Carpal Tunnel Syndrome

Medicine (Baltimore). 2016 Aug;95(31):e4424. doi: 10.1097/MD.0000000000004424.

Effectiveness of low-level laser on carpal tunnel syndrome: A meta-analysis of previously reported randomized trials.

Li ZJ1, Wang Y, Zhang HF, Ma XL, Tian P, Huang Y.

Author information

  • 1aDepartment of Orthopedics, Tianjin Medical University General Hospital bDepartment of Oncological Surgery, Tianjin Nankai Hospital, Tianjin Integrated Traditional Chinese and Western Medicine Hosptial cDepartment of Orthopedics, Tianjin Hospital, Tianjin, People’s Republic of China dCancer & Immunology Research, Children’s Research Institute, Children’s National Medical Center, Washington DC.

Abstract

BACKGROUND:

Low-level laser therapy (LLLT) has been applied in the treatment of carpal tunnel syndrome (CTS) for an extended period of time without definitive consensus on its effectiveness. This meta-analysis was conducted to evaluate the effectiveness of low-level laser in the treatment of mild to moderate CTS using a Cochrane systematic review.

METHODS:

We conducted electronic searches of PubMed (1966-2015.10), Medline (1966-2015.10), Embase (1980-2015.10), and ScienceDirect (1985-2015.10), using the terms “carpal tunnel syndrome” and “laser” according to the Cochrane Collaboration guidelines. Relevant journals or conference proceedings were searched manually to identify studies that might have been missed in the database search. Only randomized clinical trials were included, and the quality assessments were performed according to the Cochrane systematic review method. The data extraction and analyses from the included studies were conducted independently by 2 reviewers. The results were expressed as the mean difference (MD) with 95% confidence intervals (CI) for the continuous outcomes.

RESULTS:

Seven randomized clinical trials met the inclusion criteria; there were 270 wrists in the laser group and 261 wrists in the control group. High heterogeneity existed when the analysis was conducted. Hand grip (at 12 weeks) was stronger in the LLLT group than in the control group (MD?=?2.04; 95% CI: 0.08-3.99; P?=?0.04; I?=?62%), and there was better improvement in the visual analog scale (VAS) (at 12 weeks) in the LLLT group (MD?=?0.97; 95% CI: 0.84-1.11; P?<?0.01; I?=?0%). The sensory nerve action potential (SNAP) (at 12 weeks) was better in the LLLT group (MD?=?1.08; 95% CI: 0.44-1.73; P?=?0.001; I?=?0%). However, 1 included study was weighted at >95% in the calculation of these 3 parameters. There were no statistically significant differences in the other parameters between the 2 groups.

CONCLUSION:

This study revealed that low-level laser improve hand grip, VAS, and SNAP after 3 months of follow-up for mild to moderate CTS. More high-quality studies using the same laser intervention protocol are needed to confirm the effects of low-level laser in the treatment of CTS.

