Introduction: Carpal Tunnel Syndrome (CTS) is the most common type of entrapment neuropathy. Conservative therapy is usually considered as the first step in the management of CTS. Low Level Laser Therapy (LLLT) is among the new physical modalities, which has shown therapeutic effects in CTS. The aim of the present study was to compare the effects of applying LASER and splinting together with splinting alone in patients with CTS.
Methods: Fifty patients with mild and moderate CTS who met inclusion criteria were included in this study. The disease was confirmed by electrodiagnostic study (EDx) and clinical findings. Patients were randomly divided into 3 groups. Group A received LLLT and splinting. Group B received sham LLLT+ splinting and group C received only splints. Group A received LLLT (50 mw and 880nm with total dose of 6 joule/cm2). Clinical and EDx parameters were evaluated before and after treatment (3 weeks and 2 months later).
Results: Electrophysiologic parameters and clinical findings including CTS provocative tests, Symptoms severity score (SSS), Functional Severity Score (FSS) and Visual Analogue Score (VAS) were improved in all three groups at 3 weeks and 2 months after treatment. No significant changes were noticed between the three groups regarding clinical and EDX parameters.
Conclusion: We found no superiority in applying Low Intensity Laser accompanying splinting to traditional treatment which means splinting alone in patients with CTS. However, future studies investigating LLLT with parameters other than the one used in this study may reveal different results in favor of LLLT.
Irvine J, Chong SL, Amirjani N, Chan KM. Double blind randomized controlled trial of low level laser therapy in carpal tunnel syndrome”. Muscle nerve.2004; 30:182-7.
De Krom MCTFM, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: Prevalance in the general population. J Clin EpidemioI1992:45:373-6.
Atroshi L, Gummessson C , Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalance of carpal tunnel syndrome in general population. JAMA 1999;282:153-8.
Salaffi F, De Angelis R, Grassi W; MArche Pain Prevalence; INvestigation Group (MAPPING) study. Prevalence of Musculoskeletal conditions in an Italian population sample. Clin Exp Rheumatol. 2005 Nov-Dec; 23 (6):819-28.
Werner RA, Franzblau A, Gell N. Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Arch Phys Med Rehabil. 2005;86:1-7.
Munie T. Surgical management of carpal tunnel syndrome in neurosurgery practice in Ethiopia and review of literature. Ethiop med J 2005 Apr; 43: 79-83.
Dumitru D, Amato A. Focal peripheral neuropathies. in .A, Zwart, D Dumitru. Electrodiagnostic Medicine. 2nd ed.Philadelphia:Hanley andBelfus,Inc; 2002. p.1058-70.
Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndromes-American Association of Electrodiagnostic Medicine. Muscle Nerve 1993;16:1392-414.
Evcik D, Kavuncu V, Cakir T, Subasi V, Yaman M. Laser therapy in the treatment of carpal tunnel syndrome: a randomized controlled trial. Photomed Laser Surg 2007 ;25:34-9
Brosseau L, Gam A, Harman K, Morin M, Robinson VA, Shea BJ, et al. Low level laser therapy (classes I, II and III) for treating osteoarthritis (Cochrane Review). In: the Cochrane Library, lssue 3, 2004.
Bingol U, Altan L, Yurtkuran M. Low-power laser treatment for shoulder pain. Photomed laser surg. 2005 Oct;23(5): 456-64.
Walker WC, Metzler M, Cifu DX, Swartz Z. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehab 2000; 81:424-9.
Werner RA, Franzblau A, Gell N. Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Arch Phys Med Rehabil 2005;86:1-7.
Ohta K, Bousquet PJ, Akiyama K , Adachi M, Ichinose M, Ebisawa M, et al. Visual analogue scale as a predictor of GINA-defined asthma control. The SACRA study in Japan. J Asthma 2013 ;50(5):514-21.
Dorgelo MNS, Terwee CB, Stalman WA, van der Windt DA. Reproducibility and responsiveness of the Symptom Severity Scale and the hand and finger function subscale of the Dutch arthritis impact measurement scales (Dutch-AIMS2-HFF) in primary care patients with wrist or hand problems. Health Qual Life Outcomes 2006; 4:87.
Negahban H, Hessam M, Tabatabaei S, Salehi R, Sohani SM, Mehravar M. Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders. Disabil Rehabil. 2013 March 27. [Epub ahead of print]
Tascioglu F, Degirmenci NA, Ozkan S, Mehmetoglu O. Low-level laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation. Rheumatol Int. 2012 Feb;32:409-15
Naeser MA. Photobiomodulation of pain in Carpal tunnel syndrome: review of seven studies. Photomed Laser Surg 2006; 24: 101-10.
Yagci I, Elmas O, Akcan E, Ustun I, Gunduz OH, Guven Z. Low level laserComparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome. Clin Rheumatol 2009; 28:1059–106.
Bjordal JM, Couppe C, Chow RT, Tuner J, Liunggren EA. A systematic review of low level laser therapy with location-specific doses for pain form chronic joint disorders. Aust J physiother 2003; 49:107-16.
. Shooshtari SM, Badiee V, Taghizadeh SH, Nematollahi AH, Amanollahi AH, Grami MT. The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome. Electeromyogr Clin Neurophysio 2008;48:229-31.
Rayegani S, Bahrami M, Samadi B, Sedighipour L, Mokhtarirad M, Eliaspoor D. Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial. Eur J Phys Rehabil Med 2011;47:381-9.
Gur A, Karakoc M, Nas K, cevik R, Sarac J, Demir E. Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo-controlled trial. Lasers Med Sci 2002; 17:57-61.
Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S. Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize- controlled trial. Lasers Surg Med 2004;3:229-35.
Raeissadat A ,Reza Soltani Z. Study of Long Term Effects of Laser Therapy Versus Local Corticosteroid Injection in Patients with Carpal Tunnel Syndrome. J Lasers Med Sci 2010 ;1:24-30