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Effectiveness of high intensity laser therapy on pain, grip strength and median nerve conductivity in pregnant women with carpal tunnel syndrome: A randomized controlled trial

      Highlights

      • High-intensity laser therapy alleviates carpal tunnel syndrome in pregnant women.
      • Conventional physical therapy alleviates carpal tunnel syndrome to a lesser extent.
      • High-intensity laser therapy could be a rehabilitation modality for pregnant women.

      Abstract

      Study design

      Single-blind randomized controlled trial.

      Introduction

      High-intensity laser therapy (HILT) was recently introduced to the physiotherapy field as a treatment option for patients with carpal tunnel syndrome (CTS). However, evidence about its effectiveness on pregnant women with CTS is sparse.

      Purpose of study

      To test the effectiveness of HILT combined with a conventional physical therapy program to reduce pain intensity, sensory and motor nerve distal latency, and increase grip strength in pregnant women with CTS compared with the physical therapy alone.

      Methods

      Fifty-four pregnant women with mild to moderate CTS were randomized and further allocated into two groups. The HILT group (n = 27) received both HILT and conventional physical therapy, and the control group (n = 27) received only physical therapy, including nerve and tendon gliding exercises and the use of an orthotic device. Participants received the interventions at the University Hospital (omitted for review) three times per week for 5 weeks. An 11-points numerical pain rating scale, electromyography, and a handheld dynamometer were used for data collection before and after the treatment.

      Results

      Participants from both groups presented significant improvement in the median nerve motor nerve distal latency (MNDL), sensory nerve distal latency, numerical pain rating scale, and handgrip strength after the intervention. The between-group difference showed more improvements in participants of the HILT group on reducing pain intensity, mean difference (MD) = -3.11 (-4.1 to 2.1), and sensory nerve distal latency, MD = -0.3 (-0.5 to -0.1) compared with the control group.

      Discussion

      HILT produced greater improvement in outcomes of pregnant women with mild to moderate CTS whichsuggests that adding HILT to traditional CTS physical therapy protocol is beneficial and safe.

      Conclusions

      High-intensity laser therapy combined with a standard physical therapy program for CTS in pregnant women is better than the physical therapy program alone to improve pain intensity and median nerve sensory distal latency.