Lasers Med Sci. 2014 May;29(3):1279-87. doi: 10.1007/s10103-014-1527-2. Epub 2014 Jan 30.
Low-level laser therapy with a wrist splint to treat carpal tunnel syndrome: a double-blinded randomized controlled trial.
Fusakul Y1, Aranyavalai T, Saensri P, Thiengwittayaporn S.
Author information
1Department of Physical Medicine and Rehabilitation, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Abstract
The efficacy of low-level laser therapy (LLLT) was evaluated in a total of 66 patients with mild to moderate carpal tunnel syndrome (CTS) with a double-blinded randomized controlled study. The patients were randomly assigned into two groups. Group I received 15 sessions of a gallium-aluminum-arsenide laser treatment at a dosage of 18 J per session over the carpal tunnel area with neutral wrist splint. Group II received placebo laser therapy with neutral wrist splint. The patients were evaluated with the following parameters: (1) clinical parameters which consisted of visual analog scale, symptom severity scale, functional status scale, and pinch strength and grip strength before the treatment and at 5- and 12-week follow-ups and (2) electroneurophysiological parameters from nerve conduction study which were evaluated before the treatment and at 12-week follow-up. Fifty nine patients (112 hands: unilateral CTS = 6 hands and bilateral CTS = 106 hands) completed the study. Both groups I and II had n = 56 hands. Improvements were significantly more pronounced in the LLLT-treated group than the placebo group especially for grip strength at 5- and 12-week follow-ups. At 12-week follow-up, distal motor latency of the median nerve was significantly improved in the LLLT group than the placebo group (p < 0.05). LLLT therapy, as an alternative for a conservative treatment, is effective for treating mild to moderate CTS patients. It can improve hand grip strength and electroneurophysiological parameter with a carry-over effect up to 3 months after treatment for grip strength of the affected hands.
.
Photomed Laser Surg. 2014 Jun;32(6):336-44. doi: 10.1089/pho.2013.3563.
Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome.
Lazovic M1, Ilic-Stojanovic O, Kocic M, Zivkovic V, Hrkovic M, Radosavljevic N.
Author information
11 Institute for Rehabilitation , Belgrade, Serbia, Medical Faculty Belgrade, Serbia .
Abstract
OBJECTIVE:
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, 30 mW continuous wave (CW), 0.785 cm(2), 38.2 mW/cm(2)] 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/cm(2)/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.
J Back Musculoskelet Rehabil. 2015 Sep 25. [Epub ahead of print]

Efficacy of low-level laser therapy associated to orthoses for patients with carpal tunnel syndrome: A randomized single-blinded controlled trial.

Barbosa RI1,2, Fonseca MC1,3, Rodrigues EK1, Tamanini G1, Marcolino AM1,2, Mazzer N3, Guirro RR1,3, MacDermid J4.
Author information
1Rehabilitation and Performance Program, University of São Paulo, Ribeirão Preto, Brazil.
2Federal University of Santa Catarina, Araranguá, Brazil.
3Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, University of São Paulo, Ribeirão Preto, Brazil.
4School of Rehabilitation Science, McMaster University, Canada.
Abstract
OBJECTIVE:
Compare the efficacy of orthoses and patient education with and without the addition to Low-Level Laser Therapy (LLLT – 660 nm, 30 mW, a continuous regime and bean area of 0.06 cm2). The laser irradiation was delivered with the fluency of 10J/cm2 in patients with mild and moderate Carpal Tunnel Syndrome (CTS).
METHODS:
48 patients were randomized and 30 finished the protocol (a sample loss of 37.5%), 90% female and 10% males. Randomization was applied to allocate the patients in each one of the groups, with association or not to LLLT (group orthoses or LLLT and orthoses). All of them were submitted to ergonomic home orientations. The short-term symptoms and function outcome were assessed through: Boston Carpal Tunnel Questionnaire (BCTQ) – Severity of Symptoms (SS) Functional Score (FS). Pain (VAS), Semmes-Weinstein monofilaments, 2PD and pinch strength was used for characterization of the sample. Most of the participants were women, over 4th decade enrolled on heavy hand duties occupations, right-handed, 66.7% affected on dominant hand, without alterations in sensory median nerve thresholds or pinch strength.
RESULTS:
Both groups showed a reduction of total BCTQ score and its subdomains after six weeks, with significant difference (p< 0.05), comparing to baseline. No significant difference was found between groups. A Minimal clinical change was observed after the intervention in 92.3% of participants for BCTQ subdomain severity of symptoms at individual comparison for LLLT and orthoses group and 76.5% for the orthoses group, demonstrating clinical relevance. Effect size Cohen’s index was moderate for the severity of symptoms.
CONCLUSION:
LLLT in association to orthoses and ergonomic orientation seems to be effective in short-term symptoms relieve for patients with mild and moderate CTS.
Photomed Laser Surg. 2014 Jun;32(6):336-344.

Placebo-Controlled Investigation of Low-Level Laser Therapy to Treat Carpal Tunnel Syndrome.

Lazovic M1, Ilic-Stojanovic O, Kocic M, Zivkovic V, Hrkovic M, Radosavljevic N.

Author information

  • 11 Institute for Rehabilitation , Belgrade, Serbia, Medical Faculty Belgrade, Serbia .

