The aim of this study is to compare the effectiveness of rest splints and high-intensity laser therapy(HILT) added to physical therapy programs for patients with carpal tunnel syndrome in terms of pain, function, nerve conduction studies, and grip strength.
Patients aged 18-75 years who have been diagnosed with carpal tunnel syndrome based on their medical history, physical examination, clinical findings, and electromyography(EMG) results, who have applied to the outpatient clinic for physical therapy, and who have no contraindications for treatment will be included in the study after obtaining their consent.
Diabetes Mellitus
Hypothyroidism
Acromegaly
Rheumatic Diseases
Single group
Rest splint group
DeviceWe routinely provide the following physical therapy program to patients with carpal tunnel syndrome in our physical therapy unit: hand wrist ROM isometric strengthening, intrinsic muscle strengthening, hand wrist stretching, desensitization exercises, tendon gliding exercises, median nerve gliding exercises, wrist flexion and extension exercises, grip strengthening exercises) will be provided to patients with carpal tunnel syndrome in our physical therapy unit, and they will be instructed to use the resting splint as much as possible during the day and maximally at night for 6 weeks. Rest splint: The WingMed brand splint is specially designed to hold the wrist in a neutral position with volar support, allowing pronation and supination of the wrist but not allowing flexion, extension, radial, or ulnar deviation.
high-intensity laser therapy (HILT)
DeviceGroup 2 (high-intensity laser therapy (HILT)) will undergo pulsed laser therapy using the HIRO 3 device (ASA Laser, Arcugnano, Italy) five times a week for 6 weeks (a total of 30 sessions, one session per day) in addition to the physical therapy program. During each session, a three-phase treatment program will be administered to patients once a day, accompanied by a physical therapist, consisting of nerve/tendon gliding exercises.
sham high-intensity laser therapy (HILT)
DeviceThe sham-HILT group will receive sham laser therapy using the HIRO 3 device (ASA Laser, Arcugnano, Italy) five times a week for six weeks (a total of 30 sessions, one session per day) in addition to the physical therapy program. After patients see that the device is turned on during the sham application, the same treatment will be applied to the same treatment area for the same duration without allowing laser current output from the device.
Visual Analog Scale (VAS):
Patients' musculoskeletal pain intensity was assessed using the visual analog scale (VAS). The meanings of the numbers placed on a 10 cm line from 0 to 10 were explained to the patients. It was explained that no pain was 0, the most severe pain ever experienced was 10, and moderate pain was 5 points. Based on these explanations, patients were asked to rate their pain levels for the past week.
Boston Carpal Tunnel Questionnaire:
This questionnaire determines the severity of CTS-specific symptoms and functional outcome using a scale for each. The symptom severity subgroup is determined using 11 questions scored from 1 to 5, with a maximum score of 55. The higher the score, the greater the symptom severity. The functional subgroup assesses the difficulty of 8 functional activities scored from 1 to 5, with a maximum score of 40. The higher the score, the poorer the functional capacity.
LANSS neuropathic pain assessment scale
The Self-Rating of Neuropathic Symptoms and Signs (S-LANSS) scale will be administered to all patients to determine the presence of neuropathic pain. The SLANSS scale is a measure used to distinguish neuropathic pain from nociceptive pain. Unlike the LANSS scale, the physician does not examine the patient in this scale, making it easier to administer. The S-LANSS scale consists of a total of 7 questions. The patient fills out this scale themselves. The first 5 questions consist of questions that inquire about pain symptoms, while the last 2 questions include a clinical examination that the patient performs on themselves. The answers to the questions are yes/no. Each question has a different score. The total score on the scale is 24. A total score of 12 or higher suggests neuropathic pain. The Turkish version of the S-LANSS scale has been validated and is reliable.
Pittsburgh Sleep Quality Index (PSQI)
This scale, used to assess sleep quality, consists of 24 questions that inquire about sleep quality over the past 4 weeks. The scale has 7 components, each of which is scored on a scale of 0-3. The total PUKİ score ranges from 0 to 21, with a score higher than 5 indicating poor sleep quality. Turkish validity and reliability studies have been conducted.
Quick DASH Questionnaire
Created to assess functional status and symptoms by focusing on physical function in the upper extremities. This questionnaire contains a total of 11 items. Symptoms or difficulty are rated on a scale of 1 to 5. At least 10 questions must be answered to calculate the Quick DASH score. The calculation result is rated between 0 and 100.0. 0 indicates no difficulty or symptoms, while 100 indicates no activity or severe symptom
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