LIMITED RECOMMENDATION There is limited standardization of the studies assessing the effectiveness of therapeutic ultrasound on carpal tunnel symptoms; this recommendation has been downgraded for inconsistency and heterogeneity of both treatments and outcomes. Studies were inconsistent with the use of constant versus pulsed-wave treatments as well as dosages and supplementing treatment with an orthosis. Only one study provided long term follow up (Jothi, 2019) and showed no significant difference between therapeutic ultrasound and sham ultrasound therapy. Two additional papers also showed no significant difference between treatment and control groups, although the follow up was only one to two months (Catalbas 2018 and Yildiz 2011). Only one paper favored the use of ultrasound for treatment of CTS (Dincer, 2009) while Ebenbichler et al. Showed more mixed results in 1998. Many studies evaluated therapeutic ultrasound against various other treatments, including, exercise, phonophoresis, pulsed radiofrequency, heat and laser therapy, however, ultrasound was not clearly superior. There was limited standardization of the use of therapeutic ultrasound on carpal tunnel symptoms, such as the use of constant versus pulsed-wave treatments as well as dosages.
Benefits/Harms of Implementation
Therapeutic ultrasound does not show any significant difference from placebo. Although it does not have any direct biological adverse reactions, ultrasound adds to the time and cost of treatment without established benefit to patients. There are no harms expected from this recommendation based on the evidence.
Cost Effectiveness/Resource Utilization
Given the lack of effectiveness of therapeutic ultrasound, it is not cost effective to use it as a therapy for CTS.
Acceptability
Due to lack of supporting evidence, this guidance is anticipated to be accepted by surgeons, patients, and therapists.
Feasibility
Readily available and feasible to not use this modality.
Future Research
More long-term follow up studies are required to confirm the lack of effectiveness of therapeutic ultrasound in the treatment of CTS.
- Catalbas, N., Akkaya, N., Atalay, N. S., Sahin, F.. (2018). Ultrasonographic imaging of the effects of continuous, pulsed or sham ultrasound treatments on carpal tunnel syndrome: A randomized controlled study. Journal of Back & Musculoskeletal Rehabilitation, 31(5), 981-989.
- Dincer, U., Cakar, E., Kiralp, M. Z., Kilac, H., Dursun, H.. (2009). The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies. Photomedicine and Laser Surgery, 27(1), 119-25.
- Jothi, K. P., Bland, J. D. P.. (2019). Ultrasound therapy adds no benefit to splinting in carpal tunnel syndrome. Muscle & Nerve, 60(5), 538-543.
- Yildiz, N., Atalay, N. S., Gungen, G. O., Sanal, E., Akkaya, N., Topuz, O.. (2011). Comparison of ultrasound and ketoprofen phonophoresis in the treatment of carpal tunnel syndrome. Journal of Back & Musculoskeletal Rehabilitation, 24(1), 39-47.