Abstract

Abstract Objective: 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, 30?mW 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.

Adv Med Sci. 2011;56(2):270-4.Oct 29:1-5. [Epub ahead of print]

Comparison of the long – term effectiveness of physiotherapy programs with low – level laser therapy and pulsed magnetic field in patients with carpal tunnel syndrome.

Dakowicz A, Kuryliszyn-Moskal A, Koszty?a-Hojna B, Moskal D, Latosiewicz R.

Source

Department of Rehabilitation, Medical University of Bialystok, Bialystok, Poland.

Abstract

Purpose: The aim of the study was to compare the long term effects of low – level laser therapy (LLLT) and pulsed magnetic field (PMF) in the rehabilitation of patients with carpal tunnel syndrome (CTS).Methods: The study included 38 patients with idiopathic CTS, confirmed by electroneurographic (ENG) examination. All patients were randomly assigned to 2 groups: group L (18 patients) treated with LLLT and group M (20 patients) with PMF therapy. Clinical assessment, including day and night pain, the presence of paresthesia, functional tests (Phalen, Tinel, armband tests) and pain severity according to the Visual Analogue Scale (VAS) was conducted before treatment, after the first series of 10 sessions, after a two-week break, after the second series of 10 sessions and six months after the last series.

Results: After LLLT a significant reduction of day and night pain was observed at each stage of treatment and 6 months after the last series (p<0.05). However, in group M, a significant reduction of both day and night pain was demonstrated only after the second series (p<0.05). A reduction of the incidence of Phalen’s symptoms were noticed in both groups, however, only in group L the improvement was significant (p<0.05). In groups L and M a significant reduction of pain intensity was observed at every stage of treatment (p<0.05).

Conclusions: Although after LLL as well as PMF therapy clinical improvement was observed, the most significant differences were registered after the second series and persisted for up to 6 months in both groups.

Clin Rheumatol. 2009 Jun 21. [Epub ahead of print

Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome.

Yagci I, Elmas O, Akcan E, Ustun I, Gunduz OH, Guven Z.

Department of Physical Medicine and Rehabilitation, Marmara University Hospital, Istanbul, Turkey, drilkery@yahoo.com.

This study aimed to compare the short-term efficacy of splinting (S) and splinting plus low-level laser therapy (SLLLT) in mild or moderate idiopathic carpal tunnel syndrome (CTS) with a prospective, randomized controlled study. The patients with unilateral, mild, or moderate idiopathic CTS who experienced symptoms over 3 months were included in the study. The SLLLT group received ten sessions of laser therapy and splinting while S group was given only splints. The patients were evaluated at the baseline and after 3 months of the treatment. Follow-up parameters were nerve conduction study (NCS), Boston Questionnaire (BQ), grip strength, and clinical response criteria. Forty-five patients with CTS completed the study. Twenty-four patients were in S and 21 patients were in SLLLT group. In the third-month control, SLLLT group had significant improvements on both clinical and NCS parameters (median motor nerve distal latency, median sensory nerve conduction velocities, BQ symptom severity scale, and BQ functional capacity scale) while S group had only symptomatic healing (BQ symptom severity scale). The grip strength of splinting group was decreased significantly. According to clinical response criteria, in SLLLT group, five (23.8%) patients had full and 12 (57.1%) had partial recovery; four (19%) patients had no change or worsened. In S group, one patient (4.2%) had full and 17 (70.8%) partial recovery; six (25%) patients had no change or worsened. Additionally, applied laser therapy provided better outcomes on NCS but not in clinical parameters in patients with CTS.

Photomed Laser Surg. 2008 Nov 23. [Epub ahead of print

Carpal Tunnel Treated with a Diode Laser: A Controlled Treatment of the Transverse Carpal Ligament.

Chang WD, Wu JH, Jiang JA, Yeh CY, Tsai CT.

Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taipei, Taiwan., Department of Rehabilitation Medicine, Da Chien General Hospital, Miaoli, Taiwan.

Abstract 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. Materials and 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/cm(2), 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.

