Carpal Tunnel Syndrome (CTS) is a recognisable pattern of symptoms and signs, which are
caused by compression of the median (middle) nerve as it passes through the carpal tunnel at
This condition affects individuals by causing pain, numbness, tingling sensations and
sometimes weakness in the fingers and may extend to shoulder and neck areas. The cause for
most cases is unknown (idiopathic) though some common conditions are associated with an
increased incidence, including obesity, pregnancy, hypothyroidism, arthritis, diabetes, and
Diagnosis is primarily clinical and the condition is easily recognised from the
characteristic symptoms in straightforward cases but diagnostic support is provided by
investigations such as nerve conduction studies and ultrasound imaging.
Treatment may include splinting, local steroid injection at wrist, activity
modification,physical or occupational therapy (controversial), medications, and surgery.
Treatment with local therapeutic ultrasound has been suggested to be effective but existing
trials are inconclusive.
Wrist splinting is only partially effective with a success rate of 34%, Steroid injection is
followed by frequent relapses and there remains uncertainty about the safety of serial
injections. Surgery is effective but has a small but significant incidence of permanent
complications. Any demonstrably effective and safe addition to the therapeutic options would
be a significant advance in treatment. Therapeutic ultrasound at present appears a promising
option, having a very good safety record but so far uncertain evidence of efficacy.
In our trial patients, with mild carpal tunnel syndrome, confirmed by nerve conduction
studies, will all be given wrist splints so that no patients will be left untreated. They
will be randomly allocated to either therapeutic or sham ultrasound therapy (20 sessions over
7 weeks) and followed up for 1year. The patients, operators of the ultrasound equipment and
assessors will all be blind to treatment allocation.
The effect of treatment on symptoms will be assessed using a validated questionnaire and
nerve conduction studies will be repeated at completion of the ultrasound treatment, 6 and 12
This study is designed to find out to whether therapeutic ultrasound is an effective
treatment for carpal tunnel syndrome (CTS).