Post Burn Cubital Tunnel Syndrome Response to High Intensity Laser Therapy Versus Shock Wave Therapy

Post Burn Cubital Tunnel Syndrome Response to High Intensity Laser Therapy Versus Shock Wave Therapy

Post-burn cubital tunnel syndrome is a disabling complication that may occur after upper-limb burns involving the elbow due to edema, scar formation, and tissue compression around the ulnar nerve. This randomized controlled trial compared the additive effects of high-intensity laser therapy (HILT) and extracorporeal shock wave therapy (ESWT), when combined with ulnar nerve gliding exercises, on electrophysiological parameters and upper-limb function in adults with clinically and electrophysiologically confirmed unilateral post-burn cubital tunnel syndrome following healed second- or third-degree burns.

Peripheral nerve entrapment is a recognized complication of burn injuries. Following second- or third-degree burns involving the elbow, edema, scar tissue formation, and tissue contracture may contribute to compression of the ulnar nerve within the cubital tunnel. Patients with post-burn cubital tunnel syndrome commonly experience pain, paresthesia, sensory disturbances, and impaired upper-limb function. Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity after carpal tunnel syndrome.

Given the limited evidence regarding conservative management of post-burn cubital tunnel syndrome, this assessor-blinded, parallel-group randomized controlled trial evaluated the effects of high-intensity laser therapy (HILT) and extracorporeal shock wave therapy (ESWT), each combined with ulnar nerve gliding exercises, compared with ulnar nerve gliding exercises alone. The study assessed changes in motor nerve conduction velocity, compound muscle action potential amplitude, and upper-limb function in adults aged 20-50 years with healed unilateral second- or third-degree upper-limb burns involving the elbow and clinically and electrophysiologically confirmed unilateral post-burn cubital tunnel syndrome.

Inclusion Criteria

• Men and women aged 20-50 years.
• Healed unilateral second- or third-degree upper-limb burns involving the elbow with a total body surface area (TBSA) <20%.
• Unilateral post-burn cubital tunnel syndrome confirmed clinically (including Tinel's sign) and electrophysiologically by focal slowing of ulnar nerve conduction across the elbow.
• Ability and willingness to provide informed consent and comply with the study protocol.

Exclusion Criteria

• Severe axonal loss indicating direct ulnar nerve injury.
• Generalized neuropathy or abnormal nerve conduction in the contralateral upper limb.
• Concurrent median or radial neuropathy or brachial plexus injury.
• Previous elbow fracture, ulnar nerve surgery, or extensive reconstructive procedures around the cubital tunnel (simple skin grafting permitted).
• Diabetes mellitus, active malignancy, pregnancy, active infection, coagulopathy, or cardiac pacemaker implantation.
• Other neurological disorders affecting upper-limb function.
• Participation in another rehabilitation or interventional study during the study period.
• Inability to adhere to the treatment protocol or scheduled assessments.