A COMPARISON OF MANUAL THERAPY AND EXTRACORPOREAL SHOCKWAVE THERAPY IN PATIENTS WITH CARPAL TUNNEL SYNDROME
Öz
Purpose: To investigate the effects on pain, symptom severity, and functionality of different physiotherapy methods applied to patients with carpal tunnel syndrome and to evaluate the advantages of these over each other.
Methods: A total of 75 patients (69 females, 6 males) aged 25-60 years were separated into 3 groups. The patients in Group 1 were given a home exercise program (HP), including median nerve and tendon gliding exercises. Group 2 received the same HP plus manual therapy (MT), including soft tissue and joint mobilisation. Group 3 received the same HP plus extracorporeal shockwave therapy (ESWT). Pain severity was evaluated with a Visual Analog Scale. Symptom severity and levels of functionality were evaluated with the Boston Carpal Tunnel Syndrome Questionnaire and the Cochin Hand Function Questionnaire. All the patients were evaluated before and after treatment.
Results: While there was a significant decrease in the resting and activity pain levels of each 3 groups after the treatment (p<0,05), no significant difference was found between MT and ESWT groups (p> 0.05). However, the pain values of these two groups were significantly decreased compared to the EP group (p <0.05). The pain values of both groups were significantly lower than those of the HP control group (p <0.05). A statistically significant increase was determined in the level of functionality in all the groups after treatment (p<0.05). The decrease in symptom severity and the increase in functionality were significantly greater in the MT and ESWT groups compared to the HP group (p<0.05). After the treatment, there were no superiorities with respect to the pain, symptom severity, and functionality values of the MT and ESWT groups (p>0.05).
Conclusion: In our study, the MT and ESWT applications we used in patients with CTS patients provided significant improvement compared to HP exercises only. We speculate that some differences that are not seen in the early period can be seen in long-term follow-up. Further studies should be performed to assess the longterm results.
Anahtar Kelimeler
Carpal Tunnel Syndrome Nerve Gliding Tendon Gliding Manual Therapy Extracorporeal Shockwave Therapy
Kaynakça
- References1. Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci. 2010; 31:243–252.
- References2. MacDermid J C, Wessel J. Clinical diagnosis of carpal tunnel syndrome: A systematic Review. Journal of Hand Therapy 2004; 17: 309–319.
- References3. Uchiyama S., et al., Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. Journal of Orthopaedic Science. 2010; 15:1-13.
- References4. Kuran B. Ön kol, el-el bileği ağrılarında egzersiz reçeteleme: Derleme. Türk Fiz Tıp Rehab Derg. 2014;60 (Özel Sayı 2): S43-S49.
- References5. Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta- analysis. J Orthop Sports Phys Ther. 2017; 47: 593-615.
- References6. 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(8):2645-2648.
- References7. Abdolrazaghi HA, Khansari M, Mirshahi M, Ahmadi Pishkuhi M. Effectiveness of Tendon and Nerve Gliding Exercises in the Treatment of Patients With Mild Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial. Hand (N Y). 2021 Apr 15:15589447211006857.
- References8. Kaltenborn FM: Mannuel Mobilization of the Ekstremity Joints. 4th ed., Oslo:Olaf Norlis Borkhandel.1089.
- References9. Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Pareja JA, Alonso-Blanco C. The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial. JOSPT. 2017; 47:151-161.
- References10. Dommerholt, J. Manual Therapy for Musculoskeletal Pain Syndromes: An Evidence and Clinical-Informed Approach 2015.
- References11. Benjamin MS, Richard NH, Robert LW, et al. Manipulative Treatment of Carpal Tunnel Syndrome: Biomechanical and Osteopathic Intervention to Increase the Length of the Transverse Carpal Ligament: Part 2. Effect of Sex Differences and Manipulative "Priming". JAOA. 2005; 105: 135-43.
- References12. Baloğlu İ, Özsoy MH, Aydınok H, et al. Ortopedi ve Travmatolojide Şok Dalga Tedavisi. TOTBİD:Türk Ortopedi ve Travmatoloji Birliği Derneği Dergisi. 2005; 4:1-2.
- References13. Dıraçoğlu D. Kas-iskelet sistemi hastalıklarında ekstrakorporal şok dalga tedavisi. Turkiye Klinikleri J PM&R. 2004; 4:106–104.
- References14. Mariotto S, Cavalieri E, Amelio E, et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide : Biology and Chemistry. 2005; 12:89-96.
- References15. Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo- controlled multicenter study. Am J Sports Med. 2008; 36:2100–2109.
- References16. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8:1153-1157.
- References17. Akı S, Şencan S, Öztürk Y. Tünel Sendromunda Tinel ve Phalen Testinin Yeri. J. Rheum Med. Rehab.1997;8: 310-314.
