ASSIGNMENT No # 2

Scientific inquiry and research methodology

Topic: synopsis writing
Submitted to : Dr. Jaweria
Submitted by : Alisha Farasat
Roll no : 70106604
Semester : 8th
Section : A

The University of Lahore, Lahore

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1.Problem statement:
Effects of low level LASER therapy in patients with carpal tunnel
syndrome

2.Introduction
In middle-aged persons, carpal tunnel syndrome (CTS) is the most prevalent
entrapment neuropathy that affects the upper extremity (UE). With a female to
male ratio of 3:1, it affects more women than men.The median nerve is pressed as
it travels through the carpal tunnel, which is the reason for it. In addition to
weakening the muscles supplied by the median nerve, compression of the median
nerve causes sensory abnormalities like numbness and tingling along the nerve’s
route in the hand. Loss of hand sensation can have a significant impact on hand
function in CTS even if motor function is intact. The brain receives data from the
hand’s sensation for a variety of tasks, including object detection and applying the
right amount of force of power to hold a thing.[1]

Its prevalence has been estimated to range from 0.125 to 1%. Women are affected
by CTS ten times more frequently than males, and it most frequently affects people
between the ages of 40 and 60. It affects between 3% and 3.4% of females and
between 0.6% and 2.7% of males. 1,2 In terms of aetiology, there are secondary
factors such endocrine system disorders, infiltrative lesions in the carpal tunnel,
tumoral formations, traumatic events, connective tissue and rheumatic diseases,
and pregnancy. Despite the fact that there are numerous disorders that can cause
CTS, idiopathic causes account for around half of all instances. Symptoms;
Paresthesia and nighttime discomfort are the most significant characteristics. The
forearm and shoulder may also experience pain and paresthesia that wake up the
patient from sleep.[2]

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Carpal tunnel syndrome (CTS) has been treated with low-level laser therapy
(LLLT) for a long time, however there is no agreement on whether it is successful.
This meta-analysis was carried out to assess the efficacy of low-level laser therapy
in the management of mild to moderate CTS.Wavelength, power, frequency, pulse
presence or absence, action position, and treatment schedule were all crucial LLLT
parameters. The included studies used a variety of laser irradiation dosages for the
patients; the doses are expressed as energy ranging from 2.7 to 11 J for each spot
or as total energy ranging from 81 to 300 J for the entire therapy. The most
frequent action position was three or five places along the median nerve at the
wrist.[3]
3.Literature review:

Sehnaz Tezcan MD et al in June 2018 conducted a RCT to assess the effectiveness

of low-level laser therapy on median nerve stiffness in carpal tunnel syndrome
using strain elastography (CTS). The purpose of this study is to determine the
stiffness of the median nerve in CTS. They concluded that following low-level
laser therapy, the median nerve’s strain ratio and cross-sectional area decrease.
These alterations could be attributed to the beneficial effects of low-level laser
therapy, including improved vascular supply and nerve regrowth.[4]

Aliaa Elgendy et al in June 2020 conducted a placebo-controlled study to

determine the therapeutic and photobiomodulation effects of low level LASER
therapy in patients with CTS. The aims of this study is to provide light on how
LLLT affects clinical, inflammatory, and electrophysiological features in CTS
patients. According to this study, LLLT is safe and has beneficial benefits on
patients with CTS in terms of pain, inflammation, functional ability, and electro-
neurophysiological features of the median nerve.[5]

Farida Khatun Chhobi at el conducted a RCT to assess the effectiveness of LLLT

in patients with carpel tunnel syndrome. The purpose of this study is to decrease
pain, swelling, and nerve irritation by having anti-inflammatory actions, by
selectively inhibiting nociceptive activity at peripheral nerves by increasing ATP
synthesis and cellular respiration, and by improving blood circulation to flush out

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analgesics. They concluded that in mild or moderate CTS, low intensity laser
therapy is more clinically helpful after six weeks than night-resting splints.[6]

W.K.W.Cheung at el in June 2019 conducted a meta analysis to determine the

efficacy of low level laser therapy in patients of CTS with comparison to other
conservative treatments. They concluded that in terms of pain relief, symptom
severity reduction, or better functional status, using LLLT in addition to splinting
is not advised for the management of CTS.[7]

Funda Tascioglu at el in December 2010 conducted a RCT to observe the effects of

LLLT in carpel tunnel syndrome patients. The purpose of this study is to
investigate how LLLT affected electrophysiological and clinical variables in CTS
patients. Additionally, based on the findings that LLLT has anti-inflammatory and
anti-edema effects, we sought to determine whether LLLT may also have such
effects on the median nerve by using ultrasonography to measure the maximal
CSA. The outcomes revealed that, with the selected laser type and dose regimen,
LLLT was no more efficacious than a placebo in CTS.[8]

4.Objective:
The aim of my study is to improve pain , hand grip strength and self support hand
functions using Helium Neon laser (632.8mm, Laser Level 300M) in continuous
wave mood. The minimum power of 12mW has been used.

