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Abstract
Carpal tunnel syndrome is the most common nerve entrapment syndromes, resulting from compression of the median nerve between the flexor retinaculum superiorly and the flexor tendons and carpal bones inferiorly. So any pathological process that reduces capacity or increases the volume of the contents tends to increase interstitial pressure within the carpal canal(average pressure 2.5 mm Hg).This results in mechanical distortion of the myelin sheath or ischemia of the median nerve.
CTS is a condition of middle aged people, more common in women than in men. The most cases are idiopathic. CTS occurred at a rate of 3.5 cases per 1000 person per year
Diagnosis of CTS is based on a combination of clinical signs, symptoms and abnormal electrophysiological studies.
Provocative tests (Tinel test, Phalen test and reverse Phalen test) are commonly used to diagnose CTS during the physical examination.
Electrophysiological studies are objective and quantitative, and have been recognized to be highly sensitive and specific for the assessment of nerve function in CTS patients. CTS. electrophysiological classifications act as a guide for surgical and non-surgical treatments of CTS.
Iontophoresis (synonyms: cataphoresis, electrophoresis and ion transfer) is a topical application of a continuous direct electric current. In physical medicine, Iontophoresis is used to deliver medication directly to soft tissues, limiting systemic absorption.
The aim of this study was to evaluate of the effect of Dexamethasone iontophoresis in the treatment of idiopathic carpal tunnel syndrome (CTS)
This study included twenty patients were diagnosed as idiopathic CTS, 25% patients had bilateral CTS with total number 25 hands. Two patients were males and 18 were females. 50% patients were house wife, 30% patients were clerks, 10% patients were carpenters and 10% patients were nurses.
Duration of disease ranged from 5 to 48 months with (mean ± SD)(18.7± 10.2). there were 52% hands considered as mild CTS, 48% hands as moderate CTS
Tinel test, Phalen test and reverse Phalen were positive in all hands(100%).two Point Discriminating Test was positive in 88% hands, hypothesia was found in 72% hands, thenar weakness was found in 40% hands and thenar muscle atrophy was found in 20% hands.
Before treatment (mean ± SD) of SSS,FSS and VAS were (2.9± 0. 8), (2.7± 0.9) and (6.8± 1.3)
Also before treatment (mean ± SD) sensory distal latencies and motor distal latencies were (4.9± 1.8) and (5.1± 1.6)
Patients were treated by using solution of 0.4% DXMN-P iontophoresis. This treatment was applied every other day for 2 weeks and reassessment of the patients was done just after the end of the treatment.
The provocative tests after treatment showed that Tinel test and Phalen test became negative in (60%) hands.reverse Phalen test became negative in (64%) hands. two point discriminating test became negative in (60%) hands and hypothesia became negative in (80%) hands.There was a statistically highly significant difference before and after treatment (p<0.0001).
As regard thenar muscle atrophy and thenar weaknes, there was no statistically significant difference before and after treatment (p>0.05).
Comparing clinical assessment which were SSS,FSS and VAS before and after treatment, there were a statistically highly significant decreased in the mean value after treatment (improvement) (p<0.01).
Comparing sensory and motor distal latencies before and after treatment, there were a statistically highly significant decreased in the mean value after treatment (improvement) (p<0.01).
Our results reported that patients with duration of illness less than one year after treatment showed statistically highly significant decreased in the mean value of SSS, FSS, VAS,DSL and DML) (p<0.01).
Patients with duration of illness equal or more than one year after treatment showed only statistically significant decreased in the mean value of SSS, FSS, VAS,DSL and DML) (p<0.05).
Two sever cases of idiopathic CTS were received dexamethasone iontophoresis but there was no any improvement in their parameter before and after treatment