Lasers Med Sci DOI 10.1007/s10103-014-1527-2
ORIGINAL ARTICLE
Low-level laser therapy with a wrist splint to treat carpal tunnel syndrome: a double-blinded randomized controlled trial Yupadee Fusakul & Thanyaporn Aranyavalai & Phongphitch Saensri & Satit Thiengwittayaporn
Received: 27 April 2013 / Accepted: 13 January 2014 # Springer-Verlag London 2014
Abstract The efficacy of low-level laser therapy (LLLT) was evaluated in a total of 66 patients with mild to moderate carpal tunnel syndrome (CTS) with a double-blinded randomized controlled study. The patients were randomly assigned into two groups. Group I received 15 sessions of a galliumaluminum-arsenide laser treatment at a dosage of 18 J per session over the carpal tunnel area with neutral wrist splint. Group II received placebo laser therapy with neutral wrist splint. The patients were evaluated with the following parameters: (1) clinical parameters which consisted of visual analog scale, symptom severity scale, functional status scale, and pinch strength and grip strength before the treatment and at 5- and 12-week follow-ups and (2) electroneurophysiological parameters from nerve conduction study which were evaluated before the treatment and at 12-week follow-up. Fifty nine patients (112 hands: unilateral CTS=6 hands and bilateral CTS=106 hands) completed the study. Both groups I and II had n=56 hands. Improvements were significantly more pronounced in the LLLT-treated group than the placebo group especially for grip strength at 5- and 12-week follow-ups. At 12-week follow-up, distal motor latency of the median nerve was significantly improved in the LLLT group than the placebo group (p4.2 ms for DML or >3.5 ms for DSL were used to diagnose CTS. Median-ulnar mixed nerve latencies by orthodromic stimulation were measured by using surface electrodes at the median and ulnar nerve area at the wrist and by stimulating the palmar branches of the median and ulnar nerves in the palm at a distance of 8 cm from the active electrodes. CTS was diagnosed when the median-ulnar latency differences were >0.5 ms [17]. Ulnar sensory nerve conduction studies were performed to exclude the possibility of other disorders. Needle electromyography was performed to exclude severe CTS or radiculopathy. A patient’s assessment of how he or she responded to treatment was classified into six categories: (1) completely recovered, (2) much improved, (3) moderately improved, (4) slightly improved, (5) not improved, or (6) worse. VAS, SSS, FSS, grip strength, pinch strength, and patient’s assessment of his or her treatment were conducted before treatment and 5 and 12 weeks after treatment. NCS was conducted before treatment and 12 weeks later.
Lasers Med Sci Fig. 2 The consort chart
Therapeutic interventions In group I, a gallium-aluminum-arsenide (Ga-Al-As) diode laser (RJ laser, Germany) was used with a wavelength of 810 nm and a power output of 50 mW. The linear laser beam was applied in parallel with distal wrist crease using the scanning mode over the area of the median nerve by using landmarks 5 cm above and 5 cm below the distal crease of the wrist. The source of the laser beam was placed 10 cm away from the skin at the distal crease of the wrist (Fig. 3a). The dose of the treatment was 18 J per session, which was calculated by using the following equation [18]: EnergyðJouleÞ ¼ PowerðWattÞ TimeðsecondÞ Duty cycle:
The power output at equipment display screen is 50 mW. According to Kolari and Airaksine (1988), the power at target tissue site would be reduced about 37 % with 1-cm penetration. Because the median nerve is at the distance about 0.5– 1 cm below the skin, the power at target tissue site was therefore calculated to be approximately 31.5–40.7 mW
[19]. A non-contact scanning technique was employed by a static scanning device for a wider area which can cover the overall carpal tunnel area of 40 cm2 (5 cm above and below from the distal wrist crease with the laser beam width of 4 cm, resulting in a total area of 10×4=40 cm2) [20] with the treatment dose of 18 J per session, as displayed on the equipment display screen. Each patient was treated with laser therapy for 15 sessions in total over a period of 5 weeks (three times per week); therefore, the cumulated energy dose was 18×15=270 J for each patient in the laser group. Each patient also was prescribed prefabricated neoprene splint (Futuro, USA) set in neutral position (Fig. 3b). All patients were encouraged to use their wrist splints for 12 weeks during the nighttime and during the daytime whenever possible. In group II, the patients received a placebo treatment that consisted of red light (wavelength of 810 nm) without laser power output shined over the region of the carpal tunnel at the same frequency (three times per week for 5 weeks; 15 sessions in total) and duration (6 min per session) that group I received (Fig. 3c). This group of patients also wore a neutral wrist splint for the same duration that group I did.
