Diadynamic Current and Carpal Tunnel Syndrome

N/AActive Not RecruitingNCT07356648

Duzce University80 enrolled

Overview

Carpal tunnel syndrome (CTS), first described by Paget in 1854, is the most common entrapment neuropathy. Conservative treatment approaches are prioritized in patients with mild to moderate CTS. Conservative management includes education, tendon and median nerve gliding exercises, physical therapy modalities, kinesiotaping, manual therapy techniques, injection options, and oral medical treatments. First-line treatment generally consists of education, exercise, and splinting. Tendon and median nerve gliding exercises represent key components of conservative treatment. Splinting is recommended at all stages of CTS, with wrist splints designed to maintain a neutral position being the most commonly preferred option. The prevailing approach in the literature supports the use of splints primarily during nighttime. Diadynamic current (DDC) is considered to have a composite analgesic mechanism, primarily explained by the gate control theory. Additional mechanisms suggest that DDC affects both sensory and motor nerves and may increase endorphin release, contributing to pain relief. A single treatment session typically does not exceed 12 minutes. Some studies indicate that the analgesic effect of DDC may be greater than that of transcutaneous electrical nerve stimulation (TENS). Although TENS is widely used in physical therapy and rehabilitation practice, DDC may represent a realistic alternative for clinical pain management. The aim of the study is to evaluate the effect of diadynamic current therapy on clinical symptoms in patients with CTS and to investigate its impact on electrophysiological findings of the median nerve.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Interventions

Diadynamic CurrentPROCEDURE

Diadynamic current (DDC) is a routine therapeutic modality applied in the physical medicine and rehabilitation clinic to alleviate symptoms in various conditions. In individuals with carpal tunnel syndrome (CTS), DDC is routinely administered in cases where sufficient benefit is not achieved with splinting and transcutaneous electrical nerve stimulation (TENS). For this purpose, diadynamic current is applied to the palmar surface of the hand and the volar surface of the forearm using equal-sized carbon electrodes (6 × 6 cm). A sequence of different types of diadynamic currents is administered for a total duration of 10 minutes as follows: diphase fixe (DF) for 2 minutes, monophase fixe (MF) for 3 minutes, longues périodes (LP) for 3 minutes, and courtes périodes (CP) for 2 minutes. The treatment duration, parameters, and sequence of diadynamic currents are based on Bernard's current methodology and are identical to the procedure described by Ratajczak et al.

Wrist SplintPROCEDURE

In individuals with carpal tunnel syndrome, splinting is routinely prescribed as a first-line conservative treatment. A resting wrist splint extending from the distal forearm to the hand and maintaining the wrist in a neutral position is provided to both groups. The splint is worn every night before bedtime, maintained throughout the night, and removed in the morning upon waking.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Clinically and electrophysiologically diagnosed with carpal tunnel syndrome (CTS) * Provision of informed consent * Age between 18 and 65 years Exclusion Criteria: * Age below 18 years or above 65 years * Median nerve distal motor latency \> 6.0 ms on nerve conduction studies (NCS) * Thenar muscle atrophy * History of carpal tunnel syndrome surgery * History of steroid injection into the carpal tunnel * History of physical therapy for CTS within the past 6 months * Cervical radiculopathy * Tenosynovitis in the ipsilateral upper extremity * Other compressive neuropathy in the ipsilateral upper extremity * Peripheral polyneuropathy * History of trauma or fracture involving the hand, wrist, or forearm * Pregnancy * Presence of metabolic disease * Inflammatory rheumatic disease * Acute and/or chronic renal failure * Severe cognitive impairment preventing understanding and following simple instructions * Severe visual or hearing impairment preventing participation in treatment * Current use of pregabalin or gabapentin * Systemic diseases (e.g., diabetes mellitus, hypothyroidism, rheumatic diseases)

Outcomes

Primary Outcomes

Change from Baseline in Boston Carpal Tunnel Questionnaire Symptom Severity Scale Score

Boston Carpal Tunnel Questionnaire - Symptom Severity Scale (BCTQ-SSS) is a patient-reported outcome measure assessing symptom severity in individuals with carpal tunnel syndrome. Scores range from 1 to 5, with higher scores indicating worse symptom severity.