Rheumatology International

, Volume 32, Issue 2, pp 409–415 | Cite as

Low-level laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation

  • Funda Tascioglu
  • Nevbahar Akcar Degirmenci
  • Serhat Ozkan
  • Ozlem Mehmetoglu
Original Article

Abstract

The objective of this study is to investigate the efficacy of low-level laser therapy (LLLT) in patients with carpal tunnel syndrome (CTS). Sixty patients with CTS were included in this placebo-controlled and double-blind study and randomly assigned to three treatment groups: active laser with a dosage of 1.2 J/per painful point, active laser with a dosage of 0.6 J/per painful point, and placebo groups. A total of 5 points across the median nerve trace were irradiated with Gal-Al-As diode laser. All groups were treated 5 times per week for 3 weeks. Clinical assessments included pain intensity, grip strength, symptom severity score (SSS), functional status score (FSS), nerve conduction studies, and cross-sectional area (CSA) of the median nerve as measured by ultrasonography. Compared to baseline, post-treatment VAS scores (group 1, P < 0.001; group 2, P < 0.001; group 3, P < 0.01), grip strength (P < 0.05), SSS scores (group 1, P < 0.001; group 2, P < 0.001; group 3, P < 0.01), and FSS scores (P < 0.05) improved significantly in all groups. Only sensorial nerve velocity measurements on the palmar region showed a significant improvement in both active laser groups (P < 0.01). There was no significant difference in any of the outcome measures among the groups. With the chosen laser type and dose regimen, the results suggested that LLLT was no more effective than placebo in CTS.

