Ultrasound and laser therapy in the treatment of carpal tunnel syndrome

Abstract

This study was designed to compare the efficacy of ultrasound and laser treatment for mild to moderate idiopathic carpal tunnel syndrome. Ninety hands in 50 consecutive patients with carpal tunnel syndrome confirmed by electromyography were allocated randomly in two experimental groups. One group received ultrasound therapy and the other group received low level laser therapy. Ultrasound treatment (1 MHz, 1.0 W/cm(2), pulse 1:4, 15 min/session) and low level laser therapy (9 joules, 830 nm infrared laser at five points) were applied to the carpal tunnel for 15 daily treatment sessions (5 sessions/week). Measurements were performed before and after treatment and at follow up four weeks later, and included pain assessment by visual analogue scale; electroneurographic measurement (motor and sensory latency, motor and sensory action potential amplitude); and pinch and grip strength. Improvement was significantly more pronounced in the ultrasound group than in low level laser therapy group for motor latency (mean difference 0.8 m/s, 95% CI 0.6 to 1.0), motor action potential amplitude (2.0 mV, 95% CI 0.9 to 3.1), finger pinch strength (6.7 N, 95% CI 5.0 to 8.2), and pain relief (3.1 points on a 10-point scale, 95% CI 2.5 to 3.7). Effects were sustained in the follow-up period. Ultrasound treatment was more effective than laser therapy for treatment of carpal tunnel syndrome. Further study is needed to investigate the combination therapy effects of these treatments in carpal tunnel syndrome patients.

Kısa Dalga Tedavisinin ‹diyopatik Karpal Tünel Sendromundaki Etkinliği: Randomize Çift Kör Kontrollü Çalışma

“…KD grubundaki artışın KKD grubuna göre anlamlı oranda daha fazla olması, bize bu etkinin KD tedavisinin yumuşak dokulardaki derin ısıtıcı etkilerine bağlı olabileceğini düşündürmüştür. Nitekim, yine bir derin ısıtıcı olan ultrason tedavisi ile yapılmış çalışmalarda, KTS semptom şiddeti ve fonksiyonel skorlarında, ağrı skorlarında ve el kavrama ve parmak sıkma gücünde plaseboya oranla anlamlı düzelmeler saptanmıştır (26,27). Araştırmacılar bu etkiyi US'nin derin ısıtıcı etkilerinden dolayı dokularda meydana gelen kan akımında artış, lokal metabolizmada artış ve bunların sonucu olan doku rejenerasyonunda artışa bağlamışlar, aynı zamanda ağrı ve inflamasyonu azaltıcı etkilerin sinir rejenerasyonunu kolaylaştıracağının altını çizmişlerdir (26,27).…”

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

“…Thus, the laser energy might be absorbed by the soft tissue, and insufficient energy reaches the injured nerve. Bakhtiary and Rashidy-Pour tried to use an 830 nm point-like LLLT (1.8 J / point) to irradiate 5 points on the distribution of median nerve 9) , and they obtained an unsuccessful result. The reason was that the nerve dispersion is different from each patient, and this method is very hard to provide an appropriate dosage for the injured section of the nerve 21) .…”

“…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) .…”

Optimal management of carpal tunnel syndrome

“…As a result, it is suggested that ultrasound therapy may accelerate the healing process in damaged tissues. 24 It is often prescribed along with nerve and tendon exercises. The AAOS guideline recommends ultrasound treatment of CTS.…”