Low Level Laser Therapy "LLLT" combined with physical therapy to treat Carpal Tunnel Syndrome "CTS".

This randomized double blind prospective study compares the efficacy of physical therapy (PT) combined with low level laser therapy (LLLT) in the treatment of Carpal Tunnel Syndrome against a program of physical therapy alone. Subjects on disability with diagnosed carpal tunnel syndrome were randomly assigned to the active or sham laser groups. Sensory threshold, grip and pinch strength and wrist range of motion were measured as functional tests for each subject. Other evaluations included upper extremity blood flow, median nerve EMG conduction and latencies and return to work following the treatment program.

Outcome of treatment with low level laser therapy and physical therapy vs. physical therapy alone.

Muscular function was improved for both the physical therapy only group and for the physical therapy plus laser group, with a significantly greater improvement for the laser group in measures of grip and pinch strength (p < 0.05 for grip in a wrist flexion or extension posture and for pinch grip). There was also a significantly greater improvement in range of motion in the radial deviation plane for the laser treated group. Sensory thresholds were not significantly affected by laser treatment nor was wrist blood flow. EMG conduction and latencies showed statistically significant improvement for combined physical therapy and active laser only for motor nerve conduction velocity across the wrist (p < 0.05). Most significantly however, the group receiving combined PT plus LLLT showed a significantly higher incidence of return to work post-treatment (72% vs 41%. p < 0.05). suggestive of both functional improvement and subjective improvement on self-evaluation.

These data indicate that low-level therapy, when used in conjunction with a program of physical therapy intended to mobilize and strengthen the wrist and upper quadrant, improves functional measures of wrist-hand work performance and results in greater probability of return to work than physical therapy alone. Further research is needed to address efficacy of laser therapy alone in the treatment of CTS, to define the optimal treatment dosage and to evaluate treatment at the earliest stages of symptom development.

PURPOSE
The High Cost of Carpal Tunnel Syndrome

Carpal tunnel syndrome is a major contributor to disability costs for US industry, and has a significant impact on the affected worker's overall quality of life. In addition, product quality and productivity are likely to be adversely affected through loss of skilled workers to temporary or permanent disability and from direct effects on work capabilities in less severe cases.

Current Treatment Modalities
Present treatment for the syndrome typically consists of anti-inflammatory drugs, rehabilitation through physical therapy, and surgical release of the flexor retinaculum in the most severe cases. These approaches have limited success in restoring function, relieving pain and returning a person to productive employment. This research project was designed to determine whether a combined program of low level laser therapy and physical rehabilitation was effective in the treatment of symptomatic carpal tunnel syndrome, and also whether the addition of low level laser therapy enhanced functional recovery compared to physical therapy alone in the treatment of carpal tunnel syndrome.

SUMMARY AND CONCLUSIONS

• Functional measures of grip strength, important to assembly jobs, were positively affected by both the physical therapy program and the combined program of physical therapy and laser irradiation.
• The improvement was significantly greater in the group which also received laser irradiation of the carpal tunnel area transcutaneously, and the fraction of subjects showing improvement was greater for the laser group.
• Sensory thresholds were not significantly improved during the 5-week treatment period for either physical therapy alone or therapy plus laser. Additional time to allow nerve regrowth, perhaps with periodic follow-up treatments, might improve sensory recovery.
• Wrist range of motion was not affected by treatment, except for radial deviation, which was significantly improved for the laser treated group.
• EMG data were inconclusive, with the only statistically significant difference in pre versus post treatment EMG's for the active laser group appearing in motor nerve latency recorded across the wrist. A statistically significant difference for the inactive laser group was noted for palmar sensory latencies.
• Wrist blood flow measured non-invasively was increased both for subjects having prior surgical release and for those not surgically treated, but the differences observed were not statistically significant. The absence of changes in major vessel blood flow through the carpal tunnel supprts the hypothesis that any circulatory changes occurring post-treatment are at the microvascular level.
• Return to work was approximately 72% for the active laser group versus 41% for the placebo laser, a statistically significant treatment difference (p < 0.05).
• These data show that low-energy laser therapy improves functional measures of wrist-hand work performances and improves probability of return to work when used in conjunction with a program of physical therapy intended to mobilize and strengthen the wrist. Further research is needed to address efficacy of laser irradiation alone in the treatment of CTS, and to evaluate treatment at the earliest stages of symptom development.

SIGNIFICANCE
Functional measures of grip strength, important to assembly jobs, were positively affected by both the physical therapy program and the combined program of physical therapy and laser treatment. The improvement was significantly greater in the group which also received laser irradiation of the carpal tunnel area transcutaneously. These data suggest that low-energy laser therapy combined with physical therapy improves functional measures of wrist-hand work performance and increase the probability of return to work. Further research is required to address the efficacy of laser treatment alone in the treatment of CTS, especially for early stages of the syndrome.

Sciatica  •  Herniated Disc • Bursitis • Sprains • Tennis Elbow • Arthritis • Tendonitis • Whiplash • Carpal Tunnel Syndrome • Plantar Fasciitis • Temporomandibular Joint Disorders
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