Keywords

Carpal tunnel syndrome Low-power laser therapy 

References

  1. 1.
    Aroori S, Spence RAJ (2008) Carpal tunnel syndrome. Ulster Med J 77:6–17PubMedGoogle Scholar
  2. 2.
    Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 282:153–158PubMedCrossRefGoogle Scholar
  3. 3.
    Kao SY (2003) Carpal tunnel syndrome as an occupational disease. J Am Board Fam Pract 16:533–542PubMedCrossRefGoogle Scholar
  4. 4.
    Werner RA, Andary M (2002) Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 113:1373–1381PubMedCrossRefGoogle Scholar
  5. 5.
    Rempel DM, Diao E (2004) Entrapment neuropathies: pathophysiology and pathogenesis. J Electromyogr Kinesiol 14:71–75PubMedCrossRefGoogle Scholar
  6. 6.
    Hirata H, Nagakura T, Tsujii M, Morita A, Fujisawa K, Uchida A (2004) The relationship of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol 204:605–612PubMedCrossRefGoogle Scholar
  7. 7.
    Tucci MA, Barbieri RA, Freeland AE (1997) Biochemical and histological analysis of the flexor tenosynovium in patients with carpal tunnel syndrome. Biomed Sci Instrum 33:246–251PubMedGoogle Scholar
  8. 8.
    Koenig RW, Pedro MT, Heinen CPG, Schmidt T, Richter HP, Antoniadis G et al (2009) High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus 26:1–6CrossRefGoogle Scholar
  9. 9.
    Moran L, Perez M, Esteban A, Bellon J, Arranz B, del Cerro M (2009) Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies. J Clin Ultrasound 37:125–131PubMedCrossRefGoogle Scholar
  10. 10.
    Bland JDP (2007) Carpal tunnel syndrome. BMJ 335:343–346PubMedCrossRefGoogle Scholar
  11. 11.
    Yagci I, Elmas O, Akcan E, Ustun I, Gunduz OH, Guven Z (2009) Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome. Clin Rheumatol 28:1059–1065PubMedCrossRefGoogle Scholar
  12. 12.
    Evcik D, Kavuncu V, Cakir T, Subası V, Yaman M (2007) Laser therapy in the treatment of carpal tunnel syndrome: a randomized controlled trial. Photomed Laser Surg 25:34–39PubMedCrossRefGoogle Scholar
  13. 13.
    Elwakil TF, Elazzazi A, Shokeir H (2007) Treatment of carpal tunnel syndrome by low-level laser versus open carpal tunnel release. Lasers Med Sci 22:265–270PubMedCrossRefGoogle Scholar
  14. 14.
    Bakhtiary AH, Rashidy-Pour A (2004) Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother 50:147–151PubMedGoogle Scholar
  15. 15.
    Bae CS, Lim SC, Kim KY, Song CH, Pak S, Kim SG, Jang CH (2004) Effect of Ga-as laser on the regeneration of injured sciatic nerves in the rat. In Vivo 18:489–495PubMedGoogle Scholar
  16. 16.
    Vinck E, Coorevits P, Cagnie B, De Muynck M, Vanderstraeten G, Cambier D (2005) Evidence of changes in sural nerve conduction mediated by light emitting diode irradiation. Lasers Med Sci 20:35–40PubMedCrossRefGoogle Scholar
  17. 17.
    Medrado AR, Pugliese LS, Reis SR, Andrade ZA (2003) Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers Surg Med 32:239–244PubMedCrossRefGoogle Scholar
  18. 18.
    Boschi ES, Leite CE, Saciura VC, Caberlon E, Lunardelli A, Bitencourt S, Melo DA, Oliveira JR (2008) Anti-Inflammatory effects of low-level laser therapy (660 nm) in the early phase in carrageenan-induced pleurisy in rat. Lasers Surg Med 40:500–508PubMedCrossRefGoogle Scholar
  19. 19.
    Ferreira DM, Zângaro RA, Villaverde AB, Cury Y, Frigo L, Picolo G, Longo I, Barbosa DG (2005) Analgesic effect of He-Ne (632.8 nm) low-level laser therapy on acute inflammatory pain. Photomed Laser Surg 23:177–181PubMedCrossRefGoogle Scholar
  20. 20.
    Irvine J, Chong SL, Amirjani N, Chan KM (2004) Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome. Muscle Nerve 30:182–187PubMedCrossRefGoogle Scholar
  21. 21.
    Levine D, Simmons BP, Koris MJ, Daltory LH, Hohl GG, Fossel AH, Katz JN (1993) A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg (Am) 75:1585–1592Google Scholar
  22. 22.
    Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdogan C (2006) Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disabil Rehabil 28:1281–1285PubMedCrossRefGoogle Scholar
  23. 23.
    Shooshtari SM, Badiee V, Taghizadeh SH, Nematollahi AH, Amanollahi AH, Grami MT (2008) The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome. Electromyogr Clin Neurophysiol 48:229–231PubMedGoogle Scholar
  24. 24.
    Walker J (1083) Relief from chronic pain by low power laser irradiation. Neurosci Lett 43:339–344CrossRefGoogle Scholar
  25. 25.
    Bjordal JM, Lopes-Martins RA, Iversen VV (2006) A randomized, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysismeasurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med 40:76–80PubMedCrossRefGoogle Scholar
  26. 26.
    Jarvis D, MacIver B, Tanelian DL (1990) Electrophysiologic recording and thermodynamic modeling demonstrate that helium-neon laser irradiation does not affect peripheral Aδ- or C-fiber nociceptors. Pain 43:235–242PubMedCrossRefGoogle Scholar
  27. 27.
    Rochkind S, Drory V, Alon M, Nissan M, Ouaknine GE (2007) Laser phototherapy (780 nm), a new modality in treatment of long-term incomplete peripheral nerve injury: a randomized double-blind placebo-controlled study. Photomed Laser Surg 25:436–442PubMedCrossRefGoogle Scholar
  28. 28.
    Bagis S, Comelekoglu U, Sahin G, Buyukakilli B, Erdogan C, Kanik A (2002) Acute electrophysiologic effect of pulsed gallium-arsenide low energy laser irradiation on configuration of compound nerve action potential and nerve excitability. Lasers Surg Med 30:376–380PubMedCrossRefGoogle Scholar
  29. 29.
    Bagis S, Comelekoglu U, Coskun B, Milcan A, Buyukakilli B, Sahin G, Ozisik S, Erdogan C (2003) No effect of GA-AS (904 nm) laser irradiation on the intact skin of the injured rat sciatic nerve. Lasers Med Sci 18:83–88PubMedCrossRefGoogle Scholar
  30. 30.
    Beckerman H, de Bie RA, De Cuyper HJ, Oostendorp RAB (1992) The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials. Phys Ther 7:483–491Google Scholar
  31. 31.
    Turner JA, Deyo RA, Loeser JD, Von Korff M, Fordyce WE (1994) The importance of placebo effects in pain treatment and research. JAMA 271:1609–1614PubMedCrossRefGoogle Scholar
  32. 32.
    Zubieta JK, Stohler CS (2009) Neurobiological mechanisms of placebo responses. Ann N Y Acad Sci 1156:198–210PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Funda Tascioglu
    • 1
  • Nevbahar Akcar Degirmenci
    • 2
  • Serhat Ozkan
    • 3
  • Ozlem Mehmetoglu
    • 1
  1. 1.Faculty of Medicine, Department of Physical Therapy and RehabilitationOsmangazi UniversityEskisehirTurkey
  2. 2.Department of RadiologyOsmangazi UniversityEskisehirTurkey
  3. 3.Department of NeurologyOsmangazi UniversityEskisehirTurkey

Personalised recommendations