Laser therapy carpal tunnel syndrome (CTS)

Photomedicine and Laser Surg, Volume 32, Number 6, 2014

Milica Lazovic, MD, PhD,1 Olivera Ilic-Stojanovic, MD, PhD,1 Mirjana Kocic, MD, PhD,2
Vesna Zivkovic, MD, PhD, 3 Marija Hrkovic, MD,1 and Natasa Radosavljevic, MD1

Objectives: This study investigated the short-term efficacy of low-level laser therapy (LLLT) in patients with mild to moderate carpal tunnel syndrome (CTS), lasting for < 1 year.

Methods: Seventy-nine patients with CTS were included in this double-blind, placebo-controlled study, and randomly divided in two treatment groups: Experimental group (EG), active laser group (40 patients); and control group (CG), placebo (sham) laser group (39 patients). A GaAlAs diode laser [780 nm, 30mW continuous wave (CW), 0.785 cm2, 38.2 mW/cm2] was applied in contact with four points perpendicularly to the skin over the carpal tunnel area for 90 sec per point (2.7 J, 3.4 J/cm2/point). Both groups were treated five times per week, once a day over 2 weeks, followed by 10 treatments every other day for 3 weeks, that is, for a total of 20 treatments. Clinical assessment, including visual analogue scale (VAS) pain rating, Tinel�s sign, and median nerve conduction studies (NCSs) were evaluated before, and 3 weeks after, the last LLLT treatment.

Results: Significant reduction in pain, reduction in the percentage of patients with a positive Tinel�s sign, and shortening of sensory and motor latency time in the NCS examination was observed in the experimental LLLT group (but not in the control group).

Conclusions: This study has observed and documented the statistically significant short-term effects of LLLT on CTS patients in comparison with a placebo group. The results support this conclusion, especially if the LLLT is applied in the earlier stages of CTS, and with mild to moderate cases.

Wen-Dien Chang, M.S.,1,2 Jih-Huah Wu, Ph.D.,3 Joe-Air Jiang, Ph.D., P.E.,1, Chun-Yu Yeh, Ph.D.,4 and Chien-Tsung Tsai, M.S.2

Objective: The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830- nm diode laser on carpal tunnel syndrome (CTS).

Background Data: Many articles in the literature have demonstrated that low-level laser therapy (LLLT) may help to alleviate various types of nerve pain, especially for CTS treatment. We placed an 830-nm laser directly above the transverse carpal ligament, which is between the pisiform and navicular bones of the tested patients, to determine the therapeutic effect of LLLT.

Methods: Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received laser treatment (10 Hz, 50% duty cycle, 60 mW, 9.7 J/cm2, at 830 nm), and the placebo group received sham laser treatment. Both groups received treatment for 2 wk consisting of a 10-min laser irradiation session each day, 5 d a week. The therapeutic effects were assessed on symptoms and functional changes, and with nerve conduction studies (NCS), grip strength assessment, and with a visual analogue scale (VAS), soon after treatment and at 2-wk follow-up.

Results: Before treatment, there were no significant differences between the two groups for all assessments (p 0.05). The VAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up (p  0.05). After 2 wk of treatment, no significant differences were found in grip strengths or for symptoms and functional assessments (p 0.05). However, there were statistically significant differences in these variables at 2-wk follow-up (p  0.05). Regarding the findings of NCS, there was no statistically significant difference between groups after treatment and at 2- wk follow-up.

Conclusions: LLLT was effective in alleviating pain and symptoms, and in improving functional ability and finger and hand strength for mild and moderate CTS patients with no side effects.

Piazzini DB; Aprile I; Ferrara PE; Bertolini C; Tonali P; Maggi L; Rabini A; Piantelli S; Padua L

Clinical rehabilitation; VOL: 21 (4); p. 299-314 /200704/England, 8802181, 0269-2155 CEHAEN
Department of Physical Medicine and Rehabilitation, Catholic University.

Journal Article

Objective: To assess the effectiveness of conservative therapy in carpal tunnel syndrome.

Data sources: A computer-aided search of MEDLINE and the Cochrane Collaboration was conducted for randomized controlled trials (RCTs) from January 1985 to May 2006.

Review methods: RCTs were included if: (1) the patients, with clinically and electrophysiologically confirmed carpal tunnel syndrome, had not previously undergone surgical release, (2) the efficacy of one or more conservative treatment options was evaluated, (3) the study was designed as a randomized controlled trial. Two reviewers independently selected the studies and performed data extraction using a standardized form. In order to assess the methodological quality, the criteria list of the Cochrane Back Review Group for systematic reviews was applied. The different treatment methods were grouped (local injections, oral therapies, physical therapies, therapeutic exercises and splints).

Results: Thirty-three RCTs were included in the review. The studies were analysed to determine the strength of the available evidence for the efficacy of the treatment. Our review shows that: (1) locally injected steroids produce a significant but temporary improvement, (2) vitamin B6 is ineffective, (3) steroids are better than non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics, but they can produce side-effects, (4) ultrasound is effective while laser therapy shows variable results, (5) exercise therapy is not effective, (6) splints are effective, especially if used full-time.

Conclusions: There is: (1) strong evidence (level 1) on efficacy of local and oral steroids; (2) moderate evidence (level 2) that vitamin B6 is ineffective and splints are effective and (3) limited or conflicting evidence (level 3) that NSAIDs, diuretics, yoga, laser and ultrasound are effective whereas exercise therapy and botulinum toxin B injection are ineffective.

The aim was to evaluate the LLLT in CTS (ENG: < 6,9 ms) monitored by EMG and VAS (Visual Analogous Scale) recordings. 72 hands with CTS treated by LLLT (15 sessions/30 min, over a period of 5 weeks) were evaluated by a double blind � randomised study. ENG and VAS (visual analogous scale) were performed prior to and after LLLT. LLLT (wavelength 830 nm, 400 mW) with an energy of 3J per point focused on the Carpal � tunnel, on trigger and acupuncture � points was performed in 38 cases, in 38 cases (control � group) we used a red light pen. Follow-up ranged from 8 to 12 months. ENG and VAS improved in 66%, didn�t change in 8% and got worse in 26% in the LLLT group after a 12 month period. No improvement was recorded in the control group.

The results suggest that LLLT can be recommended in mild or average CTS (ENG < 4,9 ms) especially if a conservative treatment is required.

Western Heart Institute and St. Mary's Spine Center St. Mary's Medical Center. San Francisco. CA. USA and Head and Neck Pain Center, Honolulu HL. USA Abstract. Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury" (RSI) or "carpal tunnel syndrome" (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation. they have pain and tenderness at the spinous processes C5 - T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser (100 mW) was used and directed at the tips of the spinous processes C5 - Tl. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers. and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labeled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping. Cervical collars, and clavicle harnesses as well as improved work ergonomics.

E. Wong G LEE J. Zu CHERMAN and D. P. MASON
Western Heart Institute and St. Mary's Spine Center St. Mary's Medical Center. San Francisco. CA. USA and Head and Neck Pain Center, Honolulu HL. USA

Abstract: Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury" (RSI) or "carpal tunnel syndrome" (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation. they have pain and tenderness at the spinous processes C5 - T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser ( 100 mW) was used and directed at the tips of the spinous processes C5 - Tl. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers. and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labeled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping. cervical collars, and clavicle harnesses as well as improved work ergonomics.

Manuscript received: July, 1997
Accepted for publication: September, 1997
LASER THERAPY, 1997:9: 131- 136