DERLEMELER
Karpal Tünel Sendromunda Fizik Tedavi Modalitelerinde Güncel Konular: Bir Literatür Taraması
Current Issues in Physical Therapy Modalities in Carpal Tunnel Syndrome: A Literature Review
Received Date : 27 Mar 2024
Accepted Date : 07 Oct 2024
Available Online : 14 Oct 2024
Nevzat YEŞİLMENa, Muhammet Şahin ELBASTIb, Muhammed KORKMAZa
aElazığ Fethi Sekin City Hospital, Clinic of Physical Medicine and Rehabilitation, Elazığ, Türkiye
bElazığ Medical Hospital, Clinic of Physical Medicine and Rehabilitation, Elazığ, Türkiye
Doi: 10.31609/jpmrs.2024-103105 - Makale Dili: EN
Turkiye Klinikleri Journal of Physical Medicine and Rehabilitation Sciences. 2025;25(1):82-9
ÖZET
Karpal tünel sendromu (KTS), en sık görülen ve üzerinde en
çok çalışılan sinir sıkışma sendromudur ve tüm kompresif nöropatilerin
yaklaşık %90’ını oluşturur. Medyan sinirin dar bir alan olan karpal
tünelden geçerken sıkışması sonucu oluşur. Günümüzde KTS için invaziv
ve invaziv olmayan birçok tedavi önerilmektedir. İnvaziv tedaviler
arasında cerrahi ve kortikosteroid enjeksiyonu yer alır. Bu güncel
noninvaziv tedaviler arasında ise akupunktur, egzersiz ve mobilizasyon
teknikleri, splintleme, ultrason tedavisi, ekstrakorporeal şok dalga
terapisi [extracorporeal shock wave therapy (ESWT) ], düşük seviyeli
lazer tedavisi, yüksek seviyeli lazer tedavisi, kinesiotaping ve kupa tedavisi
yer almaktadır. Akupunktur ağrıyı, inflamasyonu, uyuşukluk hissini
başarılı bir şekilde hafifletir ve motor becerileri geri kazandırır.
Sinir kaydırma egzersizleri, tendonlar ve medyan sinir arasındaki yapışıklıkları
önleyerek semptomları iyileştirir. Şok dalgaları (ESWT),
enerji taşıyan ve dokular boyunca yayılabilen hızlı ancak kısa süreli
akustik dalgalardır. Lazer tedavisi, biyolojik uyarıma veya inhibisyona
neden olabilen bir fotobiyomodülasyon tedavisidir. Kinesiotaping, kan
ve lenfatik akışı artırmak ve ağrıyı azaltmak için baskıyı hafifleten elastik
bir bandajdır. Kupa terapisi, kan akışını iyileştirmek için hızlı, güçlü
ve ritmik kuvvet uygulayan eski bir yöntemdir. Sonuç olarak; çeşitli
konservatif tedaviler, hafif-orta dereceli KTS’li hastaların semptomlarını
hafifletebilir ve fonksiyonel yeteneklerini geliştirebilir. Yukarıdaki
yeni tedavi yöntemleri ve kombinasyonlarının KTS’de etkili olduğu
kanıtlanmıştır. Ancak yapılan çalışmalarda hem optimal tedavi dozları
hem de fizik tedavi yöntemlerinin uzun dönem sonuçları hala tam olarak
bilinmemektedir.
Anahtar Kelimeler: Karpal tünel sendromu; fizik tedavi; yeni modaliteler
ABSTRACT
Carpal tunnel syndrome (CTS) is the most common and
widely studied nerve entrapment syndrome, accounting for approximately
90% of all compressive neuropathies. It is caused by compression
of the median nerve while it passes through the carpal tunnel, a
limited space. Nowadays, many treatments are proposed for CTS,
which can be categorised into two groups of invasive and non-invasive.
The invasive treatments include surgery and corticosteroid injection of
carpal tunnel. Current non-invasive treatments include acupuncture, exercise
therapy and mobilization techniques, splinting, ultrasound, extracorporeal
shock wave therapy (ESWT), low-level laser therapy,
high-power laser therapy, kinesiotaping and cupping therapy. Acupuncture
successfully alleviates pain, inflammation, numbness, and restores
motor ability. Gliding exercises improve symptoms by preventing, or
stretching, the adhesions among the tendons and median nerve. Shockwaves
(ESWT) are rapid but short duration acoustic waves that carry
energy and can propagate through tissues. Laser therapy is a photobiomodulation
intervention which may cause either biological stimulation
or inhibition. Kinesiotaping is an elastic bandage that lifts up the
skin, relieving compression to increase blood and lymphatic flow and
reduce pain. Cupping therapy is an ancient method of applying quick,
vigorous, rhythmic force for improving blood supply. As a result; Various
conservative treatments can relieve symptoms and improve functional
abilities of patients with mild-to-moderate CTS. The above new
treatment modalities and combinations have proven effective in CTS.
