Ghasemi A, Olyaei G R, Bagheri H, Hadian M R, Jalaei S, Otadi K et al . The Effects of Radial Extra Corporeal Shock Wave and Low-power Laser Therapies on Clinical and Electrophysiological Parameters in Moderate Carpal Tunnel Syndrome: A Blinded Randomized Control Trial. Iranian Rehabilitation Journal 2023; 21 (3) :513-524
URL:
http://irj.uswr.ac.ir/article-1-1762-en.html
1- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: (1430 Views)
Objectives: Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy with squeezing of the median nerve and the patient is unable to function properly. There are different physiotherapy interventions for the management of these patients and recently, shock wave therapy and low-power laser (LPL) have been widely used, but there is no strong evidence comparing the effect of shock wave therapy and LLLT. Therefore, this trial was designed to compare the effect of extracorporeal shock wave therapy (ESWT), LPL, and routine interventions on clinical outcomes and electrophysiological parameters in patients with moderate CTS.
Methods: Fifty-four patients were randomly assigned to the control (routine interventions), ESWT, and LPL therapy groups. All participants received transcutaneous electrical nerve stimulation (TENS) therapeutic ultrasound, hot pack, mobilization, and stretching for ten sessions over two weeks. Additionally, the ESWT group received radial ESWT in four sessions, and the LPL therapy group received laser in ten sessions. The primary outcomes were pain (assessed by the visual analog scale), function (assessed using the Boston questionnaire (BQ)), hand grip, and finger pinch strength. Secondary outcomes were electrophysiological parameters (distal motor and sensory latency and nerve conduction velocity (NCV) of the median nerve.
Results: Time group interactions were significant for pain, the symptom severity subscale of BQ, finger pinch, and hand grip strength (p<0.001). Significant improvements were seen in clinical and sensory latency and motor NCV of the median nerve (p<0.05). The ESWT group experienced significant improvements with a large effect size in pain, function, and finger pinch strength compared to the control group (p<0.01). Additionally, the LPL therapy group showed significant changes in the function and finger pinch and hand grip strength compared to the control group. There were no significant differences between the LPL therapy and ESWT groups except for pain in favor of the ESWT group. No significant differences were found among the three groups in electrophysiological parameters (p>0.05).
Discussion: Although laser therapy increased the efficacy of routine interventions, it seems adding ESWT to the routine treatment may be superior for the management of moderate CTS patients.
Coresponding author: Khadijeh Otadi, E-mail: k_otadi@sina.tums.ac.ir
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• Low-power laser and shock wave therapies had positive effects on pain reduction, grip and pinch strength, and function in carpal tunnel patients.
• Low-power laser and shock wave therapies had a positive effect on sensory latency and motor nerve conduction velocity of the median nerve
• There were no significant differences between the low-level laser therapy (LLLT) therapy and extracorporeal shock wave therapy (ESWT) groups except for pain in favor of the ESWT group.
• The two interventions had the same effect on electrophysiological parameters.
Plain Language Summary
Compression on the wrist tunnel leads to pain, numbness, and tingling sensation or falling objects from the hand in severe cases. Nonsurgical methods can help improve the signs and symptoms in early diagnosis. Recently, using shock wave therapy and low-level laser therapy (LLLT) has been very attractive in these patients, but there are not many studies comparing the effects of these methods. In this study, we assessed the effect of adding LLLT or shock wave therapy to exercise, mobilization, and stretching, on pain, strength, function, and electrophysiological findings. After two weeks of physiotherapy intervention, positive effects were seen on the reduction of pain and the improvement of strength and function. Likewise, nerve impulses revealed recovery after treatment in three groups. Our results detected much improvement in patients who received shock wave therapy based on effect size. Therefore, we can suggest these interventions as perfect methods in the management of moderate patients with carpal tunnel syndrome, particularly the addition of shock wave therapy to routine treatment.
Article type:
Original Research Articles |
Subject:
Physiotherapy Received: 2022/08/29 | Accepted: 2023/02/7 | Published: 2023/09/6
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