THERAPEUTIC ULTRASOUND AS A TREATMENT APPROACH FOR CARPAL TUNNEL SYNDROME
Abstract
Introduction: Carpal tunnel syndrome (CTS) is a common compression neuropathy causing pain, paresthesia and impaired hand function. Conservative management includes activity modification, splinting, pharmacotherapy and physical modalities; surgical decompression is indicated for refractory or severe cases. Therapeutic ultrasound (US) is a widely used conservative modality that may exert thermal and non - thermal effects potentially reducing inflammation, promoting tissue repair and improving nerve conduction in CTS.
Aim: To review current clinical evidence on the use of therapeutic ultrasound for the management of mild to moderate carpal tunnel syndrome, with emphasis on clinical outcomes, electrophysiological changes, treatment parameters and study quality.
Review Methods: A focused literature search of PubMed and Google Scholar was performed using combinations of the following keywords: “therapeutic ultrasound”, “ultrasonography therapy”, “phonophoresis”, “underwater ultrasound”, “carpal tunnel syndrome”, “conservative treatment”, and “randomized trial”. Randomized controlled trials, sham-controlled studies, and comparative clinical studies were prioritized.
Conclusion: Therapeutic ultrasound demonstrates potential as a conservative treatment for mild - moderate CTS: several randomized and controlled trials report improvements in pain, symptom severity and certain electrophysiological measures, while other studies show comparable clinical benefit in sham or splint-only groups. Heterogeneity in US dose, mode (continuous vs pulsed), frequency, treatment schedule, concomitant therapies (notably splinting) and short follow - up periods limits firm conclusions. Standardized treatment protocols and larger, well - powered randomized trials with longer follow-up are needed to define optimal parameters and to clarify whether therapeutic ultrasound confers clinically meaningful benefits beyond placebo or standard conservative care.
References
Padua, L., Coraci, D., & Erra, C. (2016). Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol, 15(12), 1273–1284. https://doi.org/10.1016/S1474-4422(16)30231-9
Osiak, K., Elnazir, P., Walocha, J. A., & Pasternak, A. (2022). Carpal tunnel syndrome: state-of-the-art review. Folia Morphologica, 81(4), 851–862. https://doi.org/10.5603/FM.a2021.0121
Genova, A., Dix, O., Saefan, A., Thakur, M., & Hassan, A. (2020). Carpal tunnel syndrome: A review of literature. Cureus, 12(3). https://doi.org/10.7759/cureus.7333
Aroori, S., & Spence, R. A. J. (2008). Carpal tunnel syndrome. The Ulster Medical Journal, 77(1), 6–17.
Aboonq, M. S. (2015). Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh), 20(1), 4–9.
Joshi, A., Patel, K., & Mohamed, A. (2022). Carpal tunnel syndrome: Pathophysiology and comprehensive guidelines for clinical evaluation and treatment. Cureus, 14(7). https://doi.org/10.7759/cureus.27053
Li, Z.-M., & Jordan, D. B. (2023). Carpal tunnel mechanics and its relevance to carpal tunnel syndrome. Human Movement Science, 87(103044), 103044. https://doi.org/10.1016/j.humov.2022.103044
Newington, L., Harris, E. C., & Walker-Bone, K. (2015). Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol, 29(3), 440–453. https://doi.org/10.1016/j.berh.2015.04.026
Mansfield, M., Thacker, M., & Sandford, F. (2018). Psychosocial risk factors and the association with carpal tunnel syndrome: A systematic review. Hand (N Y), 13(5), 501–508. https://doi.org/10.1177/1558944717736398
Piazzini, D. B., Aprile, I., & Ferrara, P. E. (2007). A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil, 21(4), 299–314. https://doi.org/10.1177/0269215507077294
Li, Y., Luo, W., Wu, G., Cui, S., Zhang, Z., & Gu, X. (2020). Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord, 21(1). https://doi.org/10.1186/s12891-020-03306-1
De Pablo, P., & Katz, J. N. (2003). Pharmacotherapy of carpal tunnel syndrome. Expert Opin Pharmacother, 4(6), 903–909. https://doi.org/10.1517/14656566.4.6.903
Leblanc, K. E., & Cestia, W. (2011). Carpal tunnel syndrome. Am Fam Physician, 83(8), 952–958.
Gerritsen, A., De Vet, H., Scholten, R., Bertelsmann, F. W., De Krom, M., & Bouter, L. M. (2002). Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA, 288(10), 1245–1251. https://doi.org/10.1001/jama.288.10.1245
Wipperman, J., & Goerl, K. (2016). Carpal tunnel syndrome: diagnosis and management. Am Fam Physician, 94(12), 993–999.
