Comparison of Ultrasound Therapy and Local Steroid Injection for Treatment of Carpal Tunnel Syndrome using Electrodiagnostics

Abstract

Introduction: To determine the efficacy of ultrasound therapy as compared to intra lesional steroid injection in Carpal Tunnel Syndrome (CTS) using visual analogue scale (VAS) and electrodiagnostic parameters.
Study Design: Randomized Controlled Trial
Duration and Setting: 4months’ study at carried out at Armed Forces Institute of Rehabilitation Medicine.
Methods: Patients diagnosed with CTS on Nerve Conduction Studies (NCS) /Electromyography (EMG) were divided into two groups, A and B. Group A received ultrasound therapy for 5 days a week for a 4-week period. Group B received local steroid injections. Major outcome measures were VAS scores and electrodiagnostic parameters which were checked after before and after 4 weeks of treatment for both groups.
Results: In group A, the average age was 43.47 ± 10.9 years. About 73 % (n=11) were females out of which 2 were pregnant. 80 % of all the patients were matriculate with 80 % citing house work as the probable cause of CTS. 93 % of all the patients were married and out of the 11 females, 7 were housewives. In group B, the average age was 44.0 ± 9.9 years. About 86 % (n=13) were females out of which 2 were pregnant. 73 % of all the patients were matriculate with 80 % citing house work as the probable cause of CTS. 100 % of all the patients were married and out of the 13 females, 10 were housewives. In group A, before treatment with ultrasound therapy, the mean VAS was 5.27 ± 1.90; mean Distal motor latency (DML) of median nerve was 4.25 ± 0.40 and the mean Sensory conduction velocity of median nerve (SVC) was 32.37 ± 2.98. After treatment these parameters improved with the mean VAS being 3.87 ± 1.24; mean DML became 4.04 ± 0.28 and mean SVC improving to 40.40 ± 1.84. In group B, mean VAS improved from 5.47 ± 1.72 to 3.53 ± 0.83, DML from 4.29 ± 0.41 to 4.07 ± 0.33 and SCV from 32.93 ± 4.14 to 40.20 ± 2.75.
Conclusion: Both treatment modalities showed almost similar results. Where ultrasound therapy showed slightly better improvement in DML, steroid injections edged out in VAS scores. Effect on SVC was almost identical for both modalities. Thus ultrasound therapy and steroid injections both showed similar efficacy in treatment of CTS, against the common belief that injections have better efficacy.