However, in studies, both the optimal treatment doses and the longterm
results of physical therapy modalities are still not fully known.
Keywords: Carpal tunnel syndrome; physical therapy; new modalities
REFERENCES
- Olney RK. Carpal tunnel syndrome: complex issues with a "simple" condition. Neurology. 2001;56:1431-2. [Crossref] [PubMed]
- Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008;77:6-17. [PubMed] [PMC]
- Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15:1273-84. [Crossref] [PubMed]
- Annisa D, Rianawati S, Rahayuet M, et al. Carpal tunnel syndrome (Diagnosis and management). Journal of Pain, Vertigo and Headache (JPHV). 2021;2:5-7. [Crossref]
- Moharrami M, Nazari B, Anvari HM. Do the symptoms of carpal tunnel syndrome improve following the use of kinesio tape? Trauma Monthly. 2021;26:228-34. [Link]
- Berman BM, Langevin HM, Witt CM, et al. Acupuncture for chronic low back pain. N Engl J Med. 2010;363:454-61. Erratum in: N Engl J Med. 2010;363:893. [Crossref] [PubMed]
- Lao L. Acupuncture techniques and devices. J Altern Complement Med. 1996;2:23-5. [Crossref] [PubMed]
- Ye AP, Zou R. Observations on the efficacy of electroacupuncture plus acupuncture point injection in treating carpal tunnel syndrome. J Shanghai Journal of Acupuncture and Moxibustion. 2014;33:941-2. [Link]
- Mamipour H, Negahban H, Aval SB, et al. Effectiveness of physiotherapy plus acupuncture compared with physiotherapy alone on pain, disability and grip strength in people with carpal tunnel syndrome: a randomized clinical trial. J Bodyw Mov Ther. 2023;35:378-84. [Crossref] [PubMed]
- Hashmi JT, Huang YY, Osmani BZ, et al. Role of low-level laser therapy in neurorehabilitation. PM R. 2010;2:S292-305. [Crossref] [PubMed] [PMC]
- Chung H, Dai T, Sharma SK, et al. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012;40:516-33. [Crossref] [PubMed] [PMC]
- Naeser MA, Hahn KA, Lieberman BE, et al. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: a controlled study. Arch Phys Med Rehabil. 2002;83:978-88. [Crossref] [PubMed]
- Juan CW, Chang MH, Lin TH, et al. Laser acupuncture for carpal tunnel syndrome: a single-blinded controlled study. J Altern Complement Med. 2019;25:1035-43. [Crossref] [PubMed]
- Chen CC, Wu YT, Su YC, et al. Efficacy of laser acupuncture for carpal tunnel syndrome: a study protocol for a prospective double-blind randomized controlled trial. Medicine (Baltimore). 2019;98:e16516. [Crossref] [PubMed] [PMC]
- Martins RS, Siqueira MG. Conservative therapeutic management of carpal tunnel syndrome. Arq Neuropsiquiatr. 2017;75:819-24. [Crossref] [PubMed]
- Ballestero-Pérez R, Plaza-Manzano G, Urraca-Gesto A, et al. Effectiveness of nerve gliding exercises on carpal tunnel syndrome: a systematic review. J Manipulative Physiol Ther. 2017;40:50-9. [Crossref] [PubMed]
- Talebi GA, Saadat P, Javadian Y, et al. Comparison of two manual therapy techniques in patients with carpal tunnel syndrome: a randomized clinical trial. Caspian J Intern Med. 2020;11:163-70. [PubMed] [PMC]
- Karjalainen TV, Lusa V, Page MJ, et al. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2023;2:CD010003. [Crossref] [PubMed] [PMC]
- Manente G, Torrieri F, Di Blasio F, et al. An innovative hand brace for carpal tunnel syndrome: a randomized controlled trial. Muscle Nerve. 2001;24:1020-5. [Crossref] [PubMed]
- Golriz B, Ahmadi Bani M, Arazpour M, et al. Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome. Prosthet Orthot Int. 2016;40:617-23. [Crossref] [PubMed]
- Nadar MS, Alotaibi N, Manee F. Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of Carpal tunnel syndrome: an assessor-blinded randomised controlled trial. BMJ Open. 2023;13:e076961. [Crossref] [PubMed] [PMC]
- Gatheridge MA, Sholty EA, Inman A, et al. Splinting in carpal tunnel syndrome: the optimal duration. Mil Med. 2020;185:e2049-e54. [Crossref] [PubMed]