Electromyogr Clin Neurophysiol. 2008 Jun-Jul;48(5):229-31.

The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome.

Shooshtari SM, Badiee V, Taghizadeh SH, Nematollahi AH, Amanollahi AH, Grami MT.

Shiraz University of medical science, Shiraz, Iran. Jazayeri1335@yahoo.com

OBJECTIVES: Carpal tunnel syndrome (CTS) is the most common neuropathy that can be diagnosed with confidence by the nerve conduction study (NCS). One of the recent treatments of CTS is the application of low power laser (LPL) therapy. The present study evaluates the effects of LPL irradiation through NCS and clinical signs and symptoms.

METHODS: A total of 80 patients were included in this study. Diagnosis of CTS was based on both clinical examination and electromyographic (EMG) findings. Patients were randomly assigned into two groups. Test group (group A) underwent laser therapy (9-11 joules/cm2) over the carpal tunnel area. Control group (group B) received sham laser therapy. Pain, hand grip strength, median proximal sensory and motor latencies, transcarpal median sensory nerve conduction (SNCV) were recorded. After fifteen sessions of irradiation (five times per week), parameters were recorded again and clinical symptoms were measured in both groups. Pain was evaluated by Visual Analog Scale (VAS; day-night). Hand grip was measured by Jamar dynometer. Paired t-test and independent sample t-test were used for statistical analysis.

RESULTS: There was a significant improvement in clinical symptoms and hand grip in group A (p < 0.001). Proximal median sensory latency, distal median motor latency and median sensory latencies were significantly decreased (p < 0.001). Transcarpal median SNCV increased significantly after laser irradiation (p < 0.001). There were no significant changes in group B except changes in clinical symptoms (p < 0.001).

CONCLUSIONS: Laser therapy as a new conservative treatment is effective in treating CTS paresthesia and numbness and improves the subjects’ power of hand grip and electrophysiological parameters.

Swiss Med Wkly. 2007 Jun 16;137(23-24):347-52

Effect of low level laser therapy in rheumatoid arthritis patients with carpal tunnel syndrome.

Ekim A, Armagan O, Tascioglu F, Oner C, Colak M.

Osmangazi University, Department of Physical Therapy and Rehabilitation, Eskisehir, Turkey.

OBJECTIVE: the aim of the present study was to evaluate the efficacy of low level laser therapy (LLLT) in patients with rheumatoid arthritis (RA) with carpal tunnel syndrome (CTS). MATERIAL AND METHODS: a total of 19 patients with the diagnosis of CTS in 19 hands were included and randomly assigned to two treatment groups; LLLT (Group 1) (10 hands) with dosage 1.5 J/ per point and placebo laser therapy group (Group 2) (9 hands). A Galium-Aluminum-Arsenide diode laser device was used as a source of low power laser with a power output of 50 mW and wavelength of 780 nm. All treatments were applied once a day on week days for a total period of 10 days. Clinical assessments were performed at baseline, at the end of the treatment and at month 3. Tinel and Phalen signs were tested in all patients. Patients were evaluated for such clinical parameters as functional status scale (FSS), visual analogue scale (VAS), symptom severity scale (SSS) and grip-strength. However, electrophysiological examination was performed on all hands. Results were given with descriptive statistics and confidence intervals between group means at 3 months adjusted for outcome at baseline and for the difference between unadjusted group proportions. RESULTS: clinical and electrophysiological parameters were similar at baseline in both groups. Improvements were significantly more pronounced in the LLLT group than placebo group. A comparison between groups showed significant improvements in pain score and functional status scale score. Group mean differences at 3 months adjusted at baseline were found to be statistically significant for pain score and functional status scale score. The 95% significant confidence intervals were [-15 – (-5)] and [-5 – (-2)] respectively. There were no statistically significant differences in other clinical and electrophysiological parameters between groups at 3 months. CONCLUSIONS: our study results indicate that LLLT and placebo laser therapy seems to be effective for pain and hand function in CTS. We, therefore, suggest that LLLT may be used as a good alternative treatment method in CTS patients with RA.

