Effectiveness of High-intensity Laser Therapy in Combination with Conventional Conservative Treatment for Carpal Tunnel Syndrome Compared with Conventional Conservative Treatment Alone in Clinical Outcomes and Electrophysiologic Parameters: An Experimental, Non-randomized Clinical Trial Single-blind Study

Authors

  • Sucha Kumnoonsup Department of Physical medicine and Rehabilitation, Saraburi Hospital, Saraburi, Thailand

Keywords:

high-intensity laser therapy, carpal tunnel syndrome, numbness, pain, electrophysiologic parameters

Abstract

Objectives: To determine the effectiveness of the combination of high-intensity laser therapy (HILT) with conventional conservative treatment for individuals with carpal tunnel syndrome (CTS) compared to conventional treatment alone.

Study design: An experimental study using non-randomized clinical trials in a single-blind study.

Setting: Outpatient Rehabilitation Clinic, Saraburi Hospital.

Subjects: Patients diagnosed with CTS classified as minimal, mild, or moderate, based on the modified neurophysiologic grading system.

Methods: The 60 participants were divided equally into two groups, a HILT treatment (experimental) group and a conventional conservative treatment (control) group. The participants freely choose their own treatment group.  Clinical outcomes and electrophysiological parameters were measured before treatment and five weeks after treatment. Results were compared between the groups.

Results: At baseline, none of the demographic, clinical, or electro-physiologic parameters were statistical significantly different between the two groups with the exception of the chief complaint and the sensory nerve action potential amplitude (SNAP amp). Repeated-measures analysis of variance found a significant group-by-time interaction among the numeric rating scale of numbness (NRS numbness), the numeric rating scale of pain (NRS pain), the Boston questionnaire symptom severity score (BQSSS), the Boston questionnaire functional severity score (BQFSS), sensory nerve action potential peak latency (SNAP PL), sensory nerve conduction velocity (SNCV), median-ulnar sensory latency difference to the ring finger (Median vs. Ulnar), and compound motor action potential onset latency (CMAP OL).

Conclusions: This study demonstrated that the addition of HILT to conventional conservative treatment is an effective and noninvasive treatment method for minimal, mild, and moderate CTS.

References

Sevy JO, Varacallo M. Carpal tunnel syndrome. [Internet]. StatPearls Publishing; 2022 [cited 2022 Dec 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179

Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA [Internet]. 1999 Jul [cited 2022 Dec 28];282(2):153-8. Availa-ble from: https://jamanetwork.com/journals/jama/fullarticle/774263 doi:10.1001/jama.282.2.153

Stevens JC, Beard M, O’Fallon WM, Kurland LT. Conditions associated with carpal tunnel syndrome. Mayo Clin Proc [Internet].1992 Jun [cited 2022 Mar 12];67(6):541-8. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0025619612604613 doi:10.1016/s0025-6196(12)60461-3

Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso J, et al. An evaluation of gender, obesity, age, and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol [Internet]. 2002 Sep [cited 2022 Mar 12];113(9):1429-34. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1388245702002018 doi:10.1016/s1388-2457(02)00201-8

Craig A, Richardson JK. Rehabilitation with patients with neuropathies: In: Braddom RL, Chan L, Har-rast MA. Physical medicine and rehabilitation. 4th ed. Philadelphia: Saunders; 2011. p. 1084-5.

Padua L, Lomonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand [Internet]. 1997 Oct [cited 2022 Mar 15];96(4):211-7. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0404.1997.tb00271.x doi:10.1111/j.1600-0404.1997.tb00271.x

Wipperman J, Goerl K. Carpal tunnel Syndrome: diagnosis and management. Am Fam Physician [Internet]. 2016 Dec [cited 2022 Mar 15];94(23):993-9. Available from: https://www.aafp.org/pubs/afp/issues/2016/1215/p993.html

Burke F, Ellis J, McKenna H, Bradley M. Primary care management of carpal tunnel syndrome. Post-grad Med J [Internet]. 2003 Aug [cited 2022 Mar 15];79(934):433-7. Available from: https://pmj.bmj.com/content/79/934/433 doi:10.1136/pmj.79.934.433.

