Abstract 1

The Journal of Occupational Medicine, 36:166-168, 1994.

Inotophoresis: Treatment of Carpal Tunnel Syndrome (Prospective Non-Randomized Study of Inotophoresis Wrist Splinting and Anti-Inflammatory Medication in the Treatment of Early-Mild Carpal Tunnel Syndrome)

Craig A. Banta, M.D. Department of Neurology & Occupational Medicine Wichita Falls Clinic, Wichita Falls, Texas
ABSTRACT
Carpal tunnel syndrome (CTS) has become the industrial epidemic syndrome of the decade and its incidence is continuing to rise. Because of public awareness, CTS is being diagnosed much earlier in the course of the disease. Iontophoresis of dexamethasone sodium phosphate has been used for years in the treatment of many musculosketeal inflammatory disorders and clinicians have reported using this modality in the treatment of CTS. Inotophoresis is a method of transdermal administration of ionized drugs in which electrically charged molecules are propelled through the skin by an external electrical field. However, conditions of treatment and evaluation have not been standardized. A prospective, non-randomized study utilizing a standardized treatment of protocol incorporating wrist splinting with a nonsteroididal anti-inflammatory medications and iontophoresis of dexamethasone sodium phosphate revealed a success rate comparable to splinting plus injection of dexamethasone into the carpal tunnel space. In a 6-month follow-up of 23 cases (hands) of early-mild CTS, 4 of 23 hands (17%) were successfully treated with splints plus nonsteroidal anti-inflammatory medications alone. Of those that failed this treatment program and chose to proceed with iontophoresis of dexamethasone, 11 of 19 hands (58%) had a positive response to iontophoresis leaving a combined failure rate (failing both splints, nonsteroidal anti-inflammatory medications and iontophoresis) of 35%. [Patients received 40-45mA-min. treatments for three treatments.] Iontophoresis may become an alternative to steroid injection to the carpal tunnel region if further studies substantiate these findings. It provides an excellent complication and side-effect profile compared with other methods of delivering dexamethasone. No complications occurred, (including no significant elevation of serum glucose in insulin-dependent diabetics).
RESULTS and DISCUSSION
?Iontophoresis was successful in 58% of those that failed splints and ibuprofen... The procedure is simple... and has an extremely low risk of side effects and complications if properly performed, and is inexpensive compared with many other forms of treatment for CTS.

?Iontophoresis could be repeated if CTS recurs (and) has many advantages over other treatment methods.
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