Lasers Med Sci. 2007 Mar 3; [Epub ahead of print]

Treatment of carpal tunnel syndrome by low-level laser versus open carpal tunnel release.

Elwakil TF, Elazzazi A, Shokeir H.

Unit of General Surgery, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt, tfelwakil@hotmail.com

Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist. It is one of the most common peripheral nerve disorders. The cause of idiopathic CTS remains unclear. The diagnosis of CTS is still mainly clinical. Open carpal tunnel release is the standard treatment. The present study was conducted to evaluate the effectiveness of low level laser treatment (LLLT) for CTS in comparison to the standard open carpal tunnel release surgery. Out of 54 patients, 60 symptomatic hands complaining of CTS were divided into two equal groups. Group A, was subjected to LLLT by Helium Neon (He-Ne) laser (632.8 nm), whereas group B was treated by the open approach for carpal tunnel release. The patients were evaluated clinically and by nerve conduction studies (NCSs) about 6 months after the treatment. LLLT showed overall significant results but at a lower level in relation to surgery. LLLT showed significant outcomes in all parameters of subjective complaints (p </= 0.01) except for muscle weakness. Moreover, LLLT showed significant results in all parameters of objective findings (p </= 0.01) except for thenar atrophy. However, NCSs expressed the same statistical significance (p </= 0.01) after the treatment by both modalities. LLLT has proven to be an effective and noninvasive treatment modality for CTS especially for early and mild-to-moderate cases when pain is the main presenting symptom. However, surgery could be preserved for advanced and chronic cases. Refinement of laser tools and introduction of other wavelengths could make LLLT for CTS treatment a field for further investigations.

Photomed Laser Surg. 2007 Feb;25(1):34-9

Laser therapy in the treatment of carpal tunnel syndrome: a randomized controlled trial.

Evcik D, Kavuncu V, Cakir T, Subasi V, Yaman M.

Department of Physical Rehabilitation Medicine, Kocatepe University, Afyonkarahisar, Turkey. evcikd@yahoo.com.

OBJECTIVE: This prospective, randomized, placebo-controlled trial aimed to investigate the efficacy of laser therapy in the treatment of carpal tunnel syndrome (CTS).

BACKGROUND DATA: Low-level laser therapy (LLLT) has been found to have positive effects in the treatment of CTS and various musculoskeletal conditions.

METHODS:A total of 81 patients were included in this study. Diagnosis of CTS was based on both clinical examination and electromyographic (EMG) study. Patients were randomly assigned into two groups. Group 1 (n = 41) underwent laser therapy (7 joules/2 min) over the carpal tunnel area. Group 2 (n = 40) received placebo laser therapy. All patients received therapy five times per week, for a total of 10 sessions. Patients also used a wrist splint each night. Patients were assessed according to pain, hand-pinch grip strength, and functional capacity. Pain was evaluated by Visual Analog Scale (VAS; day-night). Hand grip was measured by Jamar dynometer, and pinch grip was measured by pinchmeter. Functional capacity was assessed by a self-administered questionnaire for severity of symptoms.

RESULTS: The mean age of the patients (70 women, 11 Men) was 49.3 +/- 11.0 (range, 26-78). After therapy there were statistically significant improvements in VAS, pinch grip, and functional capacity measurement in both groups (p < 0.001). Hand grip was found to have been improved in the laser group. In EMG, there were statistically improvements in sensory nerve velocity, and sensory and motor distal latancies in the laser group (p < 0.001). Only sensory nerve velocity was meaningful in the placebo group.

CONCLUSION: In using LLLT, (1) there was no difference relative to pain relief and functional capacity during the follow-up in CTS patients; (2) there were positive effects on hand and pinch grip strengths.

Photomed Laser Surg. 2006 Apr;24(2):101-10.

Photobiomodulation of pain in carpal tunnel syndrome: review of seven laser therapy studies.

 Naeser MA.

