Use of Sonophoresis with Corticosteroids in Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Search Strategy
2.3. Elegibility Criteria
2.4. Studies Selection and Data Abstraction
2.5. Assessment of the Methodological Quality of the Studies
2.6. Statistical Analysis
3. Results
Study Groups Included in the Meta-Analysis
4. Discussion
Review Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Search Formulae | Databases |
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Phonophoresis AND carpal tunnel syndrome Phonophoresis AND carpal tunnel syndrome AND treatment(s) Phonophoresis AND median neuropathy Phonophoresis AND median neuropathy AND treatment(s) Sonophoresis AND carpal tunnel syndrome Sonophoresis AND carpal tunnel syndrome AND treatment(s) Sonophoresis AND median neuropathy Sonophoresis AND median neuropathy AND treatment(s) | Web of Science |
SCOPUS | |
PUBMED | |
CINAHL Complete | |
SciELO | |
“Phonophoresis” “carpal tunnel syndrome” “Phonophoresis” “carpal tunnel syndrome” “treatment(s)” “Phonophoresis” “median neuropathy” “Phonophoresis” “median neuropathy” “treatment(s)” “Sonophoresis” “carpal tunnel syndrome” “Sonophoresis” “carpal tunnel syndrome” “treatment(s)” “Sonophoresis” “median neuropathy” “Sonophoresis” “median neuropathy” “treatment(s)” | PEDro |
TOTAL |
Authors (Year)/Design | Study Groups | Measuring and Evaluation Tools | Intervention | Parameters | Results |
---|---|---|---|---|---|
Asheghan M. et al., 2020 [22] RCT | No. = 42 (31 women. 36 right-handed). Average age: LCI: 48.6 (±11.6); LLLT: 49.4 (±5.2); PCS: 52.4 (±3.8) LCI: no = 14 (11 women) LLLT: no = 14 (9 women) PCS: no = 14 (11 women) CTS: Mild to moderate | Pain (VAS) BCTQ NCS Evaluation: Before- 4th week | LCI: methylprednisolone with lidocaine LLLT PCS: hydrocortisone acetate (10%) | LLLT: 10 sessions. (10 s/session) PCS: 10 sessions (3 times/week), Frequency: 1 MHz. Intensity: 1 W/cm2. ERA: 5 cm2. 5 min/session | All the three methods were effective. Statistically significant differences in terms of pain for LCI (p = 0.003) and for sensory latency (p = 0.001) |
Boonhong J & Thienkul W. 2020 [32] RCT | No. = 33 (50 hands. 17 bilateral) Average age: 51.5 (±10.5) US: no = 16 hands PNSAI: no = 17 hands PCS: no = 17 hands CTS: Mild to moderate | BCTQ NCS Evaluation: Before 4th week | US: Contact gel PNSAI: Piroxicam (0.5%) PCS: Dexamethasone sodium phosphate (0.4%) | For all the treatments: 10 sessions (2–3 times/week) for four weeks. Continuous mode. Frequency: 1 MHz. Intensity: 1 W/cm2. 10 min/session | All the three methods improve clinical symptoms and functionality, but not the electrophysiologic parameters. Statistically significant differences are not observed among methods (p < 0.05) |
Soyupek F. et al., 2012 [28] RCT | No. = 47 (74 hands. 28 bilateral. 14 right-handed. 4 left-handed) Average age: Splint: 47.9 (±6.9); PNSAI: 53.7 (±10.4); PCS: 50.5 (±8.7) Splint: no = 23 hands PNSAI: no = 23 hands PCS: no = 28 hands | Pain (VAS) Ecography (cross-sectional area of median nerve) Phalen and Tinel tests BCTQ NCS Evaluation: Before- 3 months | Splint: Neutral position PNSAI: diclofenac diethylammonium PCS: betamethasone valerate (0.1%) | PNSAI/PCS: 5 sessions/week for 3 weeks. Frequency: 3 MHZ. Intensity: 1.5 W/cm2. ERA: 5 cm2. 10 min/session | PCS proved more efficient, although no correlation was established between symptoms severity, functionality and ecographic and electrophysiologic findings. (p < 0.05) |
