Carpal tunnel syndrome treatment exercises.

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Abstracts Introdução: Tanto o ultrassom terapêutico quanto o laser de baixa potência são utilizados para o controle da dor musculoesquelética, apesar de controvérsias.

Ainda, a literatura é pobre e também apresenta resultados controversos sobre efeitos cumulativos da associação de técnicas.

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Assim, o objetivo foi comparar os efeitos antinociceptivos do laser, carpal tunnel syndrome treatment exercises ultrassom e da associação destes.

Resultados: Na comparação dentro dos grupos, para o limiar de retirada quando o filamento foi aplicado nos joelhos, foi possível observar volta aos valores basais apenas para GUS. Em AV4 os três grupos tratados apresentaram valores maiores que o placebo.

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Conclusão: Ambas as modalidades apresentaram efeitos antinociceptivos. Medição da dor; Terapia a laserde baixa intensidade; Terapia por ultrassom Introduction: Both therapeutic ultrasound as a low level laser therapy are used to control musculoskeletal pain, despite controversy about its effects, yet the literature is poor and also presents conflicting results on possible cumulative effects of techniques association. The aim was to compare the antinociceptive effects of carpal tunnel syndrome treatment exercises level laser therapy, therapeutic ultrasound and the association.

Results: In comparison within groups, for the withdrawal threshold when the fi lament was applied to the knee, the back to baseline was observed only for GUS. In EV4 the three groups effectively treated were higher than placebo. Conclusion: Both modalities showed antinociceptive effects. Pain measurement; Low level laser therapy; Ultrasonic therapy Introduction In cases of joint pain such as that arising from knee osteoarthritis conditions, low-level laser therapy has been suggested as therapeutic modality, Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study.

Clin Rehabil.

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Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. The analgesic effect of this modality may occur by reduction of infl ammation mediators, Low-level laser therapy alleviates neuropathic pain and promotes function recovery in rats with chronic constriction injury: possible involvements in hypoxia-inducible factor 1α HIF-1α. J Comp Neurol. Inhibitory effects of visible nm and infrared nm laser irradiation on somatosensory and compound muscle action potentials in rat sciatic nerve: implications for laser-induced analgesia.

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J Peripher Nerv Syst. Analgesic effect of a low-level laser az ujjak ízületeinek ízületi gyulladásának kezelése nm in early orthodontic treatment. Lasers Med Sci. However, in cases of deep pain in individuals with acute and chronic low back pain, more expressive a kéz interfalangeális ízületeinek ízületi gyulladása of low level laser therapy versus placebo added to thermotherapy were not observed by Ay, Dogan and Evcik; Is low-level laser therapy effective in acute or chronic low back pain?

Clin Rheumatol.

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Jang H, Lee H. Meta-analysis of pain relief effects by laser irradiation on joint areas. Photomed Laser Surg. Ultrasound therapy is likely to be the most widely used physical agent in clinical practice, and its effects may occur by increasing the temperature or by the so-called nonthermal agents, via acoustic cavitation and fl ow.

Watson T. Ultrasound in contemporary physiotherapy practice. Ultrasound is also a modality that can promote pain reduction in cases of osteoarthritis.

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Short-term effectiveness of ultrasound therapy in knee osteoarthritis. J Int Med Res. Efficacy of ultrasound therapy for the management of knee osteoarthritis: a systematic review with meta-analysis. Osteoarthritis Cartilage. However, some studies show confl icting results regarding its effects, just as it occurs with the low level laser modality. Ultrasound therapy for musculoskeletal disorders: a systematic review. The effectiveness of therapeutic ultrasound for musculoskeletal conditions of the lower limb: A literature review.

When one seeks to assess deep articular pain, the model using formalin injection proves to be valid, yielding reliable results with respect to behavioral patterns in experimental animals. This allows an evaluation of the effect of different modalities of therapy that influence behaviors, that is, stimulating or decreasing nociception. Formalin injection into knee joints of rats: pharmacologic characterization of a deep somatic nociceptive model.

J Pain. Thus, it is interesting to use this model to compare the effects of isolated and associated therapeutic techniques. Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother.

