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ORIJINAL ARAŞTIRMA

Karpal Tünel Sendromunda Ekstrakorporeal Şok Dalgası Tedavisi ve Kortikosteroid İyontoforezi Tedavisinin Etkinliğinin Karşılaştırılması: Prospektif Randomize Çalışma
Comparison of the Therapeutic Efficacy of Extracorporeal Shock Wave Therapy Versus Corticosteroid Iontophoresis in Carpal Tunnel Syndrome: A Prospective Randomized Study
Received Date : 30 Apr 2021
Accepted Date : 27 Sep 2021
Available Online : 01 Oct 2021
Doi: 10.31609/jpmrs.2021-84159 - Makale Dili: EN
J PMR Sci. 2022;25(1):63-72
ÖZET
Amaç: Karpal tünel sendromlu (KTS) hastalarda radyal ekstrakorporeal şok dalgası tedavisi [radial extracorporeal shock wave therapy (r-ESWT)] ve kortikosteroid iyontoforez [corticosteroid iontophoresis (CI)] tedavisinin etkinliğini karşılaştırmak. Gereç ve Yöntemler: Bu randomize prospektif çalışmaya, ortalama yaşları 42,2±8,7 yıl (22-59) olan 54 hastanın, KTS tanısı konulan 72 bileği dâhil edildi. Hastalar rastgele 2 gruba ayrıldı. Grup 1 (n=37) r-ESWT aldı ve Grup 2 (n=35) CI aldı. Hastalar vizüel analog skala (VAS), Boston Semptom Şiddeti Ölçeği (BSŞÖ), Boston Fonksiyonel Durum Ölçeği (BFDÖ), kavrama gücü ve elektrofizyolojik inceleme kullanılarak başlangıçta ve tedavi sonrası 0, 1 ve 3. ayda değerlendirildi. Bulgular: Başlangıç ile karşılaştırıldığında, tedaviden 0, 1 ve 3. ay sonra VAS, BSŞÖ, BFDÖ, kavrama gücü değerleri her iki grupta da önemli ölçüde iyileşti (tümü p<0,001). Ancak sinir ileti çalışması sonuçları sadece r- ESWT grubunda anlamlı olarak iyileşti (tümü p<0,001). Gruplar arası değişim seviyeleri karşılaştırıldığında, VAS’da azalma (tümü p<0,001), BSŞÖ’de iyileşme (sırasıyla p=0,029, p=0,023 ve p=0,040), BFDÖ (sırasıyla p<0,001, p=0,001 ve p<0,001), kavrama gücü (tümü p<0,001), duyusal sinir iletim hızı (sırasıyla p=0,001, p<0,001 ve p<0,001) ve distal motor latensi (p=0,001, p=0,001 ve p<0,001), tedaviden önce ve tedaviden 0, 1 ve 3 ay sonra, r-ESWT grubunda CI grubuna göre anlamlı derecede daha yüksekti. Sonuç: Bu çalışma, her iki yöntemin KTS’de ağrıyı azaltmada ve fonksiyonu iyileştirmede yararlı olduğunu, ancak r-ESWT’nin CI’dan daha etkili olduğunu ortaya koymuştur.
ABSTRACT
Objective: To compare the effectiveness of radial extracorporeal shock wave therapy (r-ESWT) and corticosteroid iontophoresis (CI) in patients with carpal tunnel syndrome (CTS). Material and Methods: This randomized prospective study included a total of 72 wrists diagnosed with CTS of 54 patients with a mean age of 42.2±8.7 years (range, 22-59 years). The patients were randomly separated into two groups. Group 1 (n=37) received r-ESWT, and Group 2 (n=35) received CI. Evaluations were made at baseline and at 0, 1 and 3 months after treatment using the visual analog scale (VAS), Boston Symptom Severity Scale (BSSS), Boston Functional Capacity Scale (BFCS), grip strength, and electrophysiological examination. Results: Compared to baseline, the VAS, BSSS, BFCS, grip strength values at the 0, 1 and 3 months after treatment improved significantly in both groups (all p<0.001). However the nerve conduction study results were significantly improved only in r-ESWT group (all p<0.001). When the change levels were compared between the groups, the decrease in VAS (all p<0.001), the improve in BSSS (p=0.029, p=0.023 and p=0.040, respectively), BFCS (p<0.001, p=0.001 and p<0.001, respectively), grip strength (all p<0.001), sensory nerve conduction velocity (p=0.001, p<0.001 and p<0.001, respectively) and distal motor latency (p=0.001, p=0.001 and p<0.001, respectively) before and at 0, 1 and 3 months after treatment were significantly higher in the r-ESWT group than the CI group. Conclusion: This study revealed that both methods were useful in alleviating pain and improving function in CTS, however r-ESWT seems to be more effective than CI.
