RESUMO
PURPOSE: To evaluate the current evidence comparing low level to high level laser therapy to reveal any superiorities in the treatment of musculoskeletal disorders. METHODS: Five databases were searched till September 2022 to obtain relevant RCTs comparing high intensity and low-level laser therapies in the management of musculoskeletal disorders. Two authors assessed the methodological quality of the included studies using the Physiotherapy Evidence Database scale and meta-analysis was conducted for studies that showed homogeneity. RESULTS: Twelve articles were included in this systematic review with a total population of 704 participants across various musculoskeletal pathologies including tennis elbow, carpal tunnel syndrome, chronic non-specific low back pain, knee arthritis, plantar fasciitis, and subacromial impingement. There were no statistical differences between the two interventions in pain, electrophysiological parameters, level of disability, quality of life, postural sway or pressure algometer, however, Low level laser therapy showed superiority in increasing grip strength compared to high intensity laser therapy while results were significant in favour of high intensity laser therapy regarding long head of biceps diameter and cross sectional area, supraspinatus thickness and echogenicity and acromio-humeral distance. CONCLUSION: The current literature suggests no superiority of both types of laser therapy in musculoskeletal disorders, however, more RCTs with larger sample size are required to reach a definitive conclusion regarding the superiority of either form of laser therapy in musculoskeletal disorders.
Assuntos
Terapia com Luz de Baixa Intensidade , Doenças Musculoesqueléticas , Humanos , Doenças Musculoesqueléticas/radioterapia , Terapia com Luz de Baixa Intensidade/métodos , Terapia a Laser/métodos , Síndrome do Túnel Carpal/radioterapia , Qualidade de Vida , Cotovelo de Tenista/radioterapia , Resultado do TratamentoRESUMO
The aim of this study was to evaluate the effects of high intensity laser therapy (HILT) on pain, functional status, hand grip strength, and median nerve cross-sectional area by ultrasonography in patients with carpal tunnel syndrome. Sixty patients who were diagnosed with carpal tunnel syndrome were included in the study. The patients observed during the research were randomly divided into two groups with 30 patients in each group. Splint+ exercise and HILT (pulsed mode with a power of 8.0 W and energy density of 8 J/cm2 for 1.40 minutes for every 25 cm2, continuous mode with a power of 3.0 W and energy density of 80 J/cm2 for 11 minutes for each 25 cm2; total 10 sessions 5 days a week) were applied for 2 weeks for the first group, and splint+exercise and sham laser treatment were applied for 2 weeks for the second group. Randomization was undertaken with the assistance of a computer-generated random number table before beginning the treatment processes. The patients were evaluated with the determined scales before the treatment, at the end of the treatment, and at the 3rd month. Hydraulic hand dynamometer was used to measure hand grip strength, visual analog scale (VAS) for pain, Boston CTS Questionnaire to assess function, and ultrasonography to measure median nerve cross-sectional area. The impact of time on the change in VAS levels was found to be of statistical significance within each group of patients (p<0.001), but between-group comparisons did not yield significant results (p<0.454). The effects of time on variations in Boston CTS Questionnaire scores were found to have been of statistical significance for both groups (p<0.001), but significance was not subsequently observed when the results of the two groups were compared on a between-group basis (p=0.226 and p=0.973 for the FSS and SSS, respectively). While time had a statistically significant effect on the change in hand grip strength for both groups (p=0.000), between-group comparisons statistical significance finding in favor of HILT was found in the early period (p=0.012). The time-group association patterns of the groups showed significant difference (p=0.025). While time had a statistically significant effect on the changes in the median cross-sectional areas of the nerve for the patients of both treatment groups (p<0.001), between-group comparisons yielded no findings of statistical significance (p=0.438). The time-group relationship patterns of the groups were found to reflect statistical significance (p=0.001). In conclusion, the results of the research presented here have confirmed that hand grip strength may increase and the median nerve's cross-sectional area may decrease upon the application of high-intensity laser for individuals experiencing CTS. However, this effect was demonstrated here only in the short-term and the evidence was not maintained through the course of follow-up of a longer duration.