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For all these reasons, this study aimed to compare the antinociceptive effects of low level laser, therapeutic ultrasound and the combination of these modalities, i.

Materials and methods Experimental groups Twenty-four female rats of the Wistar strain were used, weighing Carpal tunnel syndrome treatment exercises animals were obtained from the UNIOESTE Central Animal Bioterium, and were kept in polypropylene cages with free access to water and with food ad libitum, with light-dark cycle of 12 hours at controlled room temperature 24 ± 1ºC.

Assessment of nociception For an evaluation of nociception, the digital von Frey fi lament Insight®which tests nociceptive sensitivity to mechanical stimulus in animals, was used. An electronic pressure-meter nociception paw test for rats. Braz J Med Biol Res. The test was performed with the animal manually restrained, and the fi lament applied to the medial aspect of the tibiofemoral joint of the right hind limb.

The polypropylene filament tip was applied perpendicularly to the area, with a gradual increase in pressure, and as soon as the animal withdrew the member the test was interrupted to record the withdrawal threshold. Then the animal was placed in a wooden box with acrylic cover, and its bottom was made of metal trelliswork, through which it was possible to insert the filament in the plantar region of the feet of the animal. Again, pressure was applied and gradually increased until the animal withdrew the limb.

The study personnel were trained for five days in the nociceptive testing procedures. In carpal tunnel syndrome treatment exercises day following the last training day, values of limb withdrawing were collected before AV1 and after 15 AV2 and 30 AV3 minutes and, fi nally, after one hour AV4 of the induction of hyperaesthesia. Treatment protocols After the second evaluation, the treatment was initiated, i.

G1 did not suffer any therapeutic intervention only simulation.


Comparação do ultrassom pulsado e contínuo no reparo tendíneo de ratos. Fisioter Pesq. Avaliação do papel de opioides endógenos na analgesia do laser de baixa potência, nm, em joelhos de ratos Wistar.

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Rev Dor. After the final evaluation, the animals were euthanized by decapitation in guillotine. Statistical analysis Data normalcy was checked by using the Kolmogorov-Smirnov test, and in view of its normality, an intragroup analysis was done by ANOVA with one-way repeated measures for comparison between groups.

The effect size for each variable was calculated considering the strength of the effect as small r value 0. Both for GL Fig.

Thumbnail Fig. However, there was no difference in AV4. This last time point was signifi cantly higher than AV2 Fig. In comparisons among groups, again we were able to discern differences for AV3 and AV4. Discussion The hyperaesthesia model chosen formalin intra-articular injection produces two periods of nociceptive response, with interpolation of a period of quiescence, due to an inhibition of nociceptive transmission around 5 to 10 minutes Thus, aiming to avoid evaluations in that period of quiescence, we decided that the first reassessment would occur 15 minutes after the completion of chemical stimulation, seeking a moment in which we could evaluate more reliably the nociception with respect to therapeutic procedures.

Considering that one of the most common treatments for lesions in the carpal tunnel syndrome treatment exercises system is the use of nonhormonal anti-inflammatory drugs, with their serious side effects gastrointestinal ulcers, cardiovascular problems, etc.

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Infrared nm low-level laser therapy in rat achilles tendinitis: a consistent alternative to drugs. Photochem Photobiol. Alfredo et al.

The anti-inflammatory action may occur by changes in the cyclooxygenase pathway of arachidonic acid metabolism, besides the suppression of TNF-α, IL1β and hypoxia-inducing factor 1α HIF-1α ; Pre-Irradiation of blood by gallium aluminum arsenide nm low-level laser enhances peripheral endogenous opioid analgesia in rats.

Anesth Analg.

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In the evaluation of the withdrawal threshold, we noted signs of reduction of nociception only when the stimulus was applied to the plantar surface, returning to baseline values at the first reassessment after treatment, and, in the comparison between groups in AV3, the threshold was significantly higher than placebo, but not different from the group treated with ultrasound.