Department of Neurology, Boston University School of Medicine, MA 02130, USA. mnaeser@bu.edu

In this review, seven studies using photoradiation to treat carpal tunnel syndrome (CTS) are discussed: two controlled studies that observed real laser to have a better effect than sham laser, to treat CTS; three openprotocol studies that observed real laser to have a beneficial effect to treat CTS; and two studies that did not observe real laser to have a better effect than a control condition, to treat CTS. In the five studies that observed beneficial effect from real laser, higher laser dosages (9 Joules, 12-30 Joules, 32 J/cm(2), 225 J/cm(2)) were used at the primary treatment sites (median nerve at the wrist, or cervical neck area), than dosages in the two studies where real laser was not observed to have a better effect than a control condition (1.8 Joules or 6 J/cm(2)). The average success rate across the first five studies was 84% (SD, 8.9; total hands = 171). The average pain duration prior to successful photoradiation was 2 years. Photoradiation is a promising new, conservative treatment for mild/moderate CTS cases (motor latency < 7 msec; needle EMG, normal). It is cost-effective compared to current treatments.

Photomed Laser Surg. 2005 Apr;23(2):225-8.

Treatment of carpal tunnel syndrome with polarized polychromatic noncoherent light (Bioptron light): a preliminary, prospective, open clinical trial.

Stasinopoulos D, Stasinopoulos I, Johnson MI.

School of Health and Human Sciences, Leeds Metropolitan University, Leeds, United Kingdom. d.stasinopoulos@yahoo.gr

Abstract

OBJECTIVE: Our aim was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of idiopathic carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome is the most common compression neuropathy, but no satisfactory conservative treatment is available at present.

METHOD: An uncontrolled experimental study was conducted in patients who visited our clinic from mid-2001 to mid-2002. A total of 25 patients (22 women and three men) with unilateral idiopathic carpal tunnel syndrome, mild to moderate nocturnal pain, and paraesthesia lasting >3 months participated in the study. The average age of the patients was 47.4 years and the average duration of patients’ symptoms was 5.2 months. Polarized polychromatic noncoherent light (Bioptron light) was administered perpendicular to the carpal tunnel area. The irradiation time for each session was 6 min at an operating distance of 5-10 cm from the carpal tunnel area, three times weekly for 4 weeks. Outcome measures used were the participants’ global assessments of nocturnal pain and paraesthesia, respectively, at 4 weeks and 6 months.

RESULTS: At 4 weeks, two patients (8%) had no change in nocturnal pain, six (24%) were in slightly less nocturnal pain, 12 (48%) were much better in regard to nocturnal pain and five (20%) were pain-free. At 6 months, three patients (12%) were slightly better in regard to nocturnal pain, 13 (52%) were much better regarding nocturnal pain, and nine patients (36%) were pain-free. At 4 weeks, four patients (16%) had no change in paraesthesia, five (20%) were slightly better, 13 patients (52%) were much better, and three patients (12%) were without paraesthesia. At 6 months, two patients (8%) had no change in paraesthesia, two (8%) were slightly better, 14 (56%) were much better, and seven (28%) were without paraesthesia.

CONCLUSIONS: Nocturnal pain and paraesthesia associated with idiopathic carpal tunnel syndrome improved during polarized polychromatic noncoherent light (Bioptron light) treatment. Controlled clinical trials are needed to establish the absolute and relative effectiveness of this intervention.

Arch Phys Med Rehabil. 2002 Jul;83(7):978-88.

Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study.

Naeser MA, Hahn KA, Lieberman BE, Branco KF.

Department of Neurology, Boston University School of Medicine, Psychology Research Service, MA, USA. mnaeser@bu.edu

Abstract

OBJECTIVE: To investigate whether real or sham low-level laser therapy (LLLT) plus microamperes transcutaneous electric nerve stimulation (TENS) applied to acupuncture points significantly reduces pain in carpal tunnel syndrome (CTS).

DESIGN: Randomized, double-blind, placebo-control, crossover trial. Patients and staff administered outcome measures blinded.

SETTING: Outpatient, university-affiliated Department of Veterans Affairs medical center.

PARTICIPANTS: Eleven mild to moderate CTS cases (nerve conduction study, clinical examination) who failed standard medical or surgical treatment for 3 to 30 months.

