PMID- 31006972
OWN - NLM
STAT- MEDLINE
DCOM- 20210302
LR  - 20210302
IS  - 1934-1563 (Electronic)
IS  - 1934-1482 (Linking)
VI  - 12
IP  - 1
DP  - 2020 Jan
TI  - Effectiveness of Phonophoresis Treatment in Carpal Tunnel Syndrome: A Randomized 
      Double-blind, Controlled Trial.
PG  - 8-15
LID - 10.1002/pmrj.12171 [doi]
AB  - OBJECTIVE: To determine the effects of phonophoresis of piroxicam (PH-P) and 
      phonophoresis of dexamethasone sodium phosphate (PH-Dex) on mild to moderate 
      carpal tunnel syndrome (CTS), and to compare each of them with the control group 
      of nondrug ultrasound (US) therapy. DESIGN: A randomized, double-blind controlled 
      trial. SETTING: Department of rehabilitation medicine, university hospital. 
      PARTICIPANTS: Patients with clinical signs and symptoms of CTS underwent an 
      electrophysiological study to confirm the diagnosis of CTS and severity grading. 
      Thirty-three patients, 50 hands (52% of the patients had bilateral CTS, n = 17) 
      with mild to moderate CTS were randomly allocated into three study groups: PH-P, 
      PH-Dex, or US. INTERVENTION: All three groups received 10 sessions of 1-MHz 
      frequency, 1.0 w/cm(2) intensity ultrasound wave with stroking technique, 
      continuous mode, at the palm side of the hand over the carpal tunnel area-10 
      minutes per session, two to three times per week for 4 weeks, for a total of 10 
      sessions. During each session, the patients received 15 cm(3) of study gel 
      according to the study groups. The PH-P group received 0.5% piroxicam gel mixture 
      (equivalence of 20 mg of piroxicam). The PH-Dex group received 0.4% dexamethasone 
      sodium phosphate gel mixture (equivalence 60 mg of dexamethasone). The US group 
      received nondrug gel. MAIN OUTCOME MEASUREMENTS: Boston Carpal Tunnel 
      Questionnaire for symptom severity (BCTQ SYMPT), Boston Carpal Tunnel 
      Questionnaire for functional status (BCTQ FUNCT) and electrophysiological 
      parameters of the median nerve including distal sensory latency (DSL) and distal 
      motor latency (DML) were evaluated before the first treatment and after the last 
      treatment. RESULTS: After treatment, all treatment groups (PH-P, PH-Dex, and US) 
      showed significant improvements of the BCTQ SYMPT (P < .001, -0.74 +/- 0.73 [-1.12, 
      -0.37], -0.91 +/- 0.96 [-1.41, -0.42], and - 0.68 +/- 0.71 [-1.05, -0.30], 
      respectively) and the BCTQ FUNCT (P < .001, -0.68 +/- 0.89 [-1.14, -0.22], 
      -0.74 +/- 0.84 [-1.17, -0.30], and - 0.80 +/- 0.80 [-1.22, -0.37], respectively). For 
      the BCTQ SYMPT, only the PH-Dex showed an improvement score above MCID at 0.8 
      level [-0.91 +/- 0.96]. The improvement of BCTQ FUNCT score of all groups was above 
      Minimal Clincally Important Difference (MCID) at 0.5 level (-0.68 +/- 0.89, 
      -0.74 +/- 0.84 and - 0.80 +/- 0.80, respectively).The DSL was decreased in all groups 
      but the changes were not statistically significant (P = .70, -0.11 +/- 0.34 [-0.28, 
      0.06], -0.09 +/- 0.32 [-0.26, 0.07], and - 0.14 +/- 0.29 [-0.29, 0.02], 
      respectively). The DML showed decrease only in PH-DEX and the US group but it was 
      not statistically significant (P = .68, 0.05 +/- 0.44 [-0.17, 0.27], 
      -0.09 +/- 0.51[-0.34, 0.17], and - 0.27 +/- 0.49 [-0.53, 0.01], respectively). All 
      measured outcomes were not statistically different in between-group-comparison of 
      BCTQ SYMPT, BCTQ FUNCT, DSL, and DML (P = .58, P = .79, P = .20 and P = .39, 
      respectively). However, there was a clinically significant difference of the 
      improvement of BCTQ SYMPT in between-group comparison; only the PH-DEX was above 
      the MCID level, while the PH-P and US were not. CONCLUSIONS: Neither nondrug US 
      nor phonophoresis treatments (PH-P and PH-Dex) were effective to improve the DSL 
      and DML in mild to moderate CTS. All three groups showed significant improvements 
      in clinical symptoms (BCTQ SYMPT) and functional status (BCTQ FUNCT). At 1 MHz 
      frequency and 1.0 w/cm(2) intensity of ultrasound wave, there is no statistically 
      significant difference between phonophoresis and the nondrug US. LEVEL OF 
      EVIDENCE: I.
CI  - (c) 2019 American Academy of Physical Medicine and Rehabilitation.
FAU - Boonhong, Jariya
AU  - Boonhong J
AUID- ORCID: 0000-0002-8534-0690
AD  - Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn 
      University, Bangkok, Thailand.
FAU - Thienkul, Worakan
AU  - Thienkul W
AD  - Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn 
      University, Bangkok, Thailand.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20190606
PL  - United States
TA  - PM R
JT  - PM & R : the journal of injury, function, and rehabilitation
JID - 101491319
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Glucocorticoids)
RN  - 13T4O6VMAM (Piroxicam)
RN  - 2BP70L44PR (dexamethasone 21-phosphate)
RN  - 7S5I7G3JQL (Dexamethasone)
SB  - IM
MH  - Adult
MH  - Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage
MH  - Carpal Tunnel Syndrome/diagnosis/*drug therapy
MH  - Dexamethasone/administration & dosage/*analogs & derivatives
MH  - Double-Blind Method
MH  - Electrodiagnosis
MH  - Female
MH  - Glucocorticoids/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Phonophoresis
MH  - Piroxicam/*administration & dosage
MH  - Treatment Outcome
EDAT- 2019/04/23 06:00
MHDA- 2021/03/03 06:00
CRDT- 2019/04/23 06:00
PHST- 2019/02/08 00:00 [received]
PHST- 2019/04/13 00:00 [accepted]
PHST- 2019/04/23 06:00 [pubmed]
PHST- 2021/03/03 06:00 [medline]
PHST- 2019/04/23 06:00 [entrez]
AID - 10.1002/pmrj.12171 [doi]
PST - ppublish
SO  - PM R. 2020 Jan;12(1):8-15. doi: 10.1002/pmrj.12171. Epub 2019 Jun 6.