Assuntos
Síndrome do Túnel Carpal , Terapia com Luz de Baixa Intensidade , Humanos , Nervo Mediano/diagnóstico por imagem , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/radioterapia , Força da Mão , Estado Funcional , Terapia com Luz de Baixa Intensidade/métodos , Ultrassonografia , Dor , Resultado do TratamentoRESUMO
Background: Carpal tunnel release (CTR) is widely accepted as an effective treatment for carpal tunnel syndrome. However, the recovery is often delayed and incomplete. Photobiomodulation therapy (PBMT) produces a nonthermal effect on living tissues; it promotes healing, remodels and reduces inflammation of an injured nerve. The purpose of this study was to compare the outcome of CTR between patients who underwent postoperative PBMT and without PBMT. Materials and methods: We recruited 105 patients who had open CTR from January 2019 to January 2021. Fifty-six patients fulfilled the study criteria and were randomized into two groups: with PBMT (n = 28) and without PBMT (n = 28). Demographic and clinical data were obtained preoperatively. The PBMT group had ten 3-min sessions over 3 weeks using 808 nm, 50 mW PBMT to deliver 9 J per session to the CTR incision scar. Clinical outcomes were assessed at 1, 3, and 6 months postoperatively. Data analysis was performed with SPSS software. Results: There were significant improvements in the Functional Status Scale in the Boston Carpal Tunnel Questionnaire (p = 0.018) and pain (visual analogue scales) in the morning (p = 0.019) at 1 month postoperatively in the PBMT group compared with the non-PBMT group. Improvement of tip pinch strength at 3 months (p = 0.022) and 6 months (p = 0.024), lateral pinch strength at 1 month (p = 0.042) and 3 months (p = 0.05), and tripod pinch strength at 3 months (p = 0.005) was significantly better in the PBMT group. Thumb 2-point discrimination (2PD) at 3 months (p = 0.018) and 6 months (p = 0.016) and index finger 2PD at 3 months (p = 0.039) were also significantly improved in the PBMT group. There were no side effects of PBMT reported. Conclusions: Patients who underwent PBMT post-CTR had better outcomes. PBMT may be a valuable adjunct to post-CTR care.
Assuntos
Síndrome do Túnel Carpal , Terapia com Luz de Baixa Intensidade , Humanos , Síndrome do Túnel Carpal/radioterapia , Síndrome do Túnel Carpal/cirurgia , Resultado do Tratamento , Dor , PunhoRESUMO
To compare the effects of low level laser therapy (LLLT) and corticosteroid injection in patients with moderate carpal tunnel syndrome (CTS). Eighty-seven patients (143 wrists) with moderate CTS were randomized to the corticosteroid or LLLT groups. 40 mg of triamcinolone acetate solution was applied to carpal tunnel of 44 patients (74 wrist). LLLT was applied to 43 patients (70 wrist) five times a week, for a total of 15 sessions (fluence of 6 j/cm2 for 1 min per point at a wavelength of 830 nm). Outcome measures were numbness and pain, QuickDASH questionnaire, grasping tests, Tinel and Phalen tests, electrophysiological tests and MRI evaluations, which were tested at the baseline and 1st and 6th months after the treatment. Eighty patients (133 wrists) completed the study at the end of 6 months. VAS and Quick DASH scores were better in the corticosteroid group in the 1st month, but there were no significant differences between groups in the 6th month. Phalen and Tinel tests, strength tests, and motor distal latency improved significantly and similarly in both groups at the 1st and 6th months. Sensory distal latency and sensory nerve conduction velocity showed significant improvements in the 1st and 6th months only in the corticosteroid group. In both groups, median nerve intensity rate and palmary spring rate improved significantly after the treatment. Based on this study, corticosteroid injection and LLLT groups showed statistically significant difference at the 1st month (short-term), whereas there was no significant difference at the 6th month (intermediate-term).
Assuntos
Síndrome do Túnel Carpal , Terapia com Luz de Baixa Intensidade , Corticosteroides/uso terapêutico , Síndrome do Túnel Carpal/tratamento farmacológico , Síndrome do Túnel Carpal/radioterapia , Método Duplo-Cego , Humanos , Nervo Mediano , Condução Nervosa , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate the efficacy of low-level laser therapy on median nerve stiffness by using strain elastography in carpal tunnel syndrome (CTS). METHODS: This study included 37 wrists of 34 patients with mild or moderate CTS between January 2016 and August 2016. The control group comprised 17 patients (18 wrists) with CTS who were treated with wrist splinting for 3 weeks. The low-level laser therapy group included 17 patients (19 wrists) with CTS who were treated with a combination of splinting and low-level laser therapy, which was applied 5 times per week for 3 weeks. Clinical assessment scales, including the Symptom Severity Scale (SSS) and Functional Status Score (FSS), were obtained from our database. The cross-sectional area by ultrasound and strain ratio by elastography were studied. The differences in the strain ratio, cross-sectional area, SSS, and FSS between pretreatment and posttreatment periods in the groups were compared by the paired-sample t test. The correlations between changes in the strain ratio and the cross-sectional area, SSS, and FSS were analyzed by Pearson correlation coefficients. RESULTS: The control group included 13 women and 4 men, and the therapy group included 14 women and 3 men. In the therapy group, the mean values of the strain ratio, cross-sectional area, SSS, and FSS decreased significantly after laser therapy (P < .001) in contrast to the control group. No significant correlation was observed between the decreasing degree of the strain ratio and the cross-sectional area, SSS, and FSS after laser therapy. CONCLUSIONS: The strain ratio and cross-sectional area of the median nerve decrease after low-level laser therapy. These changes may be related to the therapeutic effects of low-level laser therapy, such as nerve regeneration and improvement of the vascular supply.