INTERVENTION: Patients received real and sham treatment series (each for 3-4wk), in a randomized order. Real treatments used red-beam laser (continuous wave, 15mW, 632.8nm) on shallow acupuncture points on the affected hand, infrared laser (pulsed, 9.4W, 904nm) on deeper points on upper extremity and cervical paraspinal areas, and microamps TENS on the affected wrist. Devices were painless, noninvasive, and produced no sensation whether they were real or sham. The hand was treated behind a hanging black curtain without the patient knowing if devices were on (real) or off (sham).

MAIN OUTCOME MEASURES: McGill Pain Questionnaire (MPQ) score, sensory and motor latencies, and Phalen and Tinel signs.

RESULTS: Significant decreases in MPQ score, median nerve sensory latency, and Phalen and Tinel signs after the real treatment series but not after the sham treatment series. Patients could perform their previous work (computer typist, handyman) and were stable for 1 to 3 years.

CONCLUSIONS: This new, conservative treatment was effective in treating CTS pain; larger studies are recommended.

 

J Altern Complement Med Feb;5(1):5-26.

Carpal tunnel syndrome: clinical outcome after LLLT-acupuncture, microamp TENS, and other alternative therapies: an open protocol study.

 

Branco K, Naeser MA (1999)

Acupuncture Healthcare Services, Westport, Massachusetts, USA.

They measured outcome for carpal tunnel syndrome (CTS) patients (who previously failed standard medical/surgical treatments) treated primarily with a red-beam, LLLT-AP and microamps TENS on the affected hand; secondarily, with other alternative therapies.

DESIGN: Open treatment protocol, patients diagnosed with CTS by their physicians. Treatment was given by licensed acupuncturist in a private practice office. 36 hands were treated (from 22 women, 9 men), ages 24-84 yr, median pain duration, 24 mo. 14 hands had failed 1-2 surgical release procedures. Primary treatment: red-beam, 670 nm, continuous wave, 5 mW, diode LLLT pointer (1-7 J per point), and microamps TENS (<900 uA) on affected hands. Secondary treatment: infrared LLLT (904 nm, pulsed, 10 W) and/or needle AP on deeper acupoints; Chinese herbal medicine and supplements, on a case-by-case basis (3 treatments/wk for 4-5 wk). Pre- and posttreatment Melzack pain scores and profession and employment status were recorded. Posttreatment, pain significantly reduced (p<.0001), and 33/36 hands (91.6%) no pain, or pain reduced by >50%. 14 hands that failed surgical release were successfully treated. Patients remained employed, if not retired. Follow-up after 1-2 yr with cases aged <60, only 2/23 hands (8.3%) had return of pain, but were successfully re-treated within a few weeks. Possible mechanisms for effectiveness include increased adenosine triphosphate (ATP) on cellular level, decreased inflammation, temporary increase in serotonin. Combined treatment with LLLT-AP + microamp TENS + Chinese herbs has potential cost-savings (current estimated cost per case, $12,000; this treatment, $1,000). It is safe when applied by licensed acupuncturist trained in laser-AP; supplemental home treatments may be performed by patient under supervision of acupuncturist. Publication Types: Clinical trial PMID: 10100028, UI: 99199801

Carpal Tunnel Syndrome Laser Acupuncture Research

The Purpose of this Research Project

The purpose of this research project is to investigate whether red-beam low-energy laser and microamps TENS (painless transcutaneous electric nerve stimulation) can be used to stimulate acupuncture points on the hand, to treat the painful symptoms of CTS, under controlled research conditions. This research project uses a painless, non-invasive, non-surgical technique, which can also be applied by the patient him/herself, at home.

Method used in this Research Project

In the controlled research at the hospital, the patient’s hand is treated behind a black curtain, and the patient does not know whether the laser beam and TENS devices are “on or off,” because each device produces no feeling. The research at the hospital is a randomized, double-blind, placebo-controlled, cross-over design. There, patients receive 3 treatments per week (every other day), with 12 real and 12 sham treatments (each for 4 weeks), order randomized. Pre- and post-testing are performed with objective and subjective tests. These tests include nerve conduction studies; Melzack pain questionnaires; and hand strength and dexterity testing which are performed by hospital staff blind as to the treatment condition (real or sham).