Aygül R et al., 2005 [24] RCT | No. = 31 (56 hands. 31 women. 27 bilateral) Average age: LCI: 46 (±13.5); Ionto: 46.1 (±13.5); PCS: 44.1 (±5.7) LCI: no = 12 Ionto: no = 9 PCS: no = 10 CTS: Mild to moderate | BCTQ NCS Evaluation: Before 2 months & 3 months | LCI: dexamethasone sodium phosphate Ionto: dexamethasone sodium phosphate (0.1%) PCS: dexamethasone sodium phosphate (0.1%) for 3 weeks | Ionto: 3 weeks (5 days/week). Galvanic current from 1 to 4 mA. 10 min/session PCS: 3 weeks (5 days/week). Frequency: 3 MHz. Intensity: 1 W/cm2. ERA: 5 cm2. 10 min/session | LCI is more effective compared to electrophysiologic parameters. Statistically significant differences are not observed between PCS and Ionto. (p < 0.05) |
Bakhtiary AH et al., 2013 [31] RCT | No. = 34 (52 hands. 18 bilateral. 16 right-handed). Average age: Ionto: 48.2(±14.5); PCS: 44.6 (±12.8) Ionto: no = 26 hands PCS: no = 26 hands CTS: Mild to moderate | Pain (VAS) Pinch and grip strength (Dynamometer) NCS Evaluation: Before-after and in week 4th | Ionto & PCS: dexamethasone sodium phosphate (0.4%) | Ionto: 2 mA/minute galvanic current. Dosage: 40 mA. 20 min PCS: 10 sessions (5 sessions/week). Pulsed emission (25%) Frequency: 1 MHz. Intensity: 1 W/cm2. 5 min/session | PCS is more efficient than Ionto (p < 0.05) |
Soyupek F et al., 2012 [29] (II)EC | No. = 51 (84 hands. 33 bilateral) Average age: LCI: 51.34 (±10.18); PNSAI: 48.3 (±8.66); PCS: 49.24 (±12.27); Splint:47.52 (±8.36) Splint: 19 hands LCI: no = 23 hands PNSAI: no = 20 hands PCS: no = 22 hands | Pain (VAS) Grip strength (Dynamometer) Manual dexterity (The grooved pegboard) Semmes-Weinstein test Duruoz Hand Index Phalen and Tinel tests NCS Evaluation: Before- 3 months | Splint: Neutral position LCI: betamethasone dipropionate (0.5 mg) PNSAI: diclofenac diethylammonium (0.1%) PCS: betamethasone valerate (0.1%) | PNSAI/PCS: 3 weeks (5 sessions/week). Frequency: 3 MHz. Intensity: 1.5 W/cm2. ERA: 5 cm2. 10 min/session | For PCS improved NCS parameters are recorded, but not for pain and other subjective parameters (p < 0.05) |
Gurkay E et al., 2012 [27] RCT | No. = 54 (45 right-handed. 7 left-handed) Average age: Splint: 43 (±6.9); Ionto: 44.1 (±9.5); PCS: 44 (±8.7) Splint: no = 18 hands Ionto: no = 16 hands PCS: no = 18 hands | BCTQ Grip strength (Dynamometer) Manual dexterity and function (Nine-holepeg test) Evaluation: Before- 3 months | Splint (all the groups): Neutral position Ionto: Betamethasone (0.1%) PCS: Betamethasone (0.1%) | Ionto: 3 weeks. (3 sessions/week). 4 mA galvanic current. 10 min/session PCS: 3 weeks. (3 sessions/week). Frequency: Continuous mode. 1 MHz. Intensity: 1 W/cm2. 10 min/session | All three methods were effective. Statistically significant difference in PCS BCTQ compared to splint. Variations are not observed concerning grip strength, manual dexterity, and function (p > 0.05) |
Rüksen S et al., 2011 [23] RCT | No. = 32 (40 hands. 29 women. 9 bilateral) Average age: LCI: 41.3 (±11.2); PCS: 45.7 (±10.3) LCI: no = 20 hands (19 women) PCS: no = 20 hands (18 women) CTS: Mild to moderate | Pain (VAS) BCTQ Pinch and grip strength (Dynamometer) Paresthesia (Likert Scale) Manual dexterity (Test Grooved Pegboard) Evaluation: Before-after and in 3 months | LCI: (6.43 mg of betamethasone dipropionate) + splint + exercises PCS: (2.63 mg of betamethasone valerate) + splint + exercises | PCS: 2 weeks (5 sessions/week). Intensity: 1 W/cm2. 10 min/session | After treatment completion both methods recorded a statistically significant improvement. No statistically significant differences were observed in relation to the degree of efficacy of both treatments. (p < 0.05) |
Tuncay R et al., 2005 [25] RCT | No. = 36 women Average age: LCI: 39.16 (±13.03) PCS: 44.05 (±8.73) LCI: no = 18 PCS: no = 18 | BCTQ Pinch and grip strength (Dynamometer) Evaluation: Before- 3 months | LCI: (Betamethasone 1 mg) + splint in a neutral position at night PCS: (Betamethasone) + splint at night in a neutral position | PCS: 3 weeks. (3 sessions/week). Continuous mode. Frequency: 1 MHz. Intensity: 1 W/cm2. 10 min/session | Both methods were effective (p < 0.001). LCI improves nerve conduction velocity (p < 0.05) |