- References18. Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdogan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disability and Rehabilitation. 2006; 28:1281-5.
- References19. Duruöz MT, Poiraudeau S, Fermanian J, Menkes CJ, Amor B, Dougados M, et al. Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996; 23:1167-72.
- References20. Wolny T. The Use of Neurodynamic Techniques in the Conservative Treatment of Carpal Tunnel Syndrome –a Critical Appraisal of the Literature. Ortop.Traumatol Rehabil. 2017; 19:427-440.
- References21. 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.
- References22. IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY.
- References23. Oskouei AE, Talebi GA, Shakouri SK, Ghabili K. Effects of neuromobilization maneuver on clinical and electrophysiological measures of patients with carpal tunnel syndrome. J Phys Ther Sci. 2014; 26:1017-1022.
- References24. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007; 30:50-61.
- References25. Tal-Akabi A, Rushton A. An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome. Man Ther. 2000; 5:214-22.
- References26. Vahdatpour B, Kiyani A, Dehghan F. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome. Adv Biomed Res. 2016; 5:120.
- References27. Koçak Ulucaköy R, Yurdakul FG, Bodur H. Extracorporeal shock wave therapy as a conservative treatment option for carpal tunnel syndrome: A double-blind, prospective, randomized, placebo-controlled study. Turk J Phys Med Rehabil. 2020;66:388-397.
- References28. Atthakomol P, Ma nosroi W, Phanphaisarn A, et al. Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial. BMC musculoskeletal disorders 2018; 19:32.
- References29. Paoloni M, Tavernese E, Cacchio A, D'orazi V, Ioppolo F, Fini M, Santilli V, Mangone M. Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial. Eur J Phys Rehabil Med. 2015; 51:521-8.
- References30. Ke MJ, Chen LC, Chou YC, Li TY, Chu HY, Tsai CK, et al. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial. Sci Rep. 2016; 6:38344–38344
KARPAL TÜNEL SENDROMLU HASTALARDA MANUEL TEDAVİ VE EKSTRAKORPOREAL ŞOK DALGA TEDAVİSİNİN ETKİLERİNİN KARŞILAŞTIRILMASI
Öz
Amaç: Karpal tünel sendromlu hastalarda farklı fizyoterapi yöntemlerinin ağrı, semptom şiddeti, fonksiyonellik düzeyleri üzerindeki erken dönem etkilerini araştırmak ve birbirlerine üstünlüğünü değerlendirmektir.
Yöntem: Çalışmamıza 25-60 yaş aralığında 75 hasta (69: K, 6: E) dahil edildi. Hastalar 3 gruba ayrıldı. Birinci gruba median sinir ve tendon kaydırma egzersizlerini içeren ev programı (EP) verildi. İkinci gruba aynı ev programına ilaveten yumuşak doku ve eklem mobilizasyonu içeren manuel tedavi (MT) uygulandı. Üçüncü gruba da aynı ev programına ilaveten ekstrakorporeal şok dalga tedavisi (ESWT) uygulandı. Ağrı şiddeti Vizuel Ağrı Skalası ile, semptom şiddeti ve fonksiyonellik düzeyleri Boston Karpal Tünel Sendromu Anketi ve Cochin El Fonksiyon Anketi ile değerlendirildi. Hastaların ölçümleri tedaviden önce ve sonra yapıldı.
Sonuçlar: Tedaviden sonraki değerlendirmelerde her 3 grubun istirahat ve aktivite ağrılarında anlamlı düşüş bulunurken (p<0,05), MT ve ESWT grupları arası fark bulunmadı (p>0,05). Ancak iki grubun ağrı değerlerinde EP grubuna göre anlamlı azalma görüldü (p<0,05). Tüm gruplarda fonksiyonellik düzeylerinde anlamlı artış bulundu (p<0,05). Semptom şiddetinde azalma ve fonksiyonellik düzeylerindeki artış, MT ile ESWT gruplarında EP grubuna göre anlamlı bulunurken (p<0,05), MT ile ESWT grupları arasında fark bulunmadı (p>0,05). Tedaviden sonra MT ve ESWT gruplarının ağrı, semptom şiddeti ve fonksiyonellik değerleri karşılaştırmasında grupların birbirlerine üstünlükleri bulunmadı.
Tartışma: Çalışmamızda KTS hastalarında kullandığımız MT ve ESWT uygulamasının yalnızca EP egzersizlerine göre anlamlı iyileşme sağladığı görüldü. Erken dönemde görülmeyen bazı farkların, uzun dönem takiplerde görülebileceğini düşünüyoruz. Uzun dönem sonuçları değerlendirmek için ileri çalışmalar yapılmalıdır.