5.Operational definition:
Carpal tunnel syndrome (CTS) is a common medical condition that remains one of
the most frequently reported forms of median nerve compression. CTS occurs
when the median nerve is squeezed or compressed as it travels through the wrist.
The syndrome is characterized by pain in the hand, numbness, and tingling in the
distribution of the median nerve [9]
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6.Hypothesis:
Null hypothesis:
There is no significant difference in the effects of low level laser therapy in
CTS patients.
Alternate hypothesis:
There is a significant difference in the effects of low level laser therapy in
CTS patients.

7.Material and methods:

Study design: RCT
Setting: UOL teaching hospital
Duration of technique: 9 months
Sampling technique: Random sampling
Sample size: 28 male, 20 females
Inclusion criteria:
Patient who have bilateral CTS are included in this study
Exclusion criteria:
Patients with
 History of wrist surgery
 Peripheral neuropathy
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  Fructure or CTS injection
 Brachial plexopathy
 Thoracic outlet syndrome
 Pregnancy
 Acromegaly
 Rheumatoid arthritis
 Diabetes
8.Data collection procedure:
Patient selection criteria:
Patients which have Carpal tunnel syndrome with pain , less hand grip strength
and disturbed self supported hand functions.

Randomization:
Simple Randomization
Blindness:
Double blindness
Assessment outcome variable:
1. Pain
 Dependent variable
 Ordinal scale
2. Hand grip strength
 Dependent variable
 Ordinal scale
3. Self supported hand functions
 Dependent variable
 Nominal scale
Intervention:
1. Low level laser therapy
 Independent variable

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Data analysis:
 MANOVA multivariate analysis of variance

10.References:

1.Elbalawy YM, Fahmy EM, Taha SI, El Sherbini AE, Abdelghany AI, El-Serougy
HR. Effect of Sensory Relearning on Sensory and Motor Functions of the Hand in
Patients with Carpal Tunnel Syndrome: A Randomized Controlled Clinical Trial.
International Journal of Psychosocial Rehabilitation. 2020;24(05).

2.Soyuer F. Effectiveness of current physiotherapy in carpal tunnel syndrome. Int J

Fam Commun Med. 2021;5(3):87-9

3.Li ZJ, Wang Y, Zhang HF, Ma XL, Tian P, Huang Y. Effectiveness of low-level
laser on carpal tunnel syndrome: a meta-analysis of previously reported
randomized trials. Medicine. 2016 Aug;95(31).

4.Tezcan S, Ulu Ozturk F, Uslu N, Nalbant M, Umit Yemisci O. Carpal tunnel

syndrome: evaluation of the effects of low‐level laser therapy with ultrasound
strain imaging. Journal of Ultrasound in Medicine. 2019 Jan;38(1):113-22.

5.Elgendy A, Ali MA, Medhat A, Zikri EN, Ganem MM. Therapeutic and
photobiomodulation effects of low-level laser irradiation on Egyptian patients with

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carpal tunnel syndrome: a placebo-controlled study. Journal of The Arab Society
for Medical Research. 2020 Jan 1;15(1):18.

6.Chhobi FK, Abedin MM, Happy BD, Yusuf MA, Hussain ME, Islam R. Efficacy
of Low Intensity Laser Therapy for Carpal Tunnel Syndrome: Experience of 54
Cases in Bangladesh. Journal of National Institute of Neurosciences Bangladesh.
2021;7(2):103-7.

7.Cheung WK, Wu IX, Sit RW, Ho RS, Wong CH, Wong SY, Chung VC. Low-
level laser therapy for carpal tunnel syndrome: systematic review and network
meta-analysis. Physiotherapy. 2020 Mar 1;106:24-35.

8.Tascioglu F, Degirmenci NA, Ozkan S, Mehmetoglu O. Low-level laser in the

treatment of carpal tunnel syndrome: clinical, electrophysiological, and
ultrasonographical evaluation. Rheumatology international. 2012 Feb;32(2):409-
15.

9.Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal tunnel syndrome: a

review of literature.

Cureus. 2020 Mar 19;12(3).