Coppieters, M. W., & Alshami, A. M. (2007). Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome. J Orthop Res, 25(7), 972–980. https://doi.org/10.1002/jor.20310
Sheereen, F. J., Sarkar, B., & Sahay, P. (2022). Comparison of two manual therapy programs, including tendon gliding exercises as a common adjunct, while managing the participants with chronic carpal tunnel syndrome. Pain Res Manag, 2022. https://doi.org/10.1155/2022/1975803
Brosseau, L., Yonge, K. A., & Robinson, V. (2003). Thermotherapy for treatment of osteoarthritis. Cochrane Database Syst Rev, 4. https://doi.org/10.1002/14651858.CD004522
Kuna, P. J., Chojniak, A. K., & Gajda-Bathelt, M. (2025). The effectiveness of acupuncture in treating carpal tunnel syndrome: A literature review. Qual Sport, 44. https://doi.org/10.12775/qs.2025.44.62856
Trumble, T. E., Diao, E., Abrams, R. A., & Gilbert-Anderson, M. M. (2002). Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial. J Bone Joint Surg Am, 84(7), 1107–1115. https://doi.org/10.2106/00004623-200207000-00003
Scholten, R., Mink Van Der Molen, A., Uitdehaag, B., Bouter, L. M., & De Vet, H. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev, 2014(4). https://doi.org/10.1002/14651858.CD003905.pub3
Armagan, O., Bakilan, F., Ozgen, M., Mehmetoglu, O., & Oner, S. (2014). Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial. Clinics (Sao Paulo), 69(8), 524–528. https://doi.org/10.6061/clinics/2014(08)04
Bagcaci, S., Yilmaz, R., & Sahin, N. (2023). Efficiency of therapeutic underwater ultrasound therapy in mild-to-moderate carpal tunnel syndrome: A randomized sham-controlled study. Turkish Journal of Physical Medicine and Rehabilitation, 69(3), 366–376. https://doi.org/10.5606/tftrd.2023.12467
Bakhtiary, A. H., & Rashidy-Pour, A. (2004). Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother, 50(3), 147–151. https://doi.org/10.1016/s0004-9514(14)60152-5
Baysal, O., Altay, Z., Ozcan, C., Ertem, K., Yologlu, S., & Kayhan, A. (2006). Comparison of three conservative treatment protocols in carpal tunnel syndrome: CARPAL TUNNEL SYNDROME. Int J Clin Pract, 60(7), 820–828. https://doi.org/10.1111/j.1742-1241.2006.00867.x
Bilgici, A., Ulusoy, H., Kuru, O., & Canturk, F. (2010). The comparison of ultrasound treatment and local steroid injection plus splinting in the carpal tunnel syndrome: a randomized controlled trial. Bratisl Lek Listy, 111(12), 659–665.
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), 119–125. https://doi.org/10.1089/pho.2008.2211
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. J Back Musculoskelet Rehabil, 24(1), 39–47. https://doi.org/10.3233/BMR-2011-0273
Ebenbichler, G. R., Resch, K. L., & Nicolakis, P. (1998). Ultrasound treatment for treating the carpal tunnel syndrome: randomised “sham” controlled trial. BMJ, 316(7133), 731–735. https://doi.org/10.1136/bmj.316.7133.731
Saeed, F., Hanif, S., & Aasim, M. (2012). The effects of laser and ultrasound therapy on carpal tunnel syndrome. Pakistan J Med Health Sci, 6(1), 238–241.
Ansar, N., Adeel, M., Liaqat, S., Maqsood, I., & Ghafoor, I. (2017). The comparison of therapeutic ultrasound and local steroid injection in treatment of mild to moderate carpal tunnel syndrome: A randomized controlled trial. Ann King Edward Med Univ, 23, 335–342.
Oztas, O., Turan, B., Bora, I., & Karakaya, M. K. (1998). Ultrasound therapy effect in carpal tunnel syndrome. Archives of Physical Medicine and Rehabilitation, 79(12), 1540–1544. https://doi.org/10.1016/s0003-9993(98)90416-6
Chang, Y.-W., Hsieh, S.-F., Horng, Y.-S., Chen, H.-L., Lee, K.-C., & Horng, Y.-S. (2014). Comparative effectiveness of ultrasound and paraffin therapy in patients with carpal tunnel syndrome: a randomized trial. BMC Musculoskeletal Disorders, 15(1), 399. https://doi.org/10.1186/1471-2474-15-399
Nazarian, M., Rahimi, M. S., Ghanbari, A., & Ghoreishi, S. A. (2024). Comparison of effects of ultrasound therapy and nerve-gliding techniques on patients with carpal tunnel syndrome: A randomized clinical trial. Anesthesiology and Pain Medicine, 14(3), e147159. https://doi.org/10.5812/aapm-147159
Page, M. J., O’Connor, D., Pitt, V., & Massy-Westropp, N. (2013). Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 3, CD009601. https://doi.org/10.1002/14651858.CD009601.pub2
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