REFERENCES
  1. Alfonso C, Jann S, Massa R, et al. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci. 2010;31:243-52. [Crossref]  [PubMed] 
  2. Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;28:153-8. [Crossref]  [PubMed] 
  3. Dec P, Zyluk A. Bilateral carpal tunnel syndrome - a review. Neurol Neurochir Pol. 2018;52:79-83. [Crossref]  [PubMed] 
  4. Carlson H, Colbert A, Frydl J, et al. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol. 2010;5:129-42. [Crossref]  [PubMed]  [PMC] 
  5. Hamamoto Filho PT, Leite FV, Ruiz T, et al. A systematic review of anti-inflammatories for mild to moderate carpal tunnel syndrome. J Clin Neuromuscul Dis. 2009;11:22-30. [Crossref]  [PubMed] 
  6. Uchiyama S, Itsubo T, Nakamura K, et al. Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci. 2010;15:1-13. [Crossref]  [PubMed] 
  7. Amirjani N, Ashworth NL, Watt MJ, et al. Corticosteroid iontophoresis to treat carpal tunnel syndrome: a double-blind randomized controlled trial. Muscle Nerve. 2009;39:627-33. [Crossref]  [PubMed] 
  8. Gökoğlu F, Fındıkoğlu G, Yorgancoğlu ZR, et al. Evaluation of iontophoresis and local corticosteroid injection in the treatment of carpal tunnel syndrome. Am J Phys Med Rehabil. 2005;84:92-6. [Crossref]  [PubMed] 
  9. Seok H, Kim SH. The effectiveness of extracorporeal shock wave therapy vs. local steroid injection for management of carpal tunnel syndrome: a randomized controlled trial. Am J Phys Med Rehabil. 2013;92:327-34. [Crossref]  [PubMed] 
  10. Cacchio A, Giordano L, Colafarina O, et al. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg Am. 2009;91:2589-97. Erratum in: J Bone Joint Surg Am. 2010;92:1241. [Crossref]  [PubMed] 
  11. Cacchio A, Rompe JD, Furia JP, et al. Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes. Am J Sports Med. 2011;39:146-53. [Crossref]  [PubMed] 
  12. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012;7:11. [Crossref]  [PubMed]  [PMC] 
  13. Mariotto S, de Prati AC, Cavalieri E, et al. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Curr Med Chem. 2009;16:2366-72. [Crossref]  [PubMed] 
  14. Padua L, LoMonaco M, Gregori B, et al. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand. 1997;96:211-7. [Crossref]  [PubMed] 
  15. Koçak Ulucaköy R, Yurdakul FG, Bodur H. Extracorporeal shock wave therapy as a conservative treatment option for carpal tunnel syndrome: a double-blind, prospective, randomized, placebo-controlled study. Turk J Phys Med Rehab. 2020;66:388-97. [Crossref]  [PubMed]  [PMC] 
  16. Ke MJ, Chen LC, Chou YC, et al. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial. Sci Rep. 2016;6:38344. [Crossref]  [PubMed]  [PMC] 
  17. Wu YH, Lun JJ, Chen WS, et al. The electrophysiological and functional effect of shock wave on peripheral nerves. Annu Int Conf IEEE Eng Med Biol Soc. 2007;2007:2369-72. [Crossref]  [PubMed] 
  18. Wu YT, Ke MJ, Chou YC, et al. Effect of radial shock wave therapy for carpal tunnel syndrome: a prospective randomized, double-blind, placebo-controlled trial. J Orthop Res. 2016;34:977-84. [Crossref]  [PubMed] 
  19. Ito K, Fukumoto Y, Shimokawa H. Extracorporeal shock wave therapy as a new and non-invasive angiogenic strategy. Tohoku J Exp Med. 2009;219:1-9. [Crossref]  [PubMed] 
  20. Takahashi N, Wada Y, Ohtori S, et al. Application of shock waves to rat skin decreases calcitonin gene-related peptide immunoreactivity in dorsal root ganglion neurons. Auton Neurosci. 2003;107:81-4. [Crossref]  [PubMed] 
  21. Dixit N, Bali V, Baboota S, et al. Iontophoresis - an approach for controlled drug delivery: a review. Curr Drug Deliv. 2007;4:1-10. [Crossref]  [PubMed] 
  22. Stefanou A, Marshall N, Holdan W, et al. A randomized study comparing corticosteroid injection to corticosteroid iontophoresis for lateral epicondylitis. J Hand Surg Am. 2012;37:104-9. [Crossref]  [PubMed]