Comparison of the effectiveness of LOW level laser therapy and therapeuthic ultrasound treatments in patients with rotator cuff tendinopathy

Introductionand Aim: Shoulder pain is the most common musculoskeletal problem after low back and neck pain. Rotator cuff syndrome, which is the most common cause of shoulder pain, is a health problem that causes limitation of daily life activities, loss of function, psychological problems and significant economic loses. The aim of our study is to investigate and compare the efficacy of low level intensity laser and therapeutic ultrasound in patients with rotator cuff tendinopathy. Material and Methods: Patients between the ages of 18-75, who applied to the physical therapy outpatient clinic between April 2021 and February 2022, had shoulder pain for at least 6 weeks, and were diagnosed with rotator cuff tendinopathy by clinical, physical examination and imaging methods were included in the study. Patients' age, gender, marial status, occupation, comorbid disease, body mass index, duration of sympoms, dominant hand, and drug used were recorded. In physical examination, range of motion of shoulderand shoulder specific tests were recorded. VAS pain levels at rest, activity and at night were assessed using a ten-point Likert scale. Pain and functional status assessment in all patients was evaluated with the ''Arm, Shoulder, Hand Injuries Scale'' (DASH), ''Shoulder Pain and Disability Index'' (SPADI), and ''Constant Murley Score'' (CMS) scales. The emotional status of the patients were evaluated with the ''Beck Depression Inventory'' (BDI), and ''Beck Anxiety Inventory'' (BAI). ''Pittsburg Sleep Quality Index'' (PSQI) was used to evaluate sleep quality, and ''Short Form-36'' (SF-36) was used to evaluate quality of life. Our study was carried out with 70 patients. The patient were randomly divided into two groups; Group 1 US (n = 35) and Group 2 laser (n = 35). Patients in both groups were treated for 3 weeks, 5 sessions per week. Hot pack and transcutaneous electrical stimulation were applied to all patients. The patients were assessed before treatment, at the 1st week after the treatment, at the 4th week after the treatment and at the 12th week after the treatment. Data comparisons were made both within and between groups. Results: No difference was observed between the groups in terms of sociodemographic characteristics (age, gender, body mass index etc.) (p = 0.41, p = 1.00, p = 0.31, respectively). At baseline evaluation, there was no significant difference in VAS, SPADI, and DASH scores between the groups (for all, p > 0.05). Post-treatment follow-up XI evaluation at 1st, 4th, 12th weeks, VAS, SPADI and DASH scores demonstrated a statistically significant decrease in both groups (for all, p < 0.001). Post-treatment follow-up evaluation, a statistically significant increase in CMS was observed compared to those at pre-treatment evaluation in both groups (p < 0.001). US group demonstrated more increase in hand grip strength value compared to those in laser group (p < 0.05, ). At the early period evaluation, US group demonstrated more increase in ROM flexion compared to those in laser group (p = 0.020). At the early period evaluation, laser group demonstrated more increase in ROM internal rotation compared to those in US group (p = 0.020). At the late evaluation, US group demonstrated more increase in ROM flexion and abduction compared to those laser group (p = 0.002, p = 0.010, respectively). Laser group demonstrated more increase in SF-36 energy vitality subheading score compared to those in US group (p = 0.040). Although there was a numerically increase in the subdomain of SF-36 for physical function, physical role difficulty, emotional role difficulty, mental health, social functionality, pain, and general health at post-treatment 12th week compared to those at pre-treatment, no statistically significant difference was observed between the groups (for all, p > 0.05). Although there was a numerically decrease in BDI, BAI and PSQI scores at post-treatment 12th week compared to those at pre-treatment in both groups, there was no statistically significant difference between the groups (for all, p > 0.05). At post-treatment follow-up evaluation, there was no significant differences in pain, function, emational status, sleep quality, and quality of life between groups. Consclusions: Many methods are used in the treatment of rotator cuff tendinopathy. Significant improvement was achieved in pain, function, sleep quality, and quality of life scores in patients with rotator cuff tendinopathy who underwent both laser therapy and therapeutic US. However, our study results revealed no superiority in terms of effectiveness between laser and US treatments. Key words: Rotator cuff tendinopathy, ultrasound, laser, pain, function