The value of iontophoresis combined with ultrasound in patients with the carpal tunnel syndrome.

Purpose: The purpose of the study was the evaluation of usefulness of iontophoresis with hydrocortisone combined with ultrasounds in conservative treatment of the carpal tunnel syndrome (CTS).

Patients and methods: Forty patients (35 women and 5 men), aged 30-72 years, with unilateral CTS confirmed by electromyographic examination were included. The patients were divided into 3 groups based on clinical symptoms according to Whitley. Subjective complaints and objective symptoms were recorded in all patients. The character of the pain, its frequency and intensity (VAS scale) as well as paresthesies was determined. Physical examination consisted of clinical tests according to Phalen and Tinnel, sensation discriminatory test, pressure test and estimation of muscular atrophy of the thenar. All the patients underwent combined physiotherapeutic procedures: iontophoresis with hydrocortisone acetate (25 mg per procedure; galvanic current up to 5 mA, the active electrode--50 cm2, time--20 min) and ultrasounds with direct coupling (the dose of 0.5-0.8 W/cm2, 1 MHz, PIP 1:4, 48 Hz; the time 3-6 min). The number of procedures was 10--one per day.

Results: Decrease of pain and paresthesia were observed in 36 patients (out of 40) with mild and moderate stage of CTS. Objective parameters (Phalen test, Tinnel test, and sensation discriminatory test) significantly improved only in 24 patients with moderate stage of CTS. There was no improvement in 4 patients with advanced form of CTS.

Conclusions: The use of combined procedures of iontophoresis with hydrocortisone and the ultrasound diminishes subjective complaints of patients with the carpal tunnel syndrome. The procedure is most effective in the treatment of mild and moderate stages of the disease.