Although the comparison intragroup had not showed benefi cial results in terms of stimulation on the knee, a significant increase in the threshold in both AV3 and AV4 versus placebo was noted.

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According to Jang and Lee, Thus, this is a useful tool, in view of the absence of side effects. These authors also point out that a major problem in the use of laser is to find the appropriate dose for each case.

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In the present study, fluency, wavelength and irradiance were used; previously, these parameters have proved to be able to reduce the joint pain in this experimental model. Avaliação funcional da nocicepção do joelho de ratos tratada com laser de baixa potência e natação. Rev Bras Med Esporte.

Treatment of cervicogenic headache. Fizioterápia : Magyar Gyógytornászok Társaságának lapja, Szita Julia - Lovei-Polik Dorottya. The relationship between the carpal tunnel syndrome and the double crush syndrome.

Tascioglu et al. These authors found that only the pulsed group had significant improvement in terms of pain and WOMAC index. They also reported that the analgesia produced by ultrasound can occur by thermal effects, which increase the pain threshold, and that non-thermal effects may increase the permeability of the cell membrane and, thus, the metabolic transport. In the present study, a significant reduction csípőízület ligamentum kezelése the nociceptive situation in the animals treated with therapeutic ultrasound in both places evaluated and in intra- and intergroup comparisons was noted.

However, despite our choice in favor of the continuous modality, we believe that the therapeutic effects were not due to hyperthermia. In this situation, it would be necessary to administer a higher dose, and the tissue temperature should increase between 40 and 45ºC for at least 5 minutes. One possible explanation for the analgesic effect of non-thermal ultrasound is that the change produced in the cell membrane permeability can reduce the function of the sodium-potassium pump, thus hampering the nerve depolarization and leading to pain relief.

The significance of membrane changes in the safe and effective use of therapeutic and diagnostic ultrasound.

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Phys Med Biol. Another explanation is the reduction of inducible nitric oxide synthase in the spinal cord, thereby reducing its activity in the processing of pain and inflammation.

Hsieh YL. Effects of ultrasound and diclofenac phonophoresis on inflammatory pain relief: suppression of inducible nitric oxide synthase in arthritic rats. Phys Ther. According to Watson, This may have occurred in this study, since the joint capsule may have produced enhanced absorption and, therefore, most pronounced effects were obtained with the use of this modality when we evaluated the knee withdrawal threshold.


In agreement with these aspects, Bakhtiary and Rashidy-Pour Different results were obtained by Calis, Berberoglu and Calis Are ultrasound, laser and exercise superior to each other in the treatment carpal tunnel syndrome treatment exercises subacromial impingement syndrome?

A randomized clinical trial. Eur J Phys Rehabil Med. These authors found no benefits with any of the mentioned modalities. Contrary to that observed in the present study, Charluz et al. Ízületi fájdalom combfájás analysis of analgesic efficacy of selected physiotherapy methods in low back pain patients. Ortop Traumatol Rehabil. Rayegani et al. Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial.

The same was observed by Demir et al. Comparison of the effects of laser and ultrasound treatments on experimental wound healing in rats. J Rehabil Res Dev. The results of this study show that in the group of combined techniques, during the assessment of nociception in the plantar region an increase in the withdrawal threshold was noted, with restoration to the previous levels after one hour of hyperaesthesia induction, but there was no improvement regarding the evaluation of threshold on the knee.

Only in the comparison with placebo in AV4 carpal tunnel syndrome treatment exercises increase in the threshold was observed. Thus, it is inferred that when used alone, the therapies showed better results than the combination of the two techniques. This fact was also observed by Gum et al. Combined ultrasound, electrical stimulation, and laser promote collagen synthesis with moderate changes in tendon biomechanics. Am J Phys Med Rehabil. Demir et al.

Hivatkozások évente

Lasers Surg Med. Thus, it appears that a combination of techniques does not result in benefit, considering the results presented here and those of our brief review of the literature. Conclusion It can be concluded that both treatment modalities had antinociceptive effects, and the therapeutic ultrasound was superior versus laser and the combination of techniques, namely, the summation of effects did not occur with the use of this latter strategy.

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