Effectiveness of Multiwave Locked System Laser therapy in treatment of Carpal Tunnel Syndrome Patients

Authors

  • Nitsara Pattapong Physical Medicine and Rehabilitation department, Faculty of medicine, Naresuan University, Phitsanulok, Thailand, 65000
  • Kanuengnid Wongwanna Physical Medicine and Rehabilitation department, Faculty of medicine, Naresuan University, Phitsanulok, Thailand, 65000
  • Pensuda Iamlaoor Physical Medicine and Rehabilitation department, Faculty of medicine, Naresuan University, Phitsanulok, Thailand, 65000
  • Pimolporn Jaion Physical Medicine and Rehabilitation department, Faculty of medicine, Naresuan University, Phitsanulok, Thailand, 65000

Keywords:

Carpal tunnel syndrome, Multiwave Locked System (MLS) laser therapy

Abstract

        The effectiveness of Multiwave Locked System (MLS) laser therapy was evaluated in a total of 30 patients, aged more than 20 years old with mild to moderate carpal tunnel syndrome (CTS) with a single-blinded randomized controlled study. The patients were randomly assigned into intervention and control groups. The intervention group received 12 sessions of MLS laser treatment at a dosage of 15.01 J/cm2 per session over the carpal tunnel area and thenar area innervated from median nerve and conventional rehabilitation treatment. The control group received placebo laser therapy that consisted of red light from flashlights covered with red cellophane without laser power output shined over the region, duration and frequency same as the intervention group. The patients were evaluated with the following parameters: (1) clinical parameters which consisted of symptom severity scale (SSS), functional status scale (FSS), visual analog scale (VAS) and EQ-5D-5L before treatment and follow-ups at 4 and 12 weeks, (2) electrophysiological parameters which were evaluated before treatment and follow-up at 12 weeks and (3) assessment for satisfaction of the service at 4 and 12 weeks. Thirty patients (52 hands: unilateral CTS=8 hands and bilateral CTS=44 hands) completed the study. Both groups had n=15 patients. The improvements were significantly more pronounced in the intervention group than control group (p<0.05) especially for VAS and Compound muscle action potential (CMAP) amplitude of the median nerve at 12 weeks follow-up. MLS laser therapy coupled with conventional rehabilitation treatments is an effective treatment option in mild to moderate degree CTS before proceeding to surgery. It can clinically improve especially for VAS and electrophysiological parameter with a carry-over effect up to 3 months.

References

Alfonso, C., Jann S., Massa, R., & Torreggiani, A. (2010). Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci, 31(3), 243-252.

American Academy of Neurology. (1993). Practice parameter for carpal tunnel syndrome (summary statement). Neurology, 43, 2406-2409.

Basford, J. R., Hallman, H. O., Matsomoto, J. Y., Moyer, S. K., Buss, J. M., & Baxter, G. D. (1993). Effects of 830 nm continuous wave laser diode irradiation onmedian nerve function in normal subjects. Laser Surg Med, 13(6), 597-604.

Burke, T. D., Burke, M. M., Stewart, G. W., & Cambre, A. (1994). Splinting for carpal tunnel syndrome: in search of the optimal angle. Arch Phys Med Rehabil, 75(11), 1241–1244.

Chang, W. D., Wu, J. H., Jiang, J. A., Yeh, C. Y., & Tsai, C. T. (2008). Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament. Photomed Laser Surg, 26(6), 551–557.

Chow, R. T., Johnson, M. I., Lopes-Martins, R. A. & Bjordal, J. M. (2009). Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet, 374(9705), 1897–1908.

De Krom, M. C., Knipschild, P. G., Kester, A. D., Thijs, C. T., Boekkooi, P. F., & Spaans, F. (1992). Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol, 45, 373.

Elwakil, T. F., Elazzazi, A., & Shokeir, H. (2007). Treatment of carpal tunnel syndrome by lowlevel laser versus open carpal tunnel release. Lasers in Medical Science, 22(4), 265-270.