- Speed CA. Therapeutic ultrasound in soft tissue lesions. Rheumatology (Oxford). 2001;40:1331-6. [Crossref] [PubMed]
- de Oliveira Perrucini PD, Poli-Frederico RC, de Almeida Pires-Oliveira DA, et al. Anti-inflammatory and healing effects of pulsed ultrasound therapy on fibroblasts. Am J Phys Med Rehabil. 2020;99:19-25. [Crossref] [PubMed]
- Jiang X, Savchenko O, Li Y, et al. A review of low-intensity pulsed ultrasound for therapeutic applications. IEEE Trans Biomed Eng. 2019;66:2704-18. [Crossref] [PubMed]
- Ortanca B, Armağan O, Bakılan F, et al. A randomized-controlled clinical trial comparing the effects of steroid phonophoresis and therapeutic ultrasound in carpal tunnel syndrome. Arch Rheumatol. 2022;37:517-26. [Crossref] [PubMed] [PMC]
- Bagcaci S, Yilmaz R, Sahin N. Efficiency of therapeutic underwater ultrasound therapy in mild-to-moderate carpal tunnel syndrome: a randomized sham-controlled study. Turk J Phys Med Rehabil. 2023;69:366-76. [Crossref] [PubMed] [PMC]
- Simplicio CL, Purita J, Murrell W, et al. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma. 2020;11:S309-S18. [Crossref] [PubMed] [PMC]
- Zhang L, Yang T, Pang L, et al. Effects of extracorporeal shock wave therapy in patients with mild-to-moderate carpal tunnel syndrome: an updated systematic review with meta-analysis. Journal of Clinical Medicine. 2023;12:7363. [Crossref] [PubMed] [PMC]
- Li W, Dong C, Wei H, et al. Extracorporeal shock wave therapy versus local corticosteroid injection for the treatment of carpal tunnel syndrome: a meta-analysis. J Orthop Surg Res. 2020;15:556. [Crossref] [PubMed] [PMC]
- Menekseoglu AK, Korkmaz MD, Segmen H. Clinical and electrophysiological efficacy of extracorporeal shock-wave therapy in carpal tunnel syndrome: a placebo-controlled, double-blind clinical trial. Rev Assoc Med Bras (1992). 2023;69:124-30. [Crossref] [PubMed] [PMC]
- Ezzati K, Fekrazad R, Raoufi Z. The effects of photobiomodulation therapy on post-surgical pain. J Lasers Med Sci. 2019;10:79-85. [Crossref] [PubMed] [PMC]
- Casale R, Damiani C, Maestri R, et al. Pain and electrophysiological parameters are improved by combined 830-1064 high-intensity LASER in symptomatic carpal tunnel syndrome versus Transcutaneous Electrical Nerve Stimulation. A randomized controlled study. Eur J Phys Rehabil Med. 2013;49:205-11. [PubMed]
- Hojjati F, Afjei MH, Ebrahimi Takamjani I, et al. The effect of high-power and low-power lasers on symptoms and the nerve conduction study in patients with carpal tunnel syndrome. a prospective randomized single-blind clinical trial. J Lasers Med Sci. 2020;11:S73-S9. [Crossref] [PubMed] [PMC]
- Ezzati K, Laakso EL, Saberi A, et al. A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome. Eur J Phys Rehabil Med. 2020;56:733-40. [Crossref] [PubMed]
- Williams S, Whatman C, Hume PA, et al. Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness. Sports Med. 2012;42:153-64. [Crossref] [PubMed]
- Movaghar S, Roostayi MM, Naimi SS, et al. Comparison of 4 weeks of cupping and Kinesio-taping on clinical and ultrasound outcomes of carpal tunnel syndrome during pregnancy. J Bodyw Mov Ther. 2023;35:57-63. [Crossref] [PubMed]
- de Sire A, Curci C, Ferrara M, et al. Efficacy of kinesio taping on hand functioning in patients with mild carpal tunnel syndrome. A double-blind randomized controlled trial. J Hand Ther. 2022;35:605-12. [Crossref] [PubMed]
- Külcü D, Bursalı C, Aktas İ, et al. Kinesiotaping as an alternative treatment method for carpal tunnel syndrome. Turkish Journal of Medical Sciences. 2016;46:1042-9. [Crossref] [PubMed]
- Farhat A, Mughal SM. Is there a role of cupping therapy in the treatment of carpal tunnel syndrome in primary care setting? Cureus. 2021;13:e12954. [Crossref] [PubMed] [PMC]
- Mohammadi S, Roostayi MM, Naimi SS, et al. The effects of cupping therapy as a new approach in the physiotherapeutic management of carpal tunnel syndrome. Physiother Res Int. 2019;24:e1770. [Crossref] [PubMed]