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

Abstract

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.

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References

  1. 1.

    Ahn DS, Yoon ES, Koo SH, Park SH (2000) A prospective study of the anatomic variations of the median nerve in the carpal tunnel in Asians. Ann Plast Surg 44:282–287

    PubMed  CAS  Article  Google Scholar 

  2. 2.

    Bland JDB (2000) The value of the history in the diagnosis of carpal tunnel syndrome. J Hand Surg 25B:445–450

    Google Scholar 

  3. 3.

    Bland JDB (2001) Do nerve conduction studies predict the outcome of carpal tunnel decompression? Muscle Nerve 24:935–940

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Bland JDB (2005) Carpal tunnel syndrome. Curr Opin Intern Med 4(6):578–582

    Article  Google Scholar 

  5. 5.

    Boz C, Ozmenoglu M, Altunayoglu V (2004) Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index and hand anthropometric measurements. Clin Neurol Neurosurg 106:294–299

    PubMed  Article  Google Scholar 

  6. 6.

    El Miedany YM, Aty SA, Ashour S (2004) Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology (Oxford) 43:887–895

    Article  Google Scholar 

  7. 7.

    Ettema AM, Amadio PC, Cha SS, Harrington JR, Harris AM, Offord KP (2006) Surgery versus conservative therapy in carpal tunnel syndrome in people aged 70 years and older. Past Reconstr Surg 118(4):947–958

    Article  CAS  Google Scholar 

  8. 8.

    Geoghegan JM, Clark DI, Bainbridge LC (2004) Risk factors in carpal tunnel syndrome. J Hand Surg 29B:315–320

    Google Scholar 

  9. 9.

    Hirata H, Nagakura T, Tsujii M (2004) The relationship of VEGF and PGE2 expression to extracellular matrix remodeling of the tenosynovium in the carpal tunnel syndrome. J Pathol 204:605–612

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Hirata H, Tsujii M, Yoshida T (2005) MMP-2 expression is associated with rapidly proliferative arteriosclerosis in the flexor tenosynovium and pain severity in carpal tunnel syndrome. J Pathol 205:443–450

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    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 30:182–187

    PubMed  Article  Google Scholar 

  12. 12.

    Kamolz LP, Beck H, Haslik W (2004) Carpal tunnel syndrome: a question of hand and wrist configurations? J Hand Surg 29B:321–324

    Google Scholar 

  13. 13.

    Kujawa J, Zavodnik L, Zavodnik I, Bryszewska M (2003) Low intensity near infrared laser radiation induces changes of acetylcholine esterase activity of human erythrocytes. Lasers Surg Med 21(6):351–355

    Article  Google Scholar 

  14. 14.

    Matson E, Perira AN, Eduardo P, Marques MM (2002) Effect of low power laser irradiation on cell growth and procollagen synthesis in cultured fibroblasts. Lasers Surg Med 31(4):263–267

    PubMed  Article  Google Scholar 

  15. 15.

    Naeser MA, Kyumg AEK, Hahn MD, Lieberman BE, Kenneth F, Branco MA (2002) Carpal tunnel syndrome pain treated with low level laser and microamperes transcutaneous electric nerve stimulation. Arch Phys Med Rehabil 83:978–988

    PubMed  Article  Google Scholar 

  16. 16.

    Nora DB, Becker J, Ehler JA, Gomes I (2004) Clinical feature of 1,039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg 107:64–69

    PubMed  Article  Google Scholar 

  17. 17.

    Rodner CM, Katarincic J (2006) Open carpal tunnel release. Tech Orthop 21(1):3–11

    Article  Google Scholar 

  18. 18.

    Schmelzer RE, Rocca GJD, Caplin DA (2006) Endoscopic carpal tunnel release: a review of 753 cases in 486 patients. Plast Reconstr Surg 117(1):177–185

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Scholten RJPM, de Krom MCTFM, Bertelsmann FW, Bouter LM (1997) Variation in the treatment of carpal tunnel syndrome (Letter). Muscle Nerve 20:1334–1335

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Witt JC, Hentz JG, Stevens JC (2004) Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve 29:515–522

    PubMed  Article  Google Scholar 

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Acknowledgment

The authors thank Mrs. Reham Shahin for her effort during the primary conduction of LLLT for CTS. Finally, we express our appreciation for the staff of the Clinical Neurophysiology unit, Cairo University, for their cooperation during NCSs.

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Correspondence to Tarek F. Elwakil.

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Elwakil, T.F., Elazzazi, A. & Shokeir, H. Treatment of carpal tunnel syndrome by low-level laser versus open carpal tunnel release. Lasers Med Sci 22, 265–270 (2007). https://doi.org/10.1007/s10103-007-0448-8

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Keywords

  • Carpal tunnel syndrome (CTS)
  • Pain
  • Helium Neon (He–Ne) laser
  • Low-level laser therapy (LLLT)
  • Photobiomodulation