In the controlled research at the hospital, various lasers are used, but limited space here does not permit discussion of all lasers. Some of these larger lasers include a 15 mW red-beam, helium neon laser, Dynatronics Model 1620; or a 50 mW infrared-beam, diode laser, 830 nm wavelength, Dynatronics Model 1650.

The laser used in the Home Treatment program is described later, under “The Naeser Laser Home Treatment Program for the Hand ©.”

Results from this Research Project

As of November, 1996, seven patients had completed the treatment under controlled research conditions at the hospital. These seven patients had significant reduction in pain scores after the series of real treatments, but no significant reduction in pain scores after the series of sham treatments. Following the real treatment condition, the Melzack pain scores were significantly reduced (p <.02). For example, before the real treatments were started, the average pain score was 17.3 points (S.D., 10.3). After the real treatments were finished, the average pain score was only 5.4 points (S.D., 6.9). Following the sham treatment condition where the lasers and microamps TENS devices were taped into place on the patient’s hand (but not turned on), the Melzack pain scores were not significantly reduced. Before the sham treatments were started, the average pain score was 16.9 points (S.D., 12.2). After the sham treatments were finished, the average pain score was 11.0 (S.D., 11.8).

Also, these seven patients treated under controlled research conditions at the hospital, had significant improvement in their nerve conduction studies after the series of real treatments, but no significant improvement in their nerve conduction studies after the series of sham treatments. Following the real treatment condition, the sensory latency of the median nerve across the wrist was significantly reduced (p <.05). In the real condition, five of the seven patients showed improved, shorter latencies following treatment; two patients showed no change. Before the real treatments were started, the average median nerve sensory latency was 4.8 msec (S.D., 1.3). After the real treatments were finished, the average sensory latency was 4.5 msec (S.D., 1.3). Following the sham treatment condition, the sensory latency of the median nerve across the wrist was not significantly reduced. In the sham condition, data were available for only six patients. Following sham treatment, only two of the six patients showed improved, shorter latencies; three patients showed no change and one patient showed an increased, longer latency. Before the sham treatments were started, the average median nerve sensory latency was 4.7 msec (S.D., 1.2). After the sham treatments were finished, the average median nerve sensory latency was 4.4 msec (S.D., 1.1).

All patients were able to resume prior work activities with less, or no pain, including keyboard typing, handyman work (cement laying, electrical wiring), and plumbing. At one year follow-up, one patient (who was diabetic and had had a stroke), had a return of hand pain.

These data indicate that after the series of real treatments, there was a significant reduction in pain, and the function of the sensory aspect of the median nerve became significantly “closer to normal.” These significant changes were not observed following the series of sham treatments. Hence, it appears that the treatments with the real laser and microamps TENS devices are promoting a positive change in the patient’s condition (not observed with the sham devices), and the placebo effect is being controlled for.

Three other cases were treated in an open protocol with the Naeser Laser Home Treatment Program for the Hand using the 5mW laser pen, and MicroStim 100 TENS device at home. All resumed prior type of work (computer keyboard typing and transcription work) without pain after 4 weeks.

We presented a research paper on the first six patients at the 16th Annual Meeting of the American Society for Laser Medicine and Surgery, Inc., Orlando, FL, April 15, 1996 and the paper was one of 12 papeLrs nominated for “Best Clinical Award.” The research will continue.

 

LOW – LEVEL – LASER THERAPY IN MILD AND MODERATE CTS – A DOUBLE BLIND, RANDOMIZED STUDY

Th. Rappl, Ch. Laback, St Quasthoff, M. Auer-Grumbach, R. Gumpert, E. Scharnagl

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 pror 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.

SUCCESSFUL MANAGEMENT OF FEMALE OFFICE WORKERS WITH “REPETITIVE STRESS INJURY” OR “CARPAL TUNNEL SYNDROME BY A NEW TREATMENT MODALITY – APPLICATION OF LOW LEVEL LASER

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.