The Effects of Nerve and Tendon Gliding Exercises Combined with Low-level Laser or Ultrasound Therapy in Carpal Tunnel Syndrome

Zuzanna Bartkowiak, Małgorzata Eliks, Małgorzata Zgorzalewicz-Stachowiak, Leszek Romanowski, Zuzanna Bartkowiak, Małgorzata Eliks, Małgorzata Zgorzalewicz-Stachowiak, Leszek Romanowski

Abstract

Background: Carpal tunnel syndrome (CTS) is a common medical condition that doctors and physiotherapists come across in clinical practice. There are no explicit recommendations concerning which physical therapy methods should be applied in its treatment; however, there have also been no studies on the effects of combining low-level laser therapy (LLLT) or ultrasound with nerve and tendon gliding exercises. The purpose of this study was to evaluate the therapeutic efficacy of ultrasound and LLLT combined with gliding exercises.

Materials and methods: A total of seventy patients with mild to moderate CTS, divided into two groups, were included in this study. Group 1 received ultrasound treatment, whereas Group 2 underwent LLLT. The treatment lasted 2 weeks (5 sessions/week). In addition, both groups were treated with nerve and tendon gliding exercises three times daily. The clinical evaluation involved an interview on subjective and objective sensory abnormalities, the intensity of pain, the measurement of grip strength, Phalen's test, Tinel's sign, and the Boston Carpal Tunnel Questionnaire. The assessment was performed before and after the treatment.

Results: A decrease in sensory impairments, improvement in visual analog scale, hand grip strength and the Boston Questionnaire results were significant in all patients after therapy. No meaningful differences between groups were noted in any of the examined variables after treatment. No adverse effects were observed.

Conclusions: The results of this study may suggest the clinical efficacy of LLLT or ultrasound combined with gliding exercises in patients with mild to moderate CTS.

Keywords: Carpal tunnel syndrome; low-level laser therapy; nerve gliding exercises; tendon gliding exercises; ultrasound treatment.

Conflict of interest statement

There are no conflicts of interest.

References

    1. Floranda EE, Jacobs BC. Evaluation and treatment of upper extremity nerve entrapment syndromes. Prim Care. 2013;40:925–43, ix.
    1. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008;77:6–17.
    1. Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome – Part I (anatomy, physiology, etiology and diagnosis) Rev Bras Ortop. 2014;49:429–36.
    1. Huisstede BM, Fridén J, Coert JH, Hoogvliet P European HANDGUIDE Group. Carpal tunnel syndrome: Hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline – Results from the European HANDGUIDE Study. Arch Phys Med Rehabil. 2014;95:2253–63.
    1. . AAOS Guideline on the Treatment of Carpal Tunnel Syndrome 2011 Report. [Last updated on 2016 Dec 12; Last cited on 2016 Dec 12]. Available from: .
    1. Naeser MA. Photobiomodulation of pain in carpal tunnel syndrome: Review of seven laser therapy studies. Photomed Laser Surg. 2006;24:101–10.
    1. Weintraub MI. Noninvasive laser neurolysis in carpal tunnel syndrome. Muscle Nerve. 1997;20:1029–31.
    1. Shooshtari SM, Badiee V, Taghizadeh SH, Nematollahi AH, Amanollahi AH, Grami MT. The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome. Electromyogr Clin Neurophysiol. 2008;48:229–31.
    1. Chang WD, Wu JH, Jiang JA, Yeh CY, Tsai CT. Carpal tunnel syndrome treated with a diode laser: A controlled treatment of the transverse carpal ligament. Photomed Laser Surg. 2008;26:551–7.
    1. Lazovic M, Ilic-Stojanovic O, Kocic M, Zivkovic V, Hrkovic M, Radosavljevic N. Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome. Photomed Laser Surg. 2014;32:336–44.
    1. Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A. Comparison of three conservative treatment protocols in carpal tunnel syndrome. Int J Clin Pract. 2006;60:820–8.
    1. Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998;11:171–9.
    1. Horng YS, Hsieh SF, Tu YK, Lin MC, Horng YS, Wang JD. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: A randomized trial. Am J Phys Med Rehabil. 2011;90:435–42.
    1. Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012;40:516–33.
    1. Miller DL, Smith NB, Bailey MR, Czarnota GJ, Hynynen K, Makin IR. Bioeffects Committee of the American Institute of Ultrasound in Medicine. Overview of therapeutic ultrasound applications and safety considerations. J Ultrasound Med. 2012;31:623–34.
    1. Whitley JM, McDonnell DE. Carpal tunnel syndrome. A guide to prompt intervention. Postgrad Med. 1995;97:89–92. 95-6.
    1. American Academy of Orthopaedic Surgeons. Practice Guideline on Management of Carpal Tunnel Syndrome. [Last cited on 2017 May 02]. Available from: .
    1. Yildirim P, Gunduz OH. What is the role of Semmes-Weinstein monofilament testing in the diagnosis of electrophysiologically graded carpal tunnel syndrome? J Phys Ther Sci. 2015;27:3749–53.
    1. Waldman DS, editor. 3rd ed. St Louis, Missouri: Elsevier; 2015. The two-point discrimination test for carpal tunnel syndrome. In: Physical Diagnosis of Pain. An Atlas of Signs and Symptoms; p. 113.
    1. Evcik D, Kavuncu V, Cakir T, Subasi V, Yaman M. Laser therapy in the treatment of carpal tunnel syndrome: A randomized controlled trial. Photomed Laser Surg. 2007;25:34–9.
    1. Bakhtiary AH, Rashidy-Pour A. Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother. 2004;50:147–51.
    1. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585–92.
    1. Ebenbichler GR, Resch KL, Nicolakis P, Wiesinger GF, Uhl F, Ghanem AH, et al. Ultrasound treatment for treating the carpal tunnel syndrome: Randomised “sham” controlled trial. BMJ. 1998;316:731–5.
    1. Totten PA, Hunter JM. Therapeutic techniques to enhance nerve gliding in thoracic outlet syndrome and carpal tunnel syndrome. Hand Clin. 1991;7:505–20.
    1. Wehbé MA, Hunter JM. Flexor tendon gliding in the hand. Part I. In vivo excursions. J Hand Surg Am. 1985;10:570–4.
    1. Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2013;3:CD009601.
    1. Oztas O, Turan B, Bora I, Karakaya MK. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil. 1998;79:1540–4.
    1. Tascioglu F, Degirmenci NA, Ozkan S, Mehmetoglu O. Low-level laser in the treatment of carpal tunnel syndrome: Clinical, electrophysiological, and ultrasonographical evaluation. Rheumatol Int. 2012;32:409–15.
    1. Akalin E, El O, Peker O, Senocak O, Tamci S, Gülbahar S, et al. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil. 2002;81:108–13.
    1. Kim SD. Efficacy of tendon and nerve gliding exercises for carpal tunnel syndrome: A systematic review of randomized controlled trials. J Phys Ther Sci. 2015;27:2645–8.
    1. Bardak AN, Alp M, Erhan B, Paker N, Kaya B, Onal AE. Evaluation of the clinical efficacy of conservative treatment in the management of carpal tunnel syndrome. Adv Ther. 2009;26:107–16.
    1. Yildiz N, Atalay NS, Gungen GO, Sanal E, Akkaya N, Topuz O. Comparison of ultrasound and ketoprofen phonophoresis in the treatment of carpal tunnel syndrome. J Back Musculoskelet Rehabil. 2011;24:39–47.

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