Krischak A, Krasteva F, Schneider D, Gulkin F, Gebhard M: Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. Arch Phys Med Rehabil [Internet]. 2009 Apr [cited cited 2022 Dec 26];90(4):537-44. Available from: https://www.archives-pmr.org/article/S0003-9993(09)00004-5/ doi:10.1016/j.apmr.2008.09.575

Dincer U, Cakar E, Kiralp MZ, Kilac H, Dursun H. The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound and low-level laser therapies. Photomed Laser Surg [Internet]. 2009 Feb [cited cited 2022 Dec 26];27(1):119-25. Available from: https://www.liebertpub.com/doi/10.1089/pho.2008.2211 doi:10.1089/pho.2008.2211

Kim JC, Jung SH, Lee SU, Lee SY. Effect of extracorporeal shockwave therapy on carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Medicine [Internet]. 2019 Aug [cited 2022 Dec 28];98(33):e16870. Available from: https://journals.lww.com/md-journal/Fulltext/2019/08160/Effect_of_extracorporeal_shockwave_therapy_on.78.aspx doi:10.1097/MD.0000000000016870

Verdugo RJ, Salinas RS, Castillo J, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev [Internet]. 2003 Jul [cited 2022 Mar 15];3: CD001552. Availa-ble from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001552/full doi:10.1002/14651858.CD001552

Kim PT, Lee HJ, Kim TG, Jeon IH. Current approaches for carpal tunnel syndrome. Clin Orthop Surg [Internet]. 2014 Sep [cited 2022 Mar 15];6(3):253-7. Available from: https://ecios.org/DOIx.php?id= 10.4055/cios.2014.6.3.253 doi:10.4055/cios.2014.6.3.253

Boulnois JL. Photophysical processes in recent medical laser developments: a review. Laser Med Sci [Internet]. 1986 Jan [cited 2022 Mar 16];1:47-66. Available from: https://link.springer.com/article/10.1007/BF02030737 doi:10.1007/BF02030737

Hochman-Elam LN, Heidel RE, Shmalberg JW. Effects of laser power, wavelength, coat length, and coat color on tissue penetration using photobiomodulation in healthy dogs. Can J Vet Res [Internet]. 2020 Apr [cited 2022 Mar 16];84(2):131-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088515/

Casale R, Damiani C, Maestri R, Wells CD. Pain and electrophy-siological parameters are improved by combined 830-1064 high-intensity laser in symptomatic carpal tunnel syndrome versus transcutaneous electrical nerve stimulation. A randomized controlled study. Eur J Phys Rehabil Med [Internet]. 2013 Apr [cited 2022 Feb 10];49(2):205-11. Available from: https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2013N02A0205#

Sudiyono N, Handoyo R. Comparison of high-intensity and low-level laser therapy effect on combined sensory index, sensory conduction velocity and distal motoric latency: a study in moderate carpal tunnel syndrome patients. J. Med. Sci [Internet]. 2020 Oct [cited 2022 Mar 25];52(4):335-42. Available from: https://journal.ugm.ac.id/bik/article/view/56245

van Breugel HH, Bar P. He-Ne laser irradiation affects proliferation of cultured rat schwann cells in a dose dependent manner. J Neurocytol [Internet]. 1993 Mar [cited 2022 Feb 22];22(3):185-90. Available from: https://pubmed.ncbi.nlm.nih.gov/8478640/ doi:10.1007/BF01246357

Passarella S, Casamassima E, Molinari S, Pastore D, Quagliariello E, Catalano M, et al. Increase of proton electrochemical potential and ATP synthesis in rat liver mitochondria irradiated in vitro by Helium-Neon laser, FEBS Lett [Internet]. 1984 Sep [cited 2022 Feb 20];175(1):95-9. Available from: https://pubmed.ncbi.nlm.nih.gov/6479342/ doi:10.1016/0014-5793(84)80577-3

Winterle JS, Einarsdottir O: Photoreactions of cytochrome c oxidase, J Photochem Photobiol [Internet]. 2007 Apr [cited 2022 Feb 20];82(3):711-9. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1562/2005-09-14-RA-684 doi:10.1562/2005-09-14-RA-684