Lasers Med Sci Fig. 3 a Low-level laser therapy over the region of the carpal tunnel. b Neutral wrist splint. c The placebo treatment as red light without a laser output
All the patients in both groups were encouraged to do tendon gliding exercises [21] and appropriate wrist-hand activities by their attending physical therapist and occupational therapist. Statistical analyses Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS version 17.0) program. Demographic data and patient characteristics were divided into quantitative and qualitative data. The quantitative data, e.g., age and duration of symptoms, were reported as means and standard deviations. The qualitative data, e.g., gender and the number of patients whose dominant hand was studied, were reported as a frequency or a percentage. Differences between scores before and after treatment were analyzed by a paired t test. Differences between scores of groups I and II were analyzed by an independent t test. Statistical significance was set as p
ORIGINAL ARTICLE
Low-level laser therapy with a wrist splint to treat carpal tunnel syndrome: a double-blinded randomized controlled trial Yupadee Fusakul & Thanyaporn Aranyavalai & Phongphitch Saensri & Satit Thiengwittayaporn
Received: 27 April 2013 / Accepted: 13 January 2014 # Springer-Verlag London 2014
Abstract The efficacy of low-level laser therapy (LLLT) was evaluated in a total of 66 patients with mild to moderate carpal tunnel syndrome (CTS) with a double-blinded randomized controlled study. The patients were randomly assigned into two groups. Group I received 15 sessions of a galliumaluminum-arsenide laser treatment at a dosage of 18 J per session over the carpal tunnel area with neutral wrist splint. Group II received placebo laser therapy with neutral wrist splint. The patients were evaluated with the following parameters: (1) clinical parameters which consisted of visual analog scale, symptom severity scale, functional status scale, and pinch strength and grip strength before the treatment and at 5- and 12-week follow-ups and (2) electroneurophysiological parameters from nerve conduction study which were evaluated before the treatment and at 12-week follow-up. Fifty nine patients (112 hands: unilateral CTS=6 hands and bilateral CTS=106 hands) completed the study. Both groups I and II had n=56 hands. Improvements were significantly more pronounced in the LLLT-treated group than the placebo group especially for grip strength at 5- and 12-week follow-ups. At 12-week follow-up, distal motor latency of the median nerve was significantly improved in the LLLT group than the placebo group (p4.2 ms for DML or >3.5 ms for DSL were used to diagnose CTS. Median-ulnar mixed nerve latencies by orthodromic stimulation were measured by using surface electrodes at the median and ulnar nerve area at the wrist and by stimulating the palmar branches of the median and ulnar nerves in the palm at a distance of 8 cm from the active electrodes. CTS was diagnosed when the median-ulnar latency differences were >0.5 ms [17]. Ulnar sensory nerve conduction studies were performed to exclude the possibility of other disorders. Needle electromyography was performed to exclude severe CTS or radiculopathy. A patient’s assessment of how he or she responded to treatment was classified into six categories: (1) completely recovered, (2) much improved, (3) moderately improved, (4) slightly improved, (5) not improved, or (6) worse. VAS, SSS, FSS, grip strength, pinch strength, and patient’s assessment of his or her treatment were conducted before treatment and 5 and 12 weeks after treatment. NCS was conducted before treatment and 12 weeks later.
Lasers Med Sci Fig. 2 The consort chart
Therapeutic interventions In group I, a gallium-aluminum-arsenide (Ga-Al-As) diode laser (RJ laser, Germany) was used with a wavelength of 810 nm and a power output of 50 mW. The linear laser beam was applied in parallel with distal wrist crease using the scanning mode over the area of the median nerve by using landmarks 5 cm above and 5 cm below the distal crease of the wrist. The source of the laser beam was placed 10 cm away from the skin at the distal crease of the wrist (Fig. 3a). The dose of the treatment was 18 J per session, which was calculated by using the following equation [18]: EnergyðJouleÞ ¼ PowerðWattÞ TimeðsecondÞ Duty cycle:
The power output at equipment display screen is 50 mW. According to Kolari and Airaksine (1988), the power at target tissue site would be reduced about 37 % with 1-cm penetration. Because the median nerve is at the distance about 0.5– 1 cm below the skin, the power at target tissue site was therefore calculated to be approximately 31.5–40.7 mW
[19]. A non-contact scanning technique was employed by a static scanning device for a wider area which can cover the overall carpal tunnel area of 40 cm2 (5 cm above and below from the distal wrist crease with the laser beam width of 4 cm, resulting in a total area of 10×4=40 cm2) [20] with the treatment dose of 18 J per session, as displayed on the equipment display screen. Each patient was treated with laser therapy for 15 sessions in total over a period of 5 weeks (three times per week); therefore, the cumulated energy dose was 18×15=270 J for each patient in the laser group. Each patient also was prescribed prefabricated neoprene splint (Futuro, USA) set in neutral position (Fig. 3b). All patients were encouraged to use their wrist splints for 12 weeks during the nighttime and during the daytime whenever possible. In group II, the patients received a placebo treatment that consisted of red light (wavelength of 810 nm) without laser power output shined over the region of the carpal tunnel at the same frequency (three times per week for 5 weeks; 15 sessions in total) and duration (6 min per session) that group I received (Fig. 3c). This group of patients also wore a neutral wrist splint for the same duration that group I did.
Lasers Med Sci Fig. 3 a Low-level laser therapy over the region of the carpal tunnel. b Neutral wrist splint. c The placebo treatment as red light without a laser output
All the patients in both groups were encouraged to do tendon gliding exercises [21] and appropriate wrist-hand activities by their attending physical therapist and occupational therapist. Statistical analyses Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS version 17.0) program. Demographic data and patient characteristics were divided into quantitative and qualitative data. The quantitative data, e.g., age and duration of symptoms, were reported as means and standard deviations. The qualitative data, e.g., gender and the number of patients whose dominant hand was studied, were reported as a frequency or a percentage. Differences between scores before and after treatment were analyzed by a paired t test. Differences between scores of groups I and II were analyzed by an independent t test. Statistical significance was set as p
