Karpal tünel sendromlu hastalarda yüksek yoğunluklu lazer tedavisinin ağrı, fonksiyonel durum, el kavrama kuvveti ve ultrasonografide median sinir kesit alanına etkisi
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Tarih
2023
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada karpal tünel sendromu (KTS) hastalarında HİLT tedavisinin ağrı, fonksiyonel durum ve el kavrama kuvveti üzerine ve USG’da median sinir kesit alanına etkisinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Bu çalışma prospektif, randomize, kontrollü çalışma olarak planlandı. Çalışmaya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon, Nöroloji polikliniklerine başvuran, KTS semptom ve bulguları olan 60 KTS hastası alınması planlandı. Fizik muayene ve elektrofizyolojik bulgularla hafif ve orta şiddette KTS tanısı konulmuş 60 hasta çalışmaya alındı. Değerlendirmede vizüel analog skala (VAS), Boston KTS Anketi (BCTQ), hidrolik el dinamometresi (Jamar) ve median sinir çapı ölçümü için USG kullanıldı. Hastalar gerçek LASER ve sham LASER tedavi grupları olarak rastgele iki gruba ayrıldı. Bütün hastalar tedavi öncesi, tedavi sonrası ve 3. ayda değerlendirildi.
Bulgular: Her iki grupta da el kavrama kuvvetinde 3. ay sonunda istatistiksel olarak anlamlı bir artış saptanırken (p<0.001), tedavi sonrası sadece YYLT grubunda istatistiksel olarak anlamlı bir artış saptandı (p<0.001). El kavrama kuvveti değişimi üzerine gruplar arası birbirine üstünlük bulunmadı (p=0.449). Tedavi öncesi median sinir kesit alanı değerleri arasında anlamlı bir fark vardı fakat bu fark YYLT grubunda
hastalık şiddeti lehineydi (p=0.013). Tedavi sonrası YYLT grubunda anlamlı düzelme gözlenirken (p<0.001), sham grubunda anlamlı bir düzelme gözlenmedi (p=0.931). 3. ay kontrollerinde ise her iki grupta da median sinir kesit alanı ölçümlerinde istatistiksel olarak anlamlı bir düzelme gözlendi (p değerleri YYLT için p<0.001, sham grubu için p=0.007). Boston anketi SSS-FDS skorları ve ağrı için VAS değerlerinde de her 3 değerlendirme parametresi için de tedavi öncesi-tedavi sonrası ve tedavi öncesi-3. ay kontrollerinde anlamlı bir düzelme gözlenirken (p<0.001), gruplar arası herhangi bir istatistiksel olarak anlamlı üstünlük bulunamamıştır (p değerleri sırasıyla p=0.973, p=0.226, p=0.454).
Sonuç: Hafif ve orta KTS’li hastalar için standart bir fizik tedavi programı ile birleştirilmiş yüksek yoğunluklu lazer tedavisi, el kavrama kuvveti ve USG’de ölçülen median sinir kesit alanı parametrelerini iyileştirmede erken dönemde tek başına fizik tedavi programından daha etkili olabilir. KTS hastalarında standart tedavi protokolü konusunda henüz kesin bir uzlaşıya varılmamış olsa da YYLT’yi konvansiyonel tedavi programına eklemek güvenli ve zararsız görünmektedir.
