.1136/bmj.316.7133.731

Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane

Database Syst Rev 2013;2013( 3):CD009601. https://doi.org/10.1002/14651858.CD009601.pub2

Werner CO, Elmqvist D, Ohlin P. Pressure and nerve lesion in the carpal tunnel. Acta Orthop Scand

;54(2):312-6. https://doi.org/10.3109/17453678308996576

Kruger VL, Kraft GH, Deitz JC, Ameis A, Polissar L. Carpal tunnel syndrome: objective measures and splint use.

Arch Phys Med Rehabil 1991;72(7):517-20. PMID: 2059127

Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 2012;2012(7):CD010003. https://doi.org/10.1002/14651858.CD010003

Halac G, Demir S, Yucel H, Niftaliyev E, Kocaman G, Duruyen H, et al. Splinting is effective for night-only

symptomatic carpal tunnel syndrome patients. J Phys Ther Sci 2015;27(4):993-6. https://doi.org/10.1589/jpts.27.993

Armenteros Pedrero J, Justo García G, Rey Pita ML, Gallego González S, Buján de Gonzalo A, Tobío Iglesias

A. Tratamiento conservador del síndrome del túnel carpiano mediante inmovilización con férulas. Rehabilitación

(Madr) 2000; 34(4): 313-9. https://www.elsevier.es/es-revista-rehabilitacion-120-articulo-tratamiento-conservador-del-sindrome-del-10017830

Massy-Westropp N, Grimmer K, Bain G. A systematic review of the clinical diagnostic tests for carpal tunnel

syndrome. J Hand Surg Am 2000;25(1):120-7. https://doi.org/10.1053/jhsu.2000.jhsu025a0120

Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity

measured on a visual analog scale. Ann Emerg Med 2001;38(6):633-8. https://doi.org/10.1067/mem.2001.118863

Stratford P, Gill C, Westaway M, Binkley J. Assessing disability and change on individual patients: a report of a

patient specific measure. Physiother Can 1995;47(4):258-63. https://doi.org/10.3138/ptc.47.4.258

Hefford C, Abbott JH, Arnold R, Baxter GD. The patient-specific functional scale: validity, reliability, and

responsiveness in patients with upper extremity musculoskeletal problems. J Orthop Sports Phys Ther 2012;42(2):56-65. https://doi.org/10.2519/jospt.2012.3953

Ng CL, Ho DD, Chow SP. The Moberg pickup test: results of testing with a standard protocol. J Hand Ther

;12(4):309-12. https://doi.org/10.1016/s0894-1130(99)80069-6

Stamm TA, Ploner A, Machold KP, Smolen J. Moberg picking-up test in patients with inflammatory joint

diseases: a survey of suitability in comparison with button test and measures of disease activity. Arthritis Rheum

;49(5):626-32. https://doi.org/10.1002/art.11378

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;60(7):820-8. https://doi.org/10.1111/j.1742-1241.2006.00867.x

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(8):524-8.

https://doi.org/10.6061/clinics/2014(08)04

Dincer U, Cakar E, Kiralp MZ, Kilac H, Dursun H. The effectiveness of conservative treatments of carpal tunnel

syndrome: splinting, ultrasound, and low-level laser therapies. Photomed Laser Surg 2009;27(1):119-25.

https://doi.org/10.1089/pho.2008.2211

Fernández-de-Las-Peñas C, Ortega-Santiago R, Díaz HF, Salom-Moreno J, Cleland JA, Pareja JA, et al. Costeffectiveness evaluation of manual physical therapy versus surgery for carpal tunnel syndrome: evidence from a randomized clinical trial. J Orthop Sports Phys Ther 2019;49(2):55-63. https://doi.org/10.2519/jospt.2019.8483

Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome.

Part I: effectiveness of nonsurgical treatments—a systematic review. Arch Phys Med Rehabil 2010;91(7):981-1004.

https://doi.org/10.1016/j.apmr.2010.03.022

Huisstede BM, Hoogvliet P, Franke TP, Randsdorp MS, Koes BW. Carpal tunnel syndrome: effectiveness of

physical therapy and electrophysical modalities. An updated systematic review of randomized controlled trials. Arch Phys Med Rehabil 2018;99(8):1623-34.e23. https://doi.org/10.1016/j.apmr.2017.08.482

Bakhtiary AH, Rashidy-Pour A. Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother 2004;50(3):147-51. https://doi.org/10.1016/s0004-9514(14)60152-5

Published
2020-11-18
How to Cite
Hernandez, D., Terpolilli, E., Verdecchia, D. H., Leiva, V., Ventos, L., Rodríguez, R., Gamboa, A., Spath, M. B., Steimberg, J., Sanz, M., Williams, E., Mohr, S., Colesnik, P., Chen, T. L., Dell’ Era, S., Dimaro, M., Díaz, R., Baldo, B., & Accoce, M. (2020). Efficacy of night splinting and ultrasound in Carpal Tunnel Syndrome. A randomized controlled clinical trial. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(4), 357-368. https://doi.org/10.15417/issn.1852-7434.2020.85.4.982
Issue
Vol 85 No 4 (2020)
Section
Clinical Research
Copyright (c) 2020 Revista de la Asociación Argentina de Ortopedia y Traumatología

Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.

In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.

It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.

The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.