Bakhtiary AH et al., 2014 [26] RCT | No. = 35 (51 hands) Ionto: no = 19 (25 hands) PCS: no = 16 (26 hands) CTS: Mild to moderate | Pain (VAS) Pinch and grip strength (Dynamometer) Paresthesia NCS Evaluation: Before-after and in week 4th | Ionto: dexamethasone sodium phosphate (0.4%) PCS: dexamethasone (0.4%) | Ionto: 2 weeks (1 session/week). 0.4 mA/cm2 continuous current. 10 min/session PCS: 2 weeks (1 session/week). Pulsed mode. Frequency: 1 MHz. Intensity: 1 W/cm2. 5 min/session | More efficacy of PCS. Improved grip strength (p = 0.006), reduced pain (p = 0.001) and improved NCS parameters (sensory: p = 0.001, motor: p = 0.008). |
Dogan-Akcam F et al., 2012 [30] RCT | No. = 39 (69 hands. 30 bilateral) Average age: US simulation: 49.8 (±5.3); US: 46.2 (±12.1); PCS: 46.1 (±7.7) US simulation: no = 13 (24 hands) US: no = 13 (21 hands) PCS: no = 13 (21 hands) | Pain (VAS) BCTQ NCS Evaluation: Before- 2 weeks and 12 weeks | US: simulation (harmless contact gel) + exercises US: (harmless contact gel) + exercises PCS: (dexamethasone 0.1%) + exercises | For all the groups: 2 weeks (5 sessions/week). Intensity: 0.1 W/cm2 (except for US simulation: 0.0 W/cm2). 5 min/session | All the methods are effective in relation to clinical parameters and evaluations. PCS is more efficient and long-lasting compared to NCS parameters (p < 0.05) |
Author (Year) | C1 | C2 | C3 | C4 | C5 | C6 | C7 | C8 | C9 | C10 | C11 | TOTAL |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Asheghan M. et al., 2020 [22] | - | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 9/10 |
Boonhong J & Thienkul W., 2020 [32] | - | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 9/10 |
Soyupek F. et al., 2012 [28] | - | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 7/10 |
Aygül R et al., 2005 [24] | - | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
Bakhtiary AH et al., 2013 [31] | - | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 9/10 |
Soyupek F et al., 2012 (II) [29] | - | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 6/10 |
Gurkay E et al., 2012 [27] | - | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 6/10 |
Rüksen S et al., 2011 [23] | - | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
Tuncay R et al., 2005 [25] | - | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 6/10 |
Bakhtiary AH et al., 2014 [26] | - | 1 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 6/10 |
Dogan-Akcam F et al., 2012 [30] | - | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 8/10 |
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Martin-Vega, F.J.; Vinolo-Gil, M.J.; Perez-Cabezas, V.; Rodríguez-Huguet, M.; Garcia-Munoz, C.; Gonzalez Medina, G. Use of Sonophoresis with Corticosteroids in Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis. J. Pers. Med. 2022, 12, 1160. https://doi.org/10.3390/jpm12071160
Martin-Vega FJ, Vinolo-Gil MJ, Perez-Cabezas V, Rodríguez-Huguet M, Garcia-Munoz C, Gonzalez Medina G. Use of Sonophoresis with Corticosteroids in Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis. Journal of Personalized Medicine. 2022; 12(7):1160. https://doi.org/10.3390/jpm12071160
Chicago/Turabian StyleMartin-Vega, Francisco Javier, Maria Jesus Vinolo-Gil, Veronica Perez-Cabezas, Manuel Rodríguez-Huguet, Cristina Garcia-Munoz, and Gloria Gonzalez Medina. 2022. "Use of Sonophoresis with Corticosteroids in Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis" Journal of Personalized Medicine 12, no. 7: 1160. https://doi.org/10.3390/jpm12071160