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Carpal Tunnel Syndrome

The Effectiveness of Conservative Treatments of Carpal Tunnel Syndrome: Splinting, Ultrasound, and Low-Level Laser Therapies

Dincer U, Cakar E, Kiralp MZ, Kilac H, Dursun H. PMID: 19196106 [PubMed - as supplied by publisher]
Photomed Laser Surg. 2009 Jan 26. [Epub ahead of print]

Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey. Abstract Objective: The objective of this study was to investigate the effectiveness of splinting, ultrasound (US), and low-level laser (LLL) in the management of carpal tunnel syndrome (CTS).
Background Data: CTS is the entrapment mononeuropathy most frequently seen in clinical practice, caused by compression of the median nerve at the wrist. Although several treatment modalities are routinely in use, there is no consensus about the best way to manage CTS.
Materials and Methods: In our study, patients were randomly allocated to three groups that received the following treatment protocols: splinting only, splinting plus US, and splinting plus LLL therapy. Patients were assessed with the Boston Questionnaire, patient satisfaction inquiry, visual analogue scale for pain, and electroneuromyography.
Results and Conclusion: The study was completed with a total of 100 hands of 50 women patients with bilateral CTS at 3 mo after treatment. At the end of the follow-up period, each of the groups had improvements to varying degrees. It appeared that the combinations of US or LLL therapy with splinting were more effective than splinting alone in treating CTS. However, LLL therapy plus splinting was more advantageous than US therapy plus splinting, especially for the outcomes of lessening of symptom severity, pain alleviation, and increased patient satisfaction.

Archives of Physical Medicine and Rehabilitation: July 2002 83(7)

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.

Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Light therapy has been shown in over 40 years of independent research worldwide in more than 1200 studies to deliver powerful therapeutic benefits to living tissues and organisms. Both visible red and invisible infrared light have been shown to affect at least 24 different positive changes at a cellular level. Einstein even touted the benefits of light on the human body in 1918.

Cold or Low Level Laser Therapy (LLLT) has proven to be a very effective treatment for many conditions including those that have not responded well to traditional methods, including surgery. In many instances, it can also be a viable alternative to surgery and long-term use of pain medications.

Selected Studies:

General Motors conducted a controlled 36-week double-blind clinical study using the ML 830™ (which we use in our clinic) in conjunction with a physical therapy program to treat 116 employees who had Carpal Tunnel Syndrome. This study showed a significant improvement in grip strength and range of motion among workers treated with the ML830™ when compared to workers treated with a placebo laser.

A prominent college of medicine in Houston, Texas, conducted a later double-blind study in 2000. That study showed 70% improvement in the active group.

One study of 324 patients obtained total pain relief in 82% of the acute cases and 66% in the chronic cases of tennis and golfer's elbow as reported in Clinical Laser Medicine & Surgery, 1998; 16 (3): 145-151.

A recent meta-analysis in the Journal of Rheumatology for rheumatoid arthritis, low-level laser therapy reduced pain by 70% relative to placebo, reduced morning stiffness, and increased flexibility. Brosseau L, Welch V, Wells G, et al. Low level laser therapy for osteoarthritis and rheumatoid arthritis: a meta-analysis. J Rheumatol. 2000;27:1961-1969

“… results obtained after low level laser therapy (LLLT) treatment of more than 200 patients (headaches, facial pain, musculoskeletal, myogenic neck pain, shoulder and arm pain, epicondylitis, tenosynovitis, low back and radicular pain, Achilles tendonitis) were better than we had ever expected…mobility is restored (functional recovery), pain decreases or disappears…” 1

“ LLLT improves local microcirculation and improves oxygen supply to hypoxic cells…normalization of microcirculation, due to laser applications, interrupts the “circulus vitosus: of the pain and its development.” 1

“ acute pain, diminished more than 70%; chronic pain more than 60%…use of analgesic drugs could be reduced or completely excluded. LLLT can be used as monotherapy or supplementary treatment to other therapeutic procedures for pain treatment.” 1

1Low Level Laser Therapy with trigger points technique: a clinical study on 243 patients. Journal of Clinical Lasers in Medicine and Surgery, 1996 Aug; 14(4):163-7

"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, San Francisco, CA, and Head and Neck Pain Center, Honolulu, HI

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. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. The [low level] laser rapidly alleviated the pain and tingling in the arms, hands and fingers and diminished tenderness at the involved spinous processes. Laser Therapy, 1997:9:131-136

“With low level laser treatment, complete resolution of pretreatment symptoms and abnormal physical findings was achieved in 77% of cases. It is a safe, cost-effective therapy producing a 77% success rate and appears to be an attractive substitute for surgery.” Noninvasive Laser Neurolysis in Carpal Tunnel Syndrome. Muscle and Nerve, 20:1029-1031, 1997.

Clinical Application of GaAIAs 830NM Diode Laser in Treatment of Rheumatoid Arthritis, Department of Orthopaedic Surgery, Osaka City University Medical School, Japan, Average patient age was 61. “This gave a total effective rating for pain attenuation of 90%, and for ROM [range of motion] improvement of 56.3%.

The Efficacy of Laser Therapy for Musculoskeletal and Skin Disorders: A Criteria-Based Meta-Analysis of Randomized Clinical Trials, Beckerman H, deBie RA, Bouter LM, et al. “The efficacy of laser therapy for musculoskeletal and skin disorders has been assessed on the basis of the results of 36 randomized clinical trials (RCTs) involving 1,704 patients. More specifically, for rheumatoid arthritis, post-traumatic joint disorders, and myofacial pain, laser therapy seems to have a substantial specific therapeutic effect. For this purpose, a criteria-based meta-analysis that took into account the methodological quality of the individual trials was used. Physical Therapy, 72(7):483-91, 1992 Jul. (60 ref)

The discovery of new applications for low level lasers are continuing with an impressive array of on-going research.

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