High Intensity Laser Therapy in Carpal Tunnel Syndrome
Condition: Carpal Tunnel Syndrome; Entrapment Neuropathy; Median Neuropathy; Musculoskeletal Diseases
MeSH terms: Musculoskeletal Diseases; Carpal Tunnel Syndrome; Nerve Compression Syndromes; Charcot-Marie-Tooth Disease; Hereditary Sensory and Motor Neuropathy; Median Neuropathy; Syndrome
Study type: Interventional

Summary: 
      This research aims to investigate the effect of high-intensity laser therapy on pain,
      function, nerve conduction studies and grip strength in patients with idiopathic carpal
      tunnel syndrome.
    

Detailed description: 
      Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, and it causes numbness
      and tingling in the hand, atrophy and muscle weakness in the later stages. Any condition that
      increases the volume of the carpal tunnel and narrows the diameter of the tunnel may increase
      the compression of the median nerve under the transverse carpal ligament and cause symptoms.
      In majority of cases, no cause can be found and it is called "idiopathic".

      While the diagnosis of CTS is made by the patient's history and physical examination methods,
      the diagnosis is confirmed with use of electrophysiological examination. Physical therapy,
      non-steroidal anti-inflammatory drug use, local steroid injection, hand-wrist rest splint,
      nerve/tendon gliding exercises; Physiotherapy modalities such as therapeutic ultrasound and
      laser are among the conservative treatment methods of CTS. Despite the effectiveness of
      surgery in the treatment of severe CTS cases, as is known, surgical treatment is not without
      risk. Therefore, mild to moderate CTS is treated conservatively.

      Laser therapy is one of the physical therapy modalities, low-intensity laser therapy (LILT),
      whose biological effects occur secondary to direct photochemical effect and are not the
      result of thermal effects. High-intensity laser therapy (HILT), which has been widely used
      recently, is frequently used since it has small and slow light absorption from chromophores.
      HILT is not a concentrated light, but it diffuses in all directions (scattering phenomenon).
      This supports the wider effectiveness of HILT. HILT also has effects such as increased
      mitochondrial oxidative reactions, increased production of adenosine triphosphate, RNA and
      DNA (photochemical effect), increased tissue stimulation (photobiological), and reduced pain
      and inflammation. HILT, which has recently found many uses in musculoskeletal diseases, can
      affect a wider and deeper area in the tissues compared to the widely used LILT. Although
      there are many studies on the effectiveness of LILT therapy in CTS, there are few trials to
      study the effectiveness of HILT on clinical and electrophysiological parameters in CTS.

      This investigation is designed as double-blind prospective sham controlled randomized study.

      Participants were randomized into 2 groups: 1) HILT + nerve/tendon gliding exercises + rest
      splint and 2) Sham HILT+ nerve/tendon gliding exercises + rest splint
    

Intervention name(s): High-intensity laser therapy (HILT); Sham High-intensity laser therapy (sham HILT)
Intervention type(s): Device; Device
Intervention description(s): High intensity laser therapy-Patients will receive pulsed laser treatment, using a HIRO 3 device (ASA Laser, Arcugnano, Italy), five times a week for a period of three weeks, and one session per day for a total of 15 sessions. A 3-phase treatment program will be performed on each session.
Other: Tendon and nerve gliding exercises will be performed three times a day with 10 repetitions each time for 3 weeks. Exercises will be performed by a trained physiotherapist.
Other: Rest splint(at night) Participants will be splinted in neutral position with standard cotton-polyester splints.The patients will be encouraged to use the splints during nighttime for 12 weeks.; Sham high intensity laser therapy-Participants will receive pulsed laser treatment, using a HIRO 3 device (ASA Laser, Arcugnano, Italy), five times a week for a period of three weeks, and one session per day for a total of 15 sessions.
Other: Tendon and nerve gliding exercises will be performed three times a day with 10 repetitions each time for 3 weeks. Exercises will be performed by a trained physiotherapist.
Other: Rest splint(at night) Participants will be splinted in neutral position with standard cotton-polyester splints.The patients will be encouraged to use the splints during nighttime for 12 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Carpal Tunnel Syndrome; Median Neuropathy; High intensity laser therapy; Nerve conduction studies; Hand function