KARPAL TÜNEL SENDROMLU HASTALARDA MANUEL TEDAVİ VE EKSTRAKORPOREAL ŞOK DALGA TEDAVİSİNİN ETKİLERİNİN KARŞILAŞTIRILMASI

Amaç: Karpal tünel sendromlu hastalarda farklı fizyoterapi yöntemlerinin ağrı, semptom şiddeti, fonksiyonellik düzeyleri üzerindeki erken dönem etkilerini araştırmak ve birbirlerine üstünlüğünü değerlendirmektir. Yöntem: Çalışmamıza 25-60 yaş aralığında 75 hasta (69: K, 6: E) dahil edildi. Hastalar 3 gruba ayrıldı. Birinci gruba median sinir ve tendon kaydırma egzersizlerini içeren ev programı (EP) verildi. İkinci gruba aynı ev programına ilaveten yumuşak doku ve eklem mobilizasyonu içeren manuel tedavi (MT) uygulandı. Üçüncü gruba da aynı ev programına ilaveten ekstrakorporeal şok dalga tedavisi (ESWT) uygulandı. Ağrı şiddeti Vizuel Ağrı Skalası ile, semptom şiddeti ve fonksiyonellik düzeyleri Boston Karpal Tünel Sendromu Anketi ve Cochin El Fonksiyon Anketi ile değerlendirildi. Hastaların ölçümleri tedaviden önce ve sonra yapıldı. Sonuçlar: Tedaviden sonraki değerlendirmelerde her 3 grubun istirahat ve aktivite ağrılarında anlamlı düşüş bulunurken (p<0,05), MT ve ESWT grupları arası fark bulunmadı (p>0,05). Ancak iki grubun ağrı değerlerinde EP grubuna göre anlamlı azalma görüldü (p<0,05). Tüm gruplarda fonksiyonellik düzeylerinde anlamlı artış bulundu (p<0,05). Semptom şiddetinde azalma ve fonksiyonellik düzeylerindeki artış, MT ile ESWT gruplarında EP grubuna göre anlamlı bulunurken (p<0,05), MT ile ESWT grupları arasında fark bulunmadı (p>0,05). Tedaviden sonra MT ve ESWT gruplarının ağrı, semptom şiddeti ve fonksiyonellik değerleri karşılaştırmasında grupların birbirlerine üstünlükleri bulunmadı. Tartışma: Çalışmamızda KTS hastalarında kullandığımız MT ve ESWT uygulamasının yalnızca EP egzersizlerine göre anlamlı iyileşme sağladığı görüldü. Erken dönemde görülmeyen bazı farkların, uzun dönem takiplerde görülebileceğini düşünüyoruz. Uzun dönem sonuçları değerlendirmek için ileri çalışmalar yapılmalıdır.

Anahtar Kelimeler:

karpal tünel sendromu, sinir kaydırma, tendon kaydırma, manuel tedavi, Ekstrakorporeal Şok Dalga Tedavisi

A COMPARISON OF MANUAL THERAPY AND EXTRACORPOREAL SHOCKWAVE THERAPY IN PATIENTS WITH CARPAL TUNNEL SYNDROME

Purpose: To investigate the effects on pain, symptom severity, and functionality of different physiotherapy methods applied to patients with carpal tunnel syndrome and to evaluate the advantages of these over each other. Methods: A total of 75 patients (69 females, 6 males) aged 25-60 years were separated into 3 groups. The patients in Group 1 were given a home exercise program (HP), including median nerve and tendon gliding exercises. Group 2 received the same HP plus manual therapy (MT), including soft tissue and joint mobilisation. Group 3 received the same HP plus extracorporeal shockwave therapy (ESWT). Pain severity was evaluated with a Visual Analog Scale. Symptom severity and levels of functionality were evaluated with the Boston Carpal Tunnel Syndrome Questionnaire and the Cochin Hand Function Questionnaire. All the patients were evaluated before and after treatment. Results: While there was a significant decrease in the resting and activity pain levels of each 3 groups after the treatment (p<0,05), no significant difference was found between MT and ESWT groups (p> 0.05). However, the pain values of these two groups were significantly decreased compared to the EP group (p <0.05). The pain values of both groups were significantly lower than those of the HP control group (p <0.05). A statistically significant increase was determined in the level of functionality in all the groups after treatment (p<0.05). The decrease in symptom severity and the increase in functionality were significantly greater in the MT and ESWT groups compared to the HP group (p<0.05). After the treatment, there were no superiorities with respect to the pain, symptom severity, and functionality values of the MT and ESWT groups (p>0.05). Conclusion: In our study, the MT and ESWT applications we used in patients with CTS patients provided significant improvement compared to HP exercises only. We speculate that some differences that are not seen in the early period can be seen in long-term follow-up. Further studies should be performed to assess the longterm results.

Keywords:

Carpal Tunnel Syndrome, Nerve Gliding, Tendon Gliding, Manual Therapy, Extracorporeal Shockwave Therapy,

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