Clinical Abstracts

With Comments from Adriane Fugh-Berman, MD

Yoga and Carpal Tunnel Syndrome

May 1999; Volume 1: 48

Source: Garfinkel MS, et al. Yoga-based intervention for carpal tunnel syndrome. JAMA 1998;280:1601-1603.

Design and Setting: Randomized, single-blind, controlled trial in a geriatric center and an industrial site.

Subjects: Forty-two individuals, age range 24-77, with carpal tunnel syndrome.

Treatment: Modified Iyengar yoga classes (11 yoga postures designed to strengthen, stretch, and balance joints in the upper body along with relaxation) for eight weeks. Patients in the control group were offered a wrist splint.

Dose/Route/Duration: Twice-weekly, 1- to 1½-hour Iyengar yoga classes for eight weeks.

Outcome Measures: Changes in grip strength, pain intensity, sleep disturbance, Phalen sign, Tinel sign, and median nerve motor and sensory conduction time.

Results: Compared to the control group, subjects in the yoga group experienced significant improvements in grip strength, pain reduction, and Phalen sign; no significant differences were found in sleep disturbance, Tinel sign, or median nerve motor and sensory conduction time.

Funding: Grant 91-07-14 from the Commonwealth of Pennsylvania.

Comments: This is a reasonable study showing the benefit of modified yoga postures in reducing symptoms associated with carpal tunnel syndrome.

Steroids Common in Chinese Herbal Creams

May 1999; Volume 1: 48

Source: Keane FM, et al. Analysis of Chinese herbal creams prescribed for dermatological conditions. BMJ 1999;318:563-564.

Materials and Methods: Eleven Chinese herbal creams used for chronic skin disorders (primarily eczema) in adults and children were obtained from patients (or parents) attending an outpatient dermatology clinic in London. Five suppliers of creams were identified but the original source of the creams is unknown. Creams were analyzed for the presence of steroids by high resolution gas chromatography and mass spectrometry.

Results: Eight of 11 creams tested contained dexamethasone in a mean concentration of 456 mg/g (range 64-1500 mg/g). The concentration of steroid in creams used for children was 5.2 times higher than the creams used for adults. Most containers were glass jars that were unlabeled or labeled only with directions and the name of the cream or supplier. The two preparations that were labeled with a list of herbs did not contain dexamethasone. None of the creams was labeled as containing steroids and patients were unaware that these preparations contained steroids.

Funding: None.

Comments: Although this study was performed in the U.K., it would not be surprising if the same situation exists in the U.S. There have been a number of cases in the U.S. in which imported patent Chinese herbal medicines have been found to contain conventional pharmaceutical drugs as well as herbs. This is not malicious adulteration; combined use of drugs and herbs is well accepted in China, Taiwan, and Hong Kong. However, drugs should be labeled (and regulated) as drugs.

The dearth of labeling of creams in this study indicates that they were probably not patent medicines but may have been made (or packaged) locally. Whatever their origin, it is of great concern that these preparations were not appropriately labeled as steroid creams. According to the study’s authors, the mean dose found in these creams is roughly equivalent to 0.05% betamethasone valerate. Because patients were unaware that these creams contained steroids, appropriate precautions for high-potency topical steroids were not followed. Creams were applied to face and flexures (sometimes several times a day); the highest concentration of dexamethasone was found in a cream applied to the face of a four-month-old baby with eczema.