Assuntos
Síndrome do Túnel Carpal/terapia , Técnicas de Imagem por Elasticidade/métodos , Terapia com Luz de Baixa Intensidade/métodos , Nervo Mediano/diagnóstico por imagem , Contenções , Adulto , Síndrome do Túnel Carpal/patologia , Síndrome do Túnel Carpal/radioterapia , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , UltrassonografiaRESUMO
In mild and moderate cases of carpal tunnel syndrome (CTS), the conservative approach is suggested. The purpose of this study is to assess and compare the effect of low-power laser versus the combination of low-power laser and kinesiotaping on pain, muscle strength, functionality, and electrophysiologic parameters in the patients with CTS. The study was planned as single-blind, prospective, randomized control. 64 hands diagnosed with CTS were included in the study. The patients were randomly divided into three groups by closed envelope method. Low-power laser therapy was applied to Group 1 (21 hands), kinesiotaping and low-power laser therapy in group 2 (22 hands), sham laser therapy in Group 3 (21 hands). All patients were assessed by visual numeric pain scale (VNS), hand grip strength (HGS), finger pinch strength (FPS), the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), before treatment, after treatment (3rd week), and after (12th week) 3 months the treatment with the same physician. Motor and sensory nerve conduction studies were performed with electroneuromyography (ENMG) before the treatment (0th week) and at the end of the 12th week. Comparison of the group 1 with the group 3 showed significantly better improvement in the former in VNS, BCTSQ at 3rd week and 12th week compared to 0th week, and in FPS and HGS at 3rd week. Comparison of the group 2 with the group 3 showed significantly better improvement in the former VNS, BCTSQ, FPS and HGS at 3rd and 12th week compared to 0th week. When Group 1 and Group 2 were compared there was no statistically significant difference in any parameters in the 3rd week, but there was a statistically significant difference in favor of group 2 in FPS and HGS parameters at the 12th week. We have found that the kinesiotaping method applied with low-power laser treatment does not provide any additional benefit to the low-power laser treatment in the short term, however, in the long term, the increase in the HGS and FPS has occurred. In conclusion, low-power laser and kinesiotaping method in the treatment of CTS may be an effective and reliable treatment option in clinical parameters.
Assuntos
Fita Atlética , Síndrome do Túnel Carpal/radioterapia , Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/instrumentação , Adulto , Fita Atlética/efeitos adversos , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Terapia Combinada , Feminino , Humanos , Lasers Semicondutores/efeitos adversos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Exame Neurológico , Medição da Dor , Projetos Piloto , Força de Pinça , Estudos Prospectivos , Recuperação de Função Fisiológica , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , TurquiaRESUMO
OBJECTIVE: To systematically review the literature on the effectiveness of low-level laser therapy for patients with carpal tunnel syndrome. DATA SOURCES: The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016. STUDY SELECTION: Two reviewers independently applied the inclusion criteria to select potential studies. DATA EXTRACTION: Two reviewers independently extracted the data and assessed the methodologic quality. DATA SYNTHESIS: A best-evidence synthesis was performed to summarize the results of the 2 systematic reviews and 17 RCTs that were included. Strong evidence was found for the effectiveness of low-level laser therapy compared with placebo treatment in the very short term (0 to ≤5wk). After 5 weeks, the positive effects of low-level laser therapy on pain, function, or recovery diminished over time (moderate and conflicting evidence were found at 7- and 12-wk follow-up, respectively). CONCLUSIONS: In the very short term, low-level laser therapy is more effective as a single intervention than placebo low-level laser therapy in patients with carpal tunnel syndrome, after which the positive effects of low-level laser therapy tend to subside. Evidence in the midterm and long term is sparse.
