Effectiveness of chitosan phonophoresis on ulnar nerve conduction velocity, pain relief, and functional outcomes for mild to moderate cubital tunnel syndrome: A double-blind randomized controlled trial

Mohamed H ElGendy; Sarah A Fetoh; Shaimaa E Salem; Baher A Daihom; Ebtesam M Fahmy; Mohamed M ElMeligie

doi:10.1016/j.jht.2024.02.006

Effectiveness of chitosan phonophoresis on ulnar nerve conduction velocity, pain relief, and functional outcomes for mild to moderate cubital tunnel syndrome: A double-blind randomized controlled trial

J Hand Ther. 2024 Mar 6:S0894-1130(24)00005-X. doi: 10.1016/j.jht.2024.02.006. Online ahead of print.

Authors

Mohamed H ElGendy¹, Sarah A Fetoh², Shaimaa E Salem³, Baher A Daihom⁴, Ebtesam M Fahmy⁵, Mohamed M ElMeligie⁶

Affiliations

¹ Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
² Faculty of Physical Therapy, October 6 University, Giza, Egypt.
³ Faculty of Physical Therapy, Cairo University, Giza, Egypt.
⁴ Faculty of Pharmacy, Cairo University, Giza, Egypt.
⁵ Faculty of Medicine, Cairo University, Giza, Egypt.
⁶ Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt. Electronic address: mohamed.elmeligie@acu.edu.eg.

PMID: 38453574
DOI: 10.1016/j.jht.2024.02.006

Abstract

Background: Cubital tunnel syndrome (CBTS) impairs hand function, with limited conservative options often leading to surgery. Chitosan neuroregenerative effects delivered via phonophoresis provide a rationale for testing this emerging treatment approach.

Purpose: The primary goal of this research was to assess the impact of chitosan phonophoresis on the conductivity of the ulnar nerve, as well as its effects on pain levels and functional outcomes in individuals diagnosed with mild to moderate CBTS.

Study design: Double-blind randomized controlled trial.

Methods: This was a prospective, double-blinded, randomized controlled study. The participants consisted of 54 individuals aged between 20-35 years who were randomly assigned using block randomization. The control group (n = 27) received standard hand therapy alone, while the experimental group (n = 27) received both standard hand therapy and chitosan phonophoresis. Both groups underwent three treatment sessions per week, each lasting for 60-72 minutes, over a period of five weeks. Pre- and post-intervention evaluations included assessments of ulnar nerve conduction velocity (NCV), pain assessment using the numerical pain rating scale (NPRS), as well as hand function evaluated using the Quick Disabilities of Arm Shoulder Hand (QuickDASH) questionnaire.

Results: After the intervention, the experimental group significantly improved in all outcome measures compared to the control group. Accordingly, ulnar NCV (MD = 2.233 m/sec; CI = 1.63:2.83; p < 0.001; η²_p = 0.516), NPRS (MD = -1.11; CI = -1.71: -0.50; p < 0.001; η²_p = 0.208) and QuickDASH (MD = -2.72; CI = -4.54:0.87; p < 0.007; η²_p = 0.133).

Conclusions: The study findings suggest that chitosan phonophoresis may have the potential as a supplementary treatment to hand therapy for individuals with mild to moderate CBTS. This approach demonstrated significant improvements in nerve conduction, pain reduction, and enhancement of hand function.

Keywords: Chitosan; Cubital tunnel syndrome; Nerve entrapment syndrome; Phonophoresis; Physical therapy; Randomized controlled trial.