Carpal Tunnel Syndrome (CTS) is the most common peripheral entrapment neuropathy, causing pain, paresthesia, and hand dysfunction due to median nerve compression at the wrist. While physiotherapy provides symptom relief, it does not effectively address the underlying neuroplastic deficits of the median nerve. Photobiomodulation (PBM), delivered at 830 nm near-infrared wavelength, has shown potential to enhance peripheral nerve regeneration via cytochrome c oxidase activation, ATP synthesis, and upregulation of neurotrophic factors including brain-derived neurotrophic factor (BDNF). This randomized controlled trial will evaluate whether 830 nm PBM (200 mW, 4 J/cm², 12 sessions over 4 weeks) combined with routine physiotherapy produces significantly greater neuroplastic recovery of the median nerve - assessed by high-resolution ultrasound (HRUS) measurement of median nerve cross-sectional area (CSA), nerve conduction study parameters and serum BDNF - compared to sham PBM combined with identical physiotherapy in adults with mild-to-moderate CTS. Neuroplasticity was operationalised as a multimodal construct comprising: (1) functional recovery, indexed by nerve conduction study parameters; (2) structural remodelling, indexed by median nerve cross-sectional area on high-resolution ultrasound; and (3) molecular neuroplastic signalling, indexed by serum BDNF. This multimodal approach was adopted because no single measure captures the full construct of peripheral nerve neuroplasticity (Padua et al., 2020).
Inclusion criteria
Exclusion Criteria
drmsajidphy@gmail.com923218486974
Participants are blinded to active versus sham allocation. The sham device is identical in appearance to the active device; an opaque probe cover prevents light emission detection. The device emits an identical audible operating tone in both conditions. Sham device thermal output is confirmed <0.1°C above ambient temperature. Treating physiotherapists are aware of allocation but do not conduct outcome assessments. The outcome assessor and neurophysiologist conducting NCS are blinded throughout.
830 nm photobiomodulation (200 mW, 46-diode cluster probe, 4 J/cm², continuous wave) applied over the carpal tunnel region (volar wrist), 3 sessions/week for 4 weeks (12 sessions total). Combined with wrist splinting in neutral position (nocturnal) and median nerve gliding exercises (3 × 10 reps twice daily).
Identical procedure using a deactivated PBM device (confirmed output \<1 mW by calibrated power meter). Same probe, contact time, and positioning as Group A. Combined with identical routine physiotherapy (wrist splinting + nerve gliding exercises).
ashfaq.ahmad@uipt.uol.edu.pk923009449192
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