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 < or = 0.01) except for muscle weakness. Moreover, LLLT showed significant results in all parameters of objective findings (p < or = 0.01) except for thenar atrophy. However, NCSs expressed the same statistical significance (p < or = 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.

Results of Surgical Treatment of Carpal Tunnel Syndrome

“…In our tests, the threshold of sensation in the pulps of fingers I, II, and III (OM) improved in 81% of the patients. Other authors have reported the following improvement rates: 88% in two-point discrimination test and 87% in the Semmes-Weinstein test (Gelberman et al), 86% in two-point discrimi nation test and 94% in the Semmes-Weinstein test (Bednarski et al), and 63% in the Semmes-Weinstein test (Elwakil) [29,30]. Richter and Bruster showed that normal sensory function of the index and middle finger was restored in 60-80% of the patients at 3 weeks after decompression and there was no further improvement at 6 weeks.…”

“…9. Improvement of Current Perception Threshold (CPT) in fingertips of fingers innervated by the median nerve [28] i 94% dla S -W, El wa kil 63% dla te stu S -W [29,30]. Rich ter i Bru ster wy ka za li, że po 3 ty go dniach od dekom pre sji 60 -80% cho rych od zy sku je pra wi dło we czu cie na wska zi cie lu i pal cu środ ko wym, a po 6 tygo dniach dal sza po pra wa już nie na stę pu je.…”

Low-level Laser Treatment Relieves Pain and Neurological Symptoms in Patients with Carpal Tunnel Syndrome

“…The analgesic effect of LLLT is still controversial, but the clinical effect is confirmed 4,8) . 5,7,8,12) , and enhance the respiration metabolism of the cells 13) . Those metabolisms reduce the wastes from the inflammation including leukotrienes and metabolite which could improve the healing process.…”

“…It was apparent based on their results as well as ours, especially for the improvement in symptom severity and neurological signs. Elwakil et al compared LLLT with the standard open carpal tunnel release surgery, and found that LLLT could improve hand weakness and the atrophy of thenar muscles 7) . The velocity of neural conduction also showed statistical significance after the treatment (p<0.05).…”

“…The efficacy of LLLT in treating CTS is controversial. The beam energy of LLLT was more than 9 J in studies [6][7][8] which found the treatment to be effective, while the energy was less than 6 J in a study which found it ineffective 9) . Besides, regarding pain, there are several reports of the effectiveness of LLLT on physiological factors and it has been shown to be an effective treatment by meta-analysis 3,5) .…”