      Keywords

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      References

        • Aboonq MS.
        Pathophysiology of carpal tunnel syndrome.
        Neurosciences (Riyadh). 2015; 20: 4-9
        • Padua L
        • Coraci D
        • Erra C
        • et al.
        Carpal tunnel syndrome: clinical features, diagnosis, and management.
        Lancet Neurol. 2016; 15: 1273-1284
        • Ablove RH
        • Ablove TS.
        Prevalence of carpal tunnel syndrome in pregnant women.
        Wmj. 2009; 108: 194-196
        • Lane LB
        • Starecki M
        • Olson A
        • Kohn N.
        Carpal tunnel syndrome diagnosis and treatment: a survey of members of the American Society For Surgery of the Hand.
        J Hand Surg Am. 2014; 39 (.e2184): 2181-2187
        • Chen PC
        • Chuang CH
        • Tu YK
        • Bai CH
        • Chen CF
        • Liaw M.
        A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome.
        BMC Musculoskelet Disord. 2015; 16: 363
        • Sim SE
        • Gunasagaran J
        • Goh K-J
        • Ahmad TS.
        Short-term clinical outcome of orthosis alone vs combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome.
        J Hand Therapy. 2019; 32: 411-416
        • Huisstede BM
        • van den Brink J
        • Randsdorp MS
        • Geelen SJ
        • Koes BW.
        Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome—A Systematic Review.
        Arch Physical Med and Rehabilitation. 2018; 99 (e1621): 1660-1680
        • Louie D
        • Earp B
        • Blazar P.
        Long-term outcomes of carpal tunnel release: a critical review of the literature.
        Hand. 2012; 7 (N Y): 242-246
        • Page MJ
        • Massy-Westropp N
        • O'Connor D
        • Pitt V
        Splinting for carpal tunnel syndrome.
        Cochrane Database of Systematic Rev. 2012; 7: 20-21
        • Page MJ
        • O'Connor D
        • Pitt V
        • Massy-Westropp N.
        Exercise and mobilisation interventions for carpal tunnel syndrome.
        Cochrane Database of Systematic Rev. 2012; 6: 99-101
        • Page MJ
        • O'Connor D
        • Pitt V
        • Massy-Westropp N.
        Therapeutic ultrasound for carpal tunnel syndrome.
        Cochrane Database of Systematic Rev. 2013; 3: 3-4
        • Erickson M
        • Lawrence M
        • Jansen CWS
        • Coker D
        • Amadio P
        • Cleary C.
        Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome.
        J Orthop Sports Phys Ther. 2019; 49: Cpg1-cpg85
        • Rankin IA
        • Sargeant H
        • Rehman H
        • Gurusamy KS.
        Low-level laser therapy for carpal tunnel syndrome.
        Cochrane Database of Systematic Rev. 2017; 8: 4-11
        • Cotler HB
        • Chow RT
        • Hamblin MR
        • Carroll J.
        The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain.
        MOJ Orthop Rheumatol. 2015; 2: 00068
        • Brosseau L
        • Wells G
        • Marchand S
        • et al.
        Randomized controlled trial on low level laser therapy (LLLT) in the treatment of osteoarthritis (OA) of the hand.
        Lasers Surg Med. 2005; 36: 210-219
        • Tantawy SA
        • Abdelbasset WK
        • Kamel DM
        • Alrawaili SM.
        A randomized controlled trial comparing helium-neon laser therapy and infrared laser therapy in patients with diabetic foot ulcer.
        Lasers Med Sci. 2018; 33: 1901-1906
        • Alayat MS
        • Elsodany AM
        • El Fiky AA.
        Efficacy of high and low level laser therapy in the treatment of Bell's palsy: a randomized double blind placebo-controlled trial.
        Lasers Med Sci. 2014; 29: 335-342
        • Jablecki CK
        • Andary MT
        • Floeter MK
        • et al.
        Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation.
        Neurology. 2002; 58: 1589-1592
        • Totten PA
        • Hunter JM.
        Therapeutic techniques to enhance nerve gliding in thoracic outlet syndrome and carpal tunnel syndrome.
        Hand Clin. 1991; 7: 505-520
        • Matts PJ
        • Dykes PJ
        • Marks R.
        The distribution of melanin in skin determined in vivo.
        Br J Dermatol. 2007; 156: 620-628
        • Roberts HC
        • Denison HJ
        • Martin HJ
        • et al.
        A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach.
        Age and ageing. 2011; 40: 423-429
        • 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
        • Casale R
        • Damiani C
        • Maestri R
        • Wells CD.
        Pain and electrophysiological parameters are improved by combined 830-1064 high-intensity LASER in symptomatic carpal tunnel syndrome versus Transcutaneous Electrical Nerve Stimulation. A randomized controlled study.
        Eur J Phys Rehabil Med. 2013; 49: 205-211
        • Ezzati K
        • Laakso EL
        • Saberi A
        • Yousefzadeh Chabok S
        • Nasiri E
        • Bakhshayesh Eghbali B.
        A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome.
        Eur J Phys Rehabil Med. 2020; 56: 733-740
        • Tabatabai SMR
        • Bashardoust Tajali S
        • Attarbashi Moghadam B
        • Mir SM
        Effects of high-power diode laser irradiation combined with electrical stimulation on wrist pain and function following carpal tunnel syndrome.
        J Clin Physiotherapy Res. 2016; 1: 61-67
        • LeBlanc KE
        • Cestia W.
        Carpal tunnel syndrome.
        Am Fam Physician. 2011; 83: 952-958
        • Keith MW
        • Masear V
        • Chung K
        • et al.
        Diagnosis of carpal tunnel syndrome.
        J Am Acad Orthop Surg. 2009; 17: 389-396
        • Fitzpatrick TB.
        The validity and practicality of sun-reactive skin types I through VI.
        Arch Dermatol. 1988; 124: 869-871
        • Fess E
        • Moran C.
        American Society of Hand Therapists Clinical Assessment Recommendations.
        American Society of Hand Therapists, USA1981
        • Hernández-Secorún M
        • Montaña-Cortés R
        • Hidalgo-García C
        • et al.
        Effectiveness of conservative treatment according to severity and systemic disease in carpal tunnel syndrome: a systematic review.
        Int J Environ Res Public Health. 2021; 18: 28-29
        • Jiménez-Del-Barrio S
        • Cadellans-Arróniz A
        • Ceballos-Laita L
        • et al.
        The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis.
        Int Orthop. 2021; 46: 306-308
        • Ekim A
        • Armagan O
        • Tascioglu F
        • Oner C
        • Colak M.
        Effect of low level laser therapy in rheumatoid arthritis patients with carpal tunnel syndrome.
        Swiss Med Wkly. 2007; 137: 347-352
        • Ansari MA
        • Erfanzadeh M
        • Mohajerani E.
        Mechanisms of Laser-Tissue Interaction: II. Tissue Thermal Properties.
        J Lasers Med Sci. 2013; 4: 99-106
        • Huang Y-Y
        • Chen ACH
        • Carroll JD
        • Hamblin MR.
        Biphasic dose response in low level light therapy.
        Dose Response. 2009; 7: 358-383
        • Ihsan FR.
        Low-level laser therapy accelerates collateral circulation and enhances microcirculation.
        Photomed Laser Surg. 2005; 23: 289-294
        • Leal Junior EC
        • Lopes-Martins RA
        • Rossi RP
        • et al.
        Effect of cluster multi-diode light emitting diode therapy (LEDT) on exercise-induced skeletal muscle fatigue and skeletal muscle recovery in humans.
        Lasers Surg Med. 2009; 41: 572-577
        • De Marchi T
        • Leal Junior EC
        • Bortoli C
        • Tomazoni SS
        • Lopes-Martins RA
        • Salvador M
        Low-level laser therapy (LLLT) in human progressive-intensity running: effects on exercise performance, skeletal muscle status, and oxidative stress.
        Lasers Med Sci. 2012; 27: 231-236