Comparison of the effectiveness of Low-intensity laser and ESWT treatments in carpal tunnel syndrome

Aim: Carpal tunnel syndrome (CTS) occurs as a result of compression of the median nerve in the carpal tunnel. It is the most common entrapment neuropathy syndrome. Patients complain of tingling and numbness that worsens at night, especially in the first three fingers and the radial half of the fourth finger. Conservative treatment is the first choice in the mild to moderate CTS. The aim of this study is to compare the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) and Low Intensity Laser Therapy (LILL) treatments in idiopathic CTS patients. Materials and Methods: This study was planned as a prospective, randomized controlled, single-center study. 70 participants, aged 18-65, who were diagnosed with mild or moderate CTS as a result of nerve conduction studies, were included in the study. Participants were randomly divided into 3 groups. The first group (G1) received neutral wrist splint for 3 weeks; the second group (G2) received LILT treatment for 15 sessions, 5 days a week in addition to neutral wrist splint for 3 weeks, the third group (G3) received ESWT 1 session a week, a total of 3 sessions in addition to neutral wrist splint for 3 weeks. All participants were evaluated clinically and ultrasonographically before and after treatment. Participants were evaluated by Visual Analog Scale (VAS) for pain and paresthesia; Boston Symptom Severity Scale (BSSS), Boston Functional Status Scale (BFDS) and Quick-DASH for functional assessment; Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale for neuropathic pain. Hand grip strength was measured with a dynamometer. Ultrasonographic evaluation was performed by measuring the median nerve cross-sectional area (MSCA) at the level of the distal palmar line. Results: Intra-group comparison revealed a statistically significant difference in VAS pain, VAS paresthesia, BSSS, BFDS, Q-DASH, LANNS, hand grip strength and MSCA after treatment compared to before treatment in all 3 groups. Intergroup comparison revealed a statistically significant difference in VAS pain, BSSS and Q-DASH scores, was found to be superior in the LILT and ESWT groups compared to the control group, and no statistically significant difference was detected between the LILT and ESWT groups. Improvement in VAS paresthesia and BFDS scores was found to be superior in the ESWT group compared to the control group. No statistically significant difference was detected between ESWT and LILT groups. No statistically significant difference was detected between the three groups in LANNS, hand grip strength and MSCA. Conclusion: LILT and ESWT applied in addition to hand-wrist splints in the treatment of CTS are effective treatment and reliable options. Further studies with larger case numbers are needed to investigate the effectiveness of ESWT and LILT in CTS. Key words: Carpal tunnel syndrome, Extracorporeal shock wave therapy, Low intensity laser therapy