Objective: In this study, it was aimed to evaluate the effects of HILT treatment on pain, functional status and hand grip strength in patients with carpal tunnel syndrome (CTS) and on the median nerve area in USG. Material and methods: This study was planned as a prospective, randomized, controlled study. It was planned to include 60 CTS patients with CTS symptoms and signs who applied to Necmettin Erbakan University Meram Medical Faculty Physical Medicine and Rehabilitation, Neurology outpatient clinics. Sixty patients diagnosed with mild and moderate CTS by physical examination and electrophysiological findings were included in the study. Visual analog scale (VAS), Boston CTS Questionnaire (BCTQ), hydraulic hand dynamometer (Jamar) and USG were used for evaluation. The patients were randomly divided into two groups as real LASER+ TENS+ exercises+ splint and sham LASER+ TENS+ exercises+ splint treatment groups. All patients were evaluated before treatment, after treatment and at 3 months. Results: While there was a statistically significant increase in hand grip strength at the end of the 3rd month in both groups (p<0.001), a statistically significant increase was found only in the HİLT group after treatment (p<0.001). There was no superiority between the groups on the change in hand grip strength (p=0.449). There was a significant difference between median nerve cross-sectional area values before treatment, but this difference was in favor of disease severity in the HİLT group (p=0.013). While significant improvement was observed in the HİLT group after treatment (p<0.001), no significant improvement was observed in the sham group (p=0.931). In the 3rd month controls, a statistically significant improvement was observed in the cross-sectional area measurements of the median nerve in both groups (p values p<0.001 for HİLT, p=0.007 for the sham group). While a significant improvement was observed in the BCTQ SSS-FSS scores and VAS values for pain in the pre-treatment-post-treatment and pre-treatment-3nd month controls for all 3 evaluation parameters (p<0.001), no statistically significant superiority was found between the groups (p values were p=0.973, p=0.226, p=0.454, respectively). Conclusion: For patients with mild and moderate CTS, high-intensity laser therapy combined with a standard physical therapy program was found to be more effective than physical therapy alone in the early period in improving hand grip strength and median nerve cross-sectional area parameters measured on USG. Although there is no definite consensus on the standard treatment protocol in CTS patients, it seems safe to add YYLT to the conventional treatment program.
Objective: In this study, it was aimed to evaluate the effects of HILT treatment on pain, functional status and hand grip strength in patients with carpal tunnel syndrome (CTS) and on the median nerve area in USG. Material and methods: This study was planned as a prospective, randomized, controlled study. It was planned to include 60 CTS patients with CTS symptoms and signs who applied to Necmettin Erbakan University Meram Medical Faculty Physical Medicine and Rehabilitation, Neurology outpatient clinics. Sixty patients diagnosed with mild and moderate CTS by physical examination and electrophysiological findings were included in the study. Visual analog scale (VAS), Boston CTS Questionnaire (BCTQ), hydraulic hand dynamometer (Jamar) and USG were used for evaluation. The patients were randomly divided into two groups as real LASER+ TENS+ exercises+ splint and sham LASER+ TENS+ exercises+ splint treatment groups. All patients were evaluated before treatment, after treatment and at 3 months. Results: While there was a statistically significant increase in hand grip strength at the end of the 3rd month in both groups (p<0.001), a statistically significant increase was found only in the HİLT group after treatment (p<0.001). There was no superiority between the groups on the change in hand grip strength (p=0.449). There was a significant difference between median nerve cross-sectional area values before treatment, but this difference was in favor of disease severity in the HİLT group (p=0.013). While significant improvement was observed in the HİLT group after treatment (p<0.001), no significant improvement was observed in the sham group (p=0.931). In the 3rd month controls, a statistically significant improvement was observed in the cross-sectional area measurements of the median nerve in both groups (p values p<0.001 for HİLT, p=0.007 for the sham group). While a significant improvement was observed in the BCTQ SSS-FSS scores and VAS values for pain in the pre-treatment-post-treatment and pre-treatment-3nd month controls for all 3 evaluation parameters (p<0.001), no statistically significant superiority was found between the groups (p values were p=0.973, p=0.226, p=0.454, respectively). Conclusion: For patients with mild and moderate CTS, high-intensity laser therapy combined with a standard physical therapy program was found to be more effective than physical therapy alone in the early period in improving hand grip strength and median nerve cross-sectional area parameters measured on USG. Although there is no definite consensus on the standard treatment protocol in CTS patients, it seems safe to add YYLT to the conventional treatment program.
Açıklama
Anahtar Kelimeler
Karpal Tünel Sendromu, Carpal Tunnel Syndrome, Yüksek Yoğunluklu Lazer Tedavisi, High İntensity Laser Therapy, Median Sinir Kesit Alanı, Median Nerve Cross Sectional Area, El Kavrama Kuvveti, Grip Strength
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Künye
Yiğit, F. (2024). Karpal tünel sendromlu hastalarda yüksek yoğunluklu lazer tedavisinin ağrı, fonksiyonel durum, el kavrama kuvveti ve ultrasonografide median sinir kesit alanına etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Konya.