Anahtar Kelimeler
karpal tünel sendromu sinir kaydırma tendon kaydırma manuel tedavi Ekstrakorporeal Şok Dalga Tedavisi
Kaynakça
- References1. Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci. 2010; 31:243–252.
- References2. MacDermid J C, Wessel J. Clinical diagnosis of carpal tunnel syndrome: A systematic Review. Journal of Hand Therapy 2004; 17: 309–319.
- References3. Uchiyama S., et al., Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. Journal of Orthopaedic Science. 2010; 15:1-13.
- References4. Kuran B. Ön kol, el-el bileği ağrılarında egzersiz reçeteleme: Derleme. Türk Fiz Tıp Rehab Derg. 2014;60 (Özel Sayı 2): S43-S49.
- References5. Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta- analysis. J Orthop Sports Phys Ther. 2017; 47: 593-615.
- References6. 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(8):2645-2648.
- References7. Abdolrazaghi HA, Khansari M, Mirshahi M, Ahmadi Pishkuhi M. Effectiveness of Tendon and Nerve Gliding Exercises in the Treatment of Patients With Mild Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial. Hand (N Y). 2021 Apr 15:15589447211006857.
- References8. Kaltenborn FM: Mannuel Mobilization of the Ekstremity Joints. 4th ed., Oslo:Olaf Norlis Borkhandel.1089.
- References9. Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Pareja JA, Alonso-Blanco C. The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial. JOSPT. 2017; 47:151-161.
- References10. Dommerholt, J. Manual Therapy for Musculoskeletal Pain Syndromes: An Evidence and Clinical-Informed Approach 2015.
- References11. Benjamin MS, Richard NH, Robert LW, et al. Manipulative Treatment of Carpal Tunnel Syndrome: Biomechanical and Osteopathic Intervention to Increase the Length of the Transverse Carpal Ligament: Part 2. Effect of Sex Differences and Manipulative "Priming". JAOA. 2005; 105: 135-43.
- References12. Baloğlu İ, Özsoy MH, Aydınok H, et al. Ortopedi ve Travmatolojide Şok Dalga Tedavisi. TOTBİD:Türk Ortopedi ve Travmatoloji Birliği Derneği Dergisi. 2005; 4:1-2.
- References13. Dıraçoğlu D. Kas-iskelet sistemi hastalıklarında ekstrakorporal şok dalga tedavisi. Turkiye Klinikleri J PM&R. 2004; 4:106–104.
- References14. Mariotto S, Cavalieri E, Amelio E, et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide : Biology and Chemistry. 2005; 12:89-96.
- References15. Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo- controlled multicenter study. Am J Sports Med. 2008; 36:2100–2109.
- References16. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8:1153-1157.
- References17. Akı S, Şencan S, Öztürk Y. Tünel Sendromunda Tinel ve Phalen Testinin Yeri. J. Rheum Med. Rehab.1997;8: 310-314.
- References18. Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdogan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disability and Rehabilitation. 2006; 28:1281-5.
- References19. Duruöz MT, Poiraudeau S, Fermanian J, Menkes CJ, Amor B, Dougados M, et al. Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996; 23:1167-72.
- References20. Wolny T. The Use of Neurodynamic Techniques in the Conservative Treatment of Carpal Tunnel Syndrome –a Critical Appraisal of the Literature. Ortop.Traumatol Rehabil. 2017; 19:427-440.
- References21. 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.
- References22. IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY.
- References23. Oskouei AE, Talebi GA, Shakouri SK, Ghabili K. Effects of neuromobilization maneuver on clinical and electrophysiological measures of patients with carpal tunnel syndrome. J Phys Ther Sci. 2014; 26:1017-1022.
- References24. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007; 30:50-61.
- References25. Tal-Akabi A, Rushton A. An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome. Man Ther. 2000; 5:214-22.
- References26. Vahdatpour B, Kiyani A, Dehghan F. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome. Adv Biomed Res. 2016; 5:120.
- References27. Koçak Ulucaköy R, Yurdakul FG, Bodur H. Extracorporeal shock wave therapy as a conservative treatment option for carpal tunnel syndrome: A double-blind, prospective, randomized, placebo-controlled study. Turk J Phys Med Rehabil. 2020;66:388-397.
- References28. Atthakomol P, Ma nosroi W, Phanphaisarn A, et al. Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial. BMC musculoskeletal disorders 2018; 19:32.
- References29. Paoloni M, Tavernese E, Cacchio A, D'orazi V, Ioppolo F, Fini M, Santilli V, Mangone M. Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial. Eur J Phys Rehabil Med. 2015; 51:521-8.
- References30. Ke MJ, Chen LC, Chou YC, Li TY, Chu HY, Tsai CK, et al. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial. Sci Rep. 2016; 6:38344–38344
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Rehabilitasyon |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Nisan 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 34 Sayı: 1 |
