Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome. Ultrasound therapy effect in carpal tunnel syndrome. Reduction of postoperative pain and swelling by ultrasound treatment: a placebo effect. A placebo controlled trial of ultrasound therapy in chronic leg ulceration. The comparison of ultrasound treatment and local steroid injection plus splinting in the carpal tunnel syndrome: a randomized controlled trial. The use of therapeutic ultrasound in venous leg ulcers: a randomized, controlled clinical trial. Pulsed ultrasound does not improve healing of venous ulcers. Anti-inflammatory effects of ultrasound therapy: evidence for a major placebo effect.
To investigate the efficacy of low intensity ultrasound thermotherapy, a conservative option of treatment of mild to moderate carpal tunnel syndrome (CTS).
                Prospective experimental, placebo- controlled, before-after treatment trial.
                King Chulalongkorn Memorial Hospital, Outpatient Clinic and Electrodiagnostic Laboratory, Department of Rehabilitation Medicine.
                Eighteen women, 30 hands who had clinical and electrophysiologic evidence of mild to moderate CTS.
                Patients of CTS were divided into two groups; A and B of 15 hands by random sampling. Group A was given placebo and continuous ultrasound therapy with the intensity of 0.5 W/cm2 applied to the palmar carpal tunnel for 10 minutes. Group B was given Diclofenac 75 mg/day in divided doses and sham ultrasound. The ultrasound was applied 5 days a week for 4 weeks.
                Each patient was clinically and electrophysiologically evaluated before and after treatment.
                There were statistically significant improvements (p < 0.05), in the clinical parameters of both groups after treatment. In the electrophysiologic study, the median SNAP amplitude was increased significantly after the treatment in ultrasound group (group A). When both groups were compared, group A had significant difference in increasing of median SNAP amplitude after treatment.
                The therapeutic efficacy of low intensity ultrasound thermotherapy was satisfied for mild to moderate CTS. However, the electrophysiological changes after ultrasound treatment need further investigation. To investigate the overall effect of repeated ultrasound treatment in carpal tunnel syndrome (CTS).
                Patient-blinded, placebo-controlled, before-after treatment trial.
                University hospital PM&R department outpatient clinic and neurology department electromyography laboratory.
                Eighteen women with diagnosis of CTS in 30 hands.
                Three groups, each with 10 cases of CTS, were randomly established. Continuous ultrasound therapy, with intensities of 1.5W/cm2 (group A), 0.8W/cm2 (group B), and 0.0W/cm2 (group C), was applied to palmar carpal tunnel area for 5 minutes, 5 days a week, for 2 weeks.
                Patients were evaluated clinically and electrophysiologically before and after the treatment.
                At the end of treatment, statistically significant improvement was obtained in clinical parameters in all groups: pain (p < .05), pain/paresthesia at night/day (p < .05), and frequency of awakening at night (p < .05). Although there was no statistically significant before-after difference in electrophysiologic studies, slightly decreased motor nerve conduction velocity and increased motor distal latency were noted in groups A and B, but not in group C.
                Ultrasound therapy in CTS was comparable to placebo ultrasound in providing symptomatic relief, and the probability of a negative effect on motor nerve conduction needs to be considered. Ultrasound (US) therapy is used to reduce pain and inflammation and to accelerate healing after soft tissue injury. However, there is little objective evidence of its effectiveness and the mechanisms which may cause these effects are unknown. In a placebo-controlled double-blind clinical trial we examined the contribution of placebo and massage effects in ultrasound therapy following bilateral surgical extraction of lower third molars. Four to 6 h after surgery the patients (25 per group) received either no therapy, US (0.1 W/cm2), 'mock' US with massage, 'mock' US without massage, or 'self-massage' with a dummy applicator. Facial swelling, trismus, serum C-reactive protein, serum cortisol, pain and anxiety were measured 24 h postoperatively. The results showed that the beneficial analgesic and anti-inflammatory effects of US therapy were placebo-mediated, with maximum effect in the placebo ('mock' US) group without circular massaging with the applicator). Self-massage by the patient produced no significant effect. This placebo action was independent of changes in serum cortisol or patient anxiety state. US therapy can significantly reduce postoperative morbidity, but by placebo-mediated mechanisms which are unrelated to the US itself. A controlled study of the effects of ultrasound on healing chronic leg ulcers was carried out in conjunction with standard treatment on 38 patients divided randomly into two groups. All patients received standard treatment (paste impregnated bandage and a self-adhesive elastic bandage plus placebo ultrasound or ultrasound (1.0 watt/cm2 at 1 MHz, for 10 min) twice weekly for 8 weeks. Percentage healed ulcer area and number of healed ulcers were compared after 2, 4, 6 and 8 weeks. There were no significant differences in the proportion of healed ulcers or ulcer area in the ultrasound group as compared with the placebo group. This study aimed to compare the efficacy of ultrasound treatment to local corticosteroid injection plus splinting in carpal tunnel syndrome (CTS). There is still limited knowledge on the efficacy of conservative treatment options for CTS.
