Filiz DOĞAN-AKÇAM, Sibel BAŞARAN, Rengin GÜZEL, Füsun Güler UYSAL

Karpal Tünel Sendromunda Steroid Fonoforezinin Klinik Bulgular ve Sinir İletim Hızlarına Olan Etkisi

Amaç: Bu çalışma karpal tünel sendromunda (KTS) steroid fonoforezinin elektronörofizyolojik ve klinik parametreler üzerine olan etkisini araştırmak ve bu etkileri ultrason (US) ve sham (taklit) US uygulamaları ile karşılaştırmak amacı ile planlandı. Gereç-Yöntem: Çalışmaya idiyopatik KTS tanısı konmuş 39 hasta (69 el) alındı. Hastalar fonoforez (n=13 hasta, 21 el), US (n=13 hasta, 24 el) ve sham US (n=13 hasta, 24 el) gruplarına randomize edildi. Fonoforez grubuna 1,0 W/cm2 dozda ve iletici ajan olarak %0,1 dexametazon pomad kullanılarak steroid fonoforezi tedavisi, US grubuna 1,0 W/cm2 dozda ultrason tedavisi, sham US grubuna ise 0,0 W/cm2 dozda taklit ultrason tedavisi uygulandı. Her üç gruba da tendon ve sinir kaydırma egzersizleri önerildi. Hastalar tedavinin başlangıcında, 2.haftasında ve 12. haftasında elektronörofizyolojik parametrelerden median sinir motor distal latansı (mMDL) ve duysal sinir iletim hızları (mSNCV), görsel analog skala (VAS) ve Boston Skalası ile değerlendirildiler. Bulgular: Steroid fonoforezi grubunda 12.haftada tüm değişkenlerde, US ve sham US gruplarında ise VAS, Boston skalası semptom şiddeti ve fonksiyonel kapasite değerlerinde anlamlı düzelme görüldü. Sham US grubunda ayrıca 12.hafta MSNCV değerlerinde de düzelme mevcuttu. Hastaların tedavi öncesi ile 12.hafta değerleri arasındaki farklar (delta) kullanılarak gruplar arası karşılaştırmalar yapıldığında elektronörofizyolojik parametrelerin delta değerlerinde steroid fonoforezi lehine anlamlı farklılık gözlenirken, diğer değişkenlerde farklılık yoktu. Sonuç: KTS tedavisinde steroid fonoforezinin elektronörofizyolojik parametreler üzerine daha olumlu etkileri olduğu ve bu etkilerin daha uzun sürdüğü görülmüştür. Klinik bulgular ve hasta kaynaklı değerlendirmelerde her üç grupta da olumlu etkiler görülmüştür. Sham US grubunda görülen düzelmeler tendon ve sinir kaydırma egzersizlerinin etkisine bağlanabilir.

Anahtar Kelimeler:

Karpal tünel sendromu, ultrason, steroid fonoforezi, Boston Skalası, EMG

The Effects of Steroid Phonophoresis on Clinical Parameters and Nerve Conduction Velocities in Carpal Tunnel Syndrome

Objective: This study was aimed to investigate the effects of steroid phonophoresis on electroneurophysiological and clinical parameters and to compare these effects with ultrasound (US) and sham US in carpal tunnel syndrome (CTS). Material-Method: 39 patients with CTS (69 hands) were included in the study. Patients were randomized to phonophoresis (n=13 patients, 21 hands), US (n=13 patients, 24 hands) and sham US (n=13 patients, 24 hands) groups. Steroid phonophoresis, using dexamethasone as conductive agent, was applied at 1.0 W/cm2 to the phonophoresis group. Ultrasound at 1.0 W/cm2 and imitative US at 0.0 W/cm2 were applied to the US and sham US groups respectively. All groups were asked to perform tendon and nerve gliding exercises. Distal motor latency (mMDL) and sensory nerve conduction velocity (mSNCV) of median nerve, visual analogue scale (VAS) and Boston Scale were assessed at the beginning, 2nd week and in the 12th week. Results: All of the variables were significantly improved in the 12th week in steroid phonophoresis group, whereas VAS, symptom severity and functional capacity of Boston scale were improved in US and sham US groups. mSNCV was also improved in sham US group. The differences between 12th week-pre treatment values (delta) were used for group comparisons. Delta values of electroneurophysiological parameters of phonophoresis group were found to be significantly different, whereas no significant differences were found between the groups for the other variables. Conclusion: Steroid phonophoresis has favorable effects on electroneurophysiological studies and these effects last longer. Favorable effects on clinical findings and patient based assessments were observed in all groups. The improvements seen in sham US group may suggest the effectiveness of tendon and nerve gliding exercises.

Keywords:

Carpal tunnel syndrome, ultrasound, steroid phonophoresis, Boston Scale, EMG,

PDF

___

Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg (Am). 2001; 26:460–6.
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999; 282:153–8.
Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L, Putz-Anderson V. The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data. Am J Public Health. 1994; 84:1846–8.
Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve. 1997; 20:1477–86.
Bengston KA, Brault JS. Hand Disorders. In: Delisa JA, editor. Physical Medicine & Rehabilitation Principles and Practice. 3th Ed. USA: Lippincott Williams& Wilkins. 2005; 843–54.
Ertekin C. Pleksus Brakiyalisten Çıkan Sinirler. In: Ertekin C, editor. Santral ve Periferik EMG Anatomi-Fizyoloji-Klinik. İzmir: Meta Basım Matbaacılık. 2006; 387–453.
de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992; 45:373–6.
Chung MS, Gong HS, Baek GH. Raynaud's phenomenon in idiopathic carpal tunnel syndrome: postoperative alteration in its prevalence. J Bone Joint Surg Br. 2000; 82:818–9.
Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007; 21:299–314.
Ebenbichler GR, Resch KL, Nicolakis P, Wiesinger GF, Uhl F, Ghanem AH. Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial. BMJ. 1998; 316:731–5.
Oztas O, Turan B, Bora I, Karakaya MK. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil. 1998;79:1540–4.
Byl NN. The use of ultrasound as an enhancer for transcutaneous drug delivery: phonophoresis. Physical Therapy. 1995;.75:89–100.
Klaiman MD, Shrader JA, Danoff JV, Hicks JE, Pesce WJ, Ferland J. Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions. Med Sci Sports Exerc. 1998;.30:1349–55.
Aygül R, Ulvi H, Karatay S, Deniz O, Varoğlu AO. Detarmination of sensitive electrophysiologic parameters at follow-up of different steroid treatments of carpal tunnel syndrome. J Clin Neurophysiol. 2005; 22:222–30.
Tuncay R, Ünlü E, Gürçay E, Çakçı A. Karpal tünel sendromlu hastalarda fonoforez ve lokal kortikosteroid enjeksiyonunun Boston Semptom
Ciddiyet ölçeği, kavrama gücü ve eletronörofizyolojik bulgular üzerine etkisi. Nobel Med. 2005; 1:11–4.
Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;.75:1585–92.
Piravej K, Boonhong J. Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome. J Med Assoc Thai. 2004; 87 (2): 100–6.
Akalin E, El O, Peker O, Şenocak O, Tamci Ş, Gulbahar S, et al. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil. 2002; 81:108–13.
Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A. Comparison of three conservative treatment protocols in carpal tunnel syndrome. Int J Clin Pract. 2006; 60:820–8. 20. Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998; 11:171–9.
Hong CZ, Liu HH, Yu J. Ultrasound thermotherapy effect on the recovery of nerve conduction in experimental compression neuropathy. Arch Phys Med Rehabil. 1988; 69:410–4.