Assuntos
Síndrome do Túnel Carpal/radioterapia , Terapia com Luz de Baixa Intensidade/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
We performed this meta-analysis to investigate the efficacy of low-level laser therapy (LLLT), a physiotherapy modality with anti-inflammatory and analgesic effects, in the management of mild-to-moderate carpal tunnel syndrome (CTS). We searched PubMed, Web of Knowledge, Scopus, Cochrane Central, and Virtual Health Library for randomized controlled trials (RCTs) that compared the effects of LLLT with or without splinting versus placebo on functional and electromyographic outcomes in CTS. All outcomes were pooled as mean differences (MD) under the inverse variance or random effects model, using the statistical add-in (MetaXL, version 5.0). Eight RCTs (473 patients/631 wrists) were eligible for the final analysis. The overall effect estimates did not favor LLLT therapy group over placebo in all primary outcomes: visual analogue scale (MD -1.11, 95% CI [-2.58, 0.35]), symptom severity scale score (MD -1.41, 95% CI [-5.12, 2.29]), and functional status scale score (MD -1.33, 95% CI [-3.27, 0.61]). However, LLLT was superior to placebo in terms of grip strength (MD 2.19, 95% CI [1.63, 2.76]) and inferior to placebo in terms of sensory nerve action potential (MD -2.74, 95% CI [-3.66, -1.82]). Laser therapy is superior to placebo in terms of improving the grip strength; however, no significant difference was found between both groups in terms of functional status improvement, pain reduction, or motor electrodiagnostic evaluations. Further high-quality trials with longer follow-up periods are required to establish the efficacy of LLLT for CTS treatment.
Assuntos
Síndrome do Túnel Carpal/radioterapia , Terapia com Luz de Baixa Intensidade , Síndrome do Túnel Carpal/fisiopatologia , Fenômenos Eletrofisiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Viés de Publicação , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Peripheral sensory neuropathy treatment is one of the common treatment problems and causes morbidity and mortality in people suffering from that. Although treatment depends on the underlying cause of the condition, nevertheless, in some cases, there is no cure for it, and it requires palliative and symptomatic treatment. In laboratory studies, low-level laser has been effective in the nerves protection and restoration. The aim of this article is to investigate the clinical efficacy of low-level laser on improvement of the peripheral somatosensory neuropathy. Search in the articles published up to 30 October 2015 (full text and abstracts) in databases PubMed (Medline), Cochrane library, Physiotherapy Evidence Database was performed. The studies of low-level laser trials on patients with peripheral neuropathy were carried out and evaluated in terms of the exclusion criteria. There are 35 articles among which 10 articles had the intended and required criteria. 1, 3, and 6 articles study the patients with diabetes, neuropathy caused by trauma, and carpal tunnel syndrome, respectively. In six studies, laser led to a reduction in sensory impairment and improvement of the physiological function of the sensory nerves. In these articles, lasers (Diode, GaAlAs, He-Ne) had wavelength range 660-860 nm, radiation power 20-250 mW, energy density 0.45-70 J/cm2. The intervention sessions range was 6-21 times and patient follow-up was 0-6 months. According to the results of these studies, low-level laser therapy can improve sensory function in patients with peripheral somatosensory neuropathy, although little research have not been done, laser treatment regimens are varied and do not recommend a specific treatment protocol. It seems it requires more research to sum up better, particularly in relation to diabetes.
Assuntos
Terapia com Luz de Baixa Intensidade , Doenças do Sistema Nervoso Periférico/radioterapia , Adulto , Síndrome do Túnel Carpal/radioterapia , Diabetes Mellitus/radioterapia , Seguimentos , Humanos , Lasers , Tamanho da Amostra , Fatores de Tempo , Resultado do Tratamento , Ferimentos e Lesões/radioterapiaRESUMO
Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.