                Fourty-nine hands of 34 patients with CTS were enrolled in this study. Patients were randomly assigned to the ultrasound treatment (group A) or local corticosteroid injection plus splinting (group B). The primary outcome measures included clinical parameters such as symptoms severity score, visual analogue scale (VAS) pain, functional status score, grip strength and two-point discrimination. The secondary outcome measures were the electrophysiological tests. The examinations were performed at baseline, and then at 4th and 8th weeks.
                At the end of the study, a statistically significant improvement was obtained in all clinical parameters in the group B: VAS pain, severity of symptoms, functional status, grip strength (p < 0.001 for each) and two-point discrimination (p < 0.016). Also the group A showed significant improvements in all clinical parameters (p < 0.001 for each), except for the grip strength. Additionally, significant improvements in the median nerve sensory conduction velocity and distal motor latency were also found in both groups at the end of the 8 week follow-up period. There was no significant difference between the groups in the primary and secondary outcome measures, except for the grip strength.
                Both ultrasound treatment and corticosteroid injection plus splinting were effective on the clinical symptoms and the electrophysiological findings of CTS. Thus, the ultrasound therapy may be an alternative treatment for CTS, particularly in patient who do not accept injection or splinting (Tab. 3, Fig. 2, Ref. 36). To estimate the usefulness of therapeutic ultrasound for healing of venous leg ulcers.
                Eighty-one patients were included in this study. Patients in groups 1 and 2 were treated surgically. Patients in groups 3 and 4 were treated conservatively. Patients in groups 1 and 3 were additionally treated with the ultrasound (1 MHz, 0.5 W/cm(2)) once daily, six times a week for seven weeks.
                Comparison of the number of complete healed wounds indicated statistically significant differences between groups 1 and 4 (P = 0.03), 2 and 4 (P = 0.03), 3 and 4 (P = 0.03) in favour of groups 1, 2 and 3. Comparison of the other parameters also demonstrated more efficient therapy effects in groups 1, 2 and 3 than in group 4. There were no statistical differences in all examined parameters between groups 1, 2 and 3 (P > 0.05).
                The ultrasound is an efficient and useful method only in conservatively treated venous leg ulcers. There are no special reasons for application of the ultrasound in surgically treated patients. A well-conducted surgical operation is much more effective for a healing process than conservative pharmacological procedures. A controlled study of the effects of pulsed ultrasound was carried out in conjunction with a standard treatment for healing chronic leg ulcers on 44 patients divided randomly into two groups. All patients received standard treatment (paste impregnated bandage and a self-adhesive elastic bandage) plus placebo-ultrasound or pulsed ultrasound (1:9, 0.5 watt/cm2 at 1 MHz, for 10 min) 3 days a week for 4 weeks, thereafter twice weekly for 4 weeks and once weekly for the following 4 weeks. Percentage healed ulcer area and comparison of percentage healed ulcers were examined after 4, 8 and 12 weeks. There were no significant differences in the proportion of healed ulcers or ulcer area in the pulsed ultrasound group as compared with the placebo group. The value of therapeutic ultrasound (US) for reducing inflammation was tested in a double-blind controlled study in 150 patients following surgical removal of impacted lower third molars. Facial swelling, trismus, pain and serum C-reactive protein (CRP) were significantly reduced in the US-treated groups and in a placebo group ('mock' US) compared with an untreated control group. The majority of the anti-inflammatory activity was attributable to the placebo effect, and the highest intensity of US (1.5 W.cm-2) was consistently less beneficial than the lower intensities (0.1 and 0.5 W.cm-2) and the mock US.
There is only poor quality evidence from very limited data to suggest that therapeutic ultrasound may be more effective than placebo for either short- or long-term symptom improvement in people with CTS. There is insufficient evidence to support the greater benefit of one type of therapeutic ultrasound regimen over another or to support the use of therapeutic ultrasound as a treatment with greater efficacy compared to other non-surgical interventions for CTS, such as splinting, exercises, and oral drugs. More methodologically rigorous studies are needed to determine the effectiveness and safety of therapeutic ultrasound for CTS.