Anders JJ, Geuna S, Rochkind S: Phototherapy promotes regeneration and functional recovery of injured peripheral nerve, Neurol Res [Internet]. 2004 Mar [cited 2022 Feb 20];26(2):234-40. Available from: https://www.tandfonline.com/doi/abs/10.1179/016164104225013914 doi:10.1179/016164104225013914

Yu HS, Chang KL, Yu CL, Chen JW, Chen GS. Low-energy helium-neon laser irradiation stimulates interleukin-1 alpha and interleukin-8 release from cultured human keratinocytes, J Invest Dermatol [Internet]. 1996 Oct [cited 2022 Feb 25];107(4):593-6. Available from: https://pubmed.ncbi.nlm.nih.gov/8823366/ doi:10.1111/1523-1747.ep12583090

Aimbire F, Albertini R, Pacheco MT, Castro-Faria-Neto HC, Leonardo LM, Iversen VV, et al. Low-level laser therapy induces dose-dependent reduction of TNFalpha levels in acute inflammation, Photomed Laser Surg [Internet]. 2006 Feb [cited 2022 Feb 20];24(1):33-7. Available from: https://www.liebertpub.com/doi/10.1089/pho.2006.24.33 doi:10.1089/pho.2006.24.33

Anders JJ, Geuna S, Rochkind S. Phototherapy promotes regeneration and functional recovery of injured peripheral nerve. Neurol Res [Internet]. 2004 Jul [cited 2022 Feb 25;26(2):233-9. Available from: https://www.tandfonline.com/doi/abs/10.1179/016164104225013914 doi:10.1179/016164104225013914

Hojjati F, Afjei M, Ebrahimi I, Rayegani S, Sarrafzadeh J, Raeissadat S, et al. The effect of high-power and low-power lasers on symptoms and the nerve conduction study in patients with carpal tunnel syndrome. A prospective randomized single-blind clinical trial. J Lasers Med Sci [Internet]. 2020 Dec [cited 2022 Mar 7];30(1):73-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956036/ doi:10.34172/jlms.2020.S12

Michelle H. Cameron. Physical agents in rehabilitation. 5th ed. Canada, Saunders; 2018.

Upatham S, Kumnerddee W. Reliability of Thai version Boston questionnaire. J Med Assoc Thai [Internet]. 2008 Aug [cited 2022 Feb 28];91(8):1250-6. Available from: http://www.jmatonline.com/index.php/jmat/article/view/635#

Preston DC, Shapiro BE. Electromyography and neuromuscular disorders clinical-electrophysiologic-ultrasound correlations. 4th ed. Canada: Elsevier; 2021.

Ogura Y, Ogura K, Kobayashi Y, Kitagawa T, Yonezawa Y, Takahashi Y, et al. Minimum clinically important difference of major patient-reported outcome measures in patients undergoing decompression surgery for lumbar spinal stenosis. Clin Neurol Neurosurg [Internet]. 2020 Sep [cited 2022 Nov 13];196:105966. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0303846720303097 doi:10.1016/j.clineuro.2020.105966

Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain [Internet]. 2004 Aug [cited 2022 Nov 13];8(4):283-91. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.2003.09.004 doi:10.1016/j.ejpain.2003.09.004

De Kleermaeker FGCM, Boogaarts HD, Meulstee J, Verhagen WIM. Minimal clinically important difference for the Boston carpal tunnel questionnaire: new insights and review of literature. J Hand Surg Eur [Internet]. 2019 Mar [cited 2022 Nov 14];44(3): 283-9. Available from: https://journals.sagepub.com/ doi/10.1177/ 1753193418812616 doi:10.1177/1753193418812616

Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol [Internet]. 2015 Jun [cited 2022 Nov 15];29(3):440-53. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1521694215000339 doi:10.1016/j.berh.2015.04.026

Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal Tunnel Syndrome: A review of literature. Cureus [Internet]. 2020 Mar [cited 2022 Nov 15];12(3):e7333. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164699/ doi:10.7759/cureus.7333

Downloads

Published

2023-03-08

Issue

Section

Original Article