Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Floranda EE, Jacobs BC. Evaluation and treatment of upper extremity nerve entrapment syndromes. Prim Care 2013;40:925–43, ix.

    Article  PubMed  Google Scholar 

  2. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008;77:6–17.

    PubMed  PubMed Central  Google Scholar 

  3. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. aaos.org. AAOS Guideline on the Treatment of Carpal Tunnel Syndrome 2011 Report. Available from: http://www.aaos.org/research/guidelines/CTSTreatmentGuideline.pdf. [Last updated on 2016 Dec 12; Last cited on 2016 Dec 12].

  6. Naeser MA. Photobiomodulation of pain in carpal tunnel syndrome: Review of seven laser therapy studies. Photomed Laser Surg 2006;24:101–10.

    Article  PubMed  Google Scholar 

  7. Weintraub MI. Noninvasive laser neurolysis in carpal tunnel syndrome. Muscle Nerve 1997;20:1029–31.

    Article  CAS  PubMed  Google Scholar 

  8. 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.

    CAS  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  CAS  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Whitley JM, McDonnell DE. Carpal tunnel syndrome. A guide to prompt intervention. Postgrad Med 1995;97:89–92, 95–6.

    Article  CAS  PubMed  Google Scholar 

  17. American Academy of Orthopaedic Surgeons. Practice Guideline on Management of Carpal Tunnel Syndrome. Available from: https://www.guideline.gov/summaries/summary/50092/americanacademy-of-orthopaedic-surgeons-clinical-practice-guidelineon-management-of-carpal-tunnel-syndrome. [Last cited on 2017 May 02].

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Waldman DS, editor. The two-point discrimination test for carpal tunnel syndrome. In: Physical Diagnosis of Pain. An Atlas of Signs and Symptoms. 3rd ed, St Louis, Missouri: Elsevier; 2015. p. 113.

    Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Bakhtiary AH, Rashidy-Pour A. Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother 2004;50:147–51.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Totten PA, Hunter JM. Therapeutic techniques to enhance nerve gliding in thoracic outlet syndrome and carpal tunnel syndrome. Hand Clin 1991;7:505–20.

    CAS  PubMed  Google Scholar 

  25. Wehbé MA, Hunter JM. Flexor tendon gliding in the hand. Part I. In vivo excursions. J Hand Surg Am 1985;10:570–4.

    Article  PubMed  Google Scholar 

  26. Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev 2013;3:CD009601.

    Google Scholar 

  27. Oztas O, Turan B, Bora I, Karakaya MK. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil 1998;79:1540–4.

    Article  CAS  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Małgorzata Eliks.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bartkowiak, Z., Eliks, M., Zgorzalewicz-Stachowiak, M. et al. The Effects of Nerve and Tendon Gliding Exercises Combined with Low-level Laser or Ultrasound Therapy in Carpal Tunnel Syndrome. JOIO 53, 347–352 (2019). https://doi.org/10.4103/ortho.IJOrtho_45_17

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ortho.IJOrtho_45_17

Keywords

Navigation