Comparison of high density laser treatment (HILT), extracorporoal shock wave treatment (ESWT) and transchutaneous electrical nerve stimulation treatment (TENS) activity in carpal tunnel syndrome

Objective: Previous studies have investigated the efficacy of high intensity laser therapy (HILT), extracorporeal shock wave therapy (ESWT) and transcutaneous electrical nerve stimulation therapy (TENS) in the treatment of carpal tunnel syndrome (CTS).Each of these physiotherapy agents has been shown to be effective separately. However, we didn't find comparison of the activities of HILT, ESWT and TENS in CTS patients in our literature review. In this study, we aimed to compare the activities of HILT, ESWT and TENS in the treatment of CTS. Method: From May 2015 to October 2015, 54 patients who applied for treatment and who had a diagnosis of CTS were hand picked from the Department of Physical Medicine and Rehabilitation of the Medical Faculty of Gaziantep University. Patients were randomized according to the order of the outpatient clinic, and 3 groups were formed by taking HILT, ESWT and TENS treatment in the 30s. Both hands of patients with bilateral CTS were taken to the same treatment group, but the evaluations were done separately for both hands. Before the treatment, before and after the treatment, and after the treatment the second month phalen test, reverse phalen test and tinel test were performed and the boston carpal tunnel questionnaire (BKTSA), visual analogue scale (VAS) pain / drowsiness day and night, patient satisfaction scale done. Hand grip strength and finger grip strength measurements were made. Electromyography (EMG) was withdrawn before and at 2 months after the treatment and median nerve motor-sensory distal latency and transmission rate were recorded. Results: There was no statistically significant difference in clinical findings, scales and electro-neurophysiologic parameters compared with treatment groups (p>0.05). The groups were compared statistically in pretreatment, posttreatment and posttreatment second month in comparison with the phalen test, reverse phalen test, hand grip strength, finger grip strength, VAS day / night pain / drowsiness scale, BKTSA functional scale, symptom scale and PEM scale significant improvement was detected. When the groups were compared in terms of pre-treatment and post-treatment second month EMG findings, only median nerve sensory distal latency (mSDL) in the HILT and TENS group and median nerve motor transmission rate (mMNCV) in the ESWT group were significantly different. Conclusion: When we compared HILT, ESWT and TENS activities in our study with CTS, one was not superior to the other. Each treatment has been shown to be effective in CTS. There is a need for longer follow-up and randomized controlled trials involving a larger number of patients to meet the efficacy of these treatment modalities. Key words: Carpal tunnel syndrome, high intensity laser therapy, extracorporeal shock wave therapy, transcutaneous nerve stimulation therapy