Assuntos
Síndrome do Túnel Carpal/radioterapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Ondas de Choque de Alta Energia/uso terapêutico , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Relação Dose-Resposta à Radiação , Feminino , Humanos , Masculino , Nervo Mediano/fisiopatologia , Nervo Mediano/efeitos da radiação , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Inquéritos e Questionários , Resultado do TratamentoRESUMO
BACKGROUND: Low-level laser therapy (LLLT) has been applied in the treatment of carpal tunnel syndrome (CTS) for an extended period of time without definitive consensus on its effectiveness. This meta-analysis was conducted to evaluate the effectiveness of low-level laser in the treatment of mild to moderate CTS using a Cochrane systematic review. METHODS: We conducted electronic searches of PubMed (1966-2015.10), Medline (1966-2015.10), Embase (1980-2015.10), and ScienceDirect (1985-2015.10), using the terms "carpal tunnel syndrome" and "laser" according to the Cochrane Collaboration guidelines. Relevant journals or conference proceedings were searched manually to identify studies that might have been missed in the database search. Only randomized clinical trials were included, and the quality assessments were performed according to the Cochrane systematic review method. The data extraction and analyses from the included studies were conducted independently by 2 reviewers. The results were expressed as the mean difference (MD) with 95% confidence intervals (CI) for the continuous outcomes. RESULTS: Seven randomized clinical trials met the inclusion criteria; there were 270 wrists in the laser group and 261 wrists in the control group. High heterogeneity existed when the analysis was conducted. Hand grip (at 12 weeks) was stronger in the LLLT group than in the control group (MDâ=â2.04; 95% CI: 0.08-3.99; Pâ=â0.04; Iâ=â62%), and there was better improvement in the visual analog scale (VAS) (at 12 weeks) in the LLLT group (MDâ=â0.97; 95% CI: 0.84-1.11; Pâ<â0.01; Iâ=â0%). The sensory nerve action potential (SNAP) (at 12 weeks) was better in the LLLT group (MDâ=â1.08; 95% CI: 0.44-1.73; Pâ=â0.001; Iâ=â0%). However, 1 included study was weighted at >95% in the calculation of these 3 parameters. There were no statistically significant differences in the other parameters between the 2 groups. CONCLUSION: This study revealed that low-level laser improve hand grip, VAS, and SNAP after 3 months of follow-up for mild to moderate CTS. More high-quality studies using the same laser intervention protocol are needed to confirm the effects of low-level laser in the treatment of CTS.
Assuntos
Síndrome do Túnel Carpal/radioterapia , Força da Mão/fisiologia , Terapia com Luz de Baixa Intensidade/métodos , Síndrome do Túnel Carpal/diagnóstico , Feminino , Humanos , Masculino , Medição da Dor , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. METHODS/DESIGN: Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test. DISCUSSION: This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184.
Assuntos
Síndrome do Túnel Carpal/radioterapia , Terapia com Luz de Baixa Intensidade , Projetos de Pesquisa , Brasil , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Terapia Combinada , Desenho de Equipamento , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Assistência Domiciliar , Humanos , Aparelhos Ortopédicos , Medição da Dor , Limiar da Dor , Folhetos , Educação de Pacientes como Assunto , Fisioterapeutas , Estudos Prospectivos , Recuperação de Função Fisiológica , Método Simples-Cego , Contenções , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
The objective of this study is to investigate the efficacy of low-level laser therapy (LLLT) in patients with carpal tunnel syndrome (CTS). Sixty patients with CTS were included in this placebo-controlled and double-blind study and randomly assigned to three treatment groups: active laser with a dosage of 1.2 J/per painful point, active laser with a dosage of 0.6 J/per painful point, and placebo groups. A total of 5 points across the median nerve trace were irradiated with Gal-Al-As diode laser. All groups were treated 5 times per week for 3 weeks. Clinical assessments included pain intensity, grip strength, symptom severity score (SSS), functional status score (FSS), nerve conduction studies, and cross-sectional area (CSA) of the median nerve as measured by ultrasonography. Compared to baseline, post-treatment VAS scores (group 1, P < 0.001; group 2, P < 0.001; group 3, P < 0.01), grip strength (P < 0.05), SSS scores (group 1, P < 0.001; group 2, P < 0.001; group 3, P < 0.01), and FSS scores (P < 0.05) improved significantly in all groups. Only sensorial nerve velocity measurements on the palmar region showed a significant improvement in both active laser groups (P < 0.01). There was no significant difference in any of the outcome measures among the groups. With the chosen laser type and dose regimen, the results suggested that LLLT was no more effective than placebo in CTS.
Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/radioterapia , Terapia com Luz de Baixa Intensidade/métodos , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico por imagem , Relação Dose-Resposta à Radiação , Método Duplo-Cego , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/fisiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVE: To search for an effective therapy for carpal tunnel syndrome in early stage. METHODS: Sixty cases were randomly divided into an observation group 1 (21 cases), an observation group 2 (22 cases) and a basic treatment group (17 cases). The patients in three groups were treated with oral administration of Vitamin B1, Vitamin B12, compound Vitamin B and small splint for wrist protection as basic treatment, and the observation group 1 was also treated with acupuncture on local points as Laogong (PC 8), Yuji (LU 10), Hegu (LI 4) and Waiguan (TE 5) etc. combined with TDP irradiation, and the observation group 2 was treated with herbal steaming and washing on the affected part using Safflower and Lopseed etc. Electromyography, visual analogue scale (VAS) and clinical effect of three groups were observed before and after treatment. RESULTS: The changes of electromyogra phy had no significant difference before and after treatment in all groups (all P > 0.05), the VAS scores in two ob servation groups were superior to that in basic treatment group (both P < 0.05). The excellent and good rates were 90.5% and 86.4% in the observation group 1 and the observation group 2 respectively, both higher than that of 64.7% in the basic treatment group. CONCLUSION: Acupunture combined with TDP irradiation and Chinese herbal steaming and washing therapy both have significant therapeutic effects for treatment of carpal tunnel syndrome in early stage.
Assuntos
Terapia por Acupuntura , Síndrome do Túnel Carpal/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Radioterapia , Adulto , Idoso , Síndrome do Túnel Carpal/tratamento farmacológico , Síndrome do Túnel Carpal/radioterapia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830-nm diode laser on carpal tunnel syndrome (CTS). BACKGROUND DATA: Many articles in the literature have demonstrated that low-level laser therapy (LLLT) may help to alleviate various types of nerve pain, especially for CTS treatment. We placed an 830-nm laser directly above the transverse carpal ligament, which is between the pisiform and navicular bones of the tested patients, to determine the therapeutic effect of LLLT. MATERIALS AND METHODS: Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received laser treatment (10 Hz, 50% duty cycle, 60 mW, 9.7 J/cm(2), at 830 nm), and the placebo group received sham laser treatment. Both groups received treatment for 2 wk consisting of a 10-min laser irradiation session each day, 5 d a week. The therapeutic effects were assessed on symptoms and functional changes, and with nerve conduction studies (NCS), grip strength assessment, and with a visual analogue scale (VAS), soon after treatment and at 2-wk follow-up. RESULTS: Before treatment, there were no significant differences between the two groups for all assessments (p > 0.05). The VAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up (p < 0.05). After 2 wk of treatment, no significant differences were found in grip strengths or for symptoms and functional assessments (p > 0.05). However, there were statistically significant differences in these variables at 2-wk follow-up (p < 0.05). Regarding the findings of NCS, there was no statistically significant difference between groups after treatment and at 2-wk follow-up. CONCLUSIONS: LLLT was effective in alleviating pain and symptoms, and in improving functional ability and finger and hand strength for mild and moderate CTS patients with no side effects.
Assuntos
Síndrome do Túnel Carpal/radioterapia , Lasers Semicondutores/uso terapêutico , Ligamentos Articulares/efeitos da radiação , Síndrome do Túnel Carpal/fisiopatologia , Método Duplo-Cego , Força da Mão , Humanos , Terapia com Luz de Baixa Intensidade , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Condução Nervosa , Medição da DorRESUMO
OBJECTIVES: Carpal tunnel syndrome (CTS) is the most common neuropathy that can be diagnosed with confidence by the nerve conduction study (NCS). One of the recent treatments of CTS is the application of low power laser (LPL) therapy. The present study evaluates the effects of LPL irradiation through NCS and clinical signs and symptoms. METHODS: A total of 80 patients were included in this study. Diagnosis of CTS was based on both clinical examination and electromyographic (EMG) findings. Patients were randomly assigned into two groups. Test group (group A) underwent laser therapy (9-11 joules/cm2) over the carpal tunnel area. Control group (group B) received sham laser therapy. Pain, hand grip strength, median proximal sensory and motor latencies, transcarpal median sensory nerve conduction (SNCV) were recorded. After fifteen sessions of irradiation (five times per week), parameters were recorded again and clinical symptoms were measured in both groups. Pain was evaluated by Visual Analog Scale (VAS; day-night). Hand grip was measured by Jamar dynometer. Paired t-test and independent sample t-test were used for statistical analysis. RESULTS: There was a significant improvement in clinical symptoms and hand grip in group A (p < 0.001). Proximal median sensory latency, distal median motor latency and median sensory latencies were significantly decreased (p < 0.001). Transcarpal median SNCV increased significantly after laser irradiation (p < 0.001). There were no significant changes in group B except changes in clinical symptoms (p < 0.001). CONCLUSIONS: Laser therapy as a new conservative treatment is effective in treating CTS paresthesia and numbness and improves the subjects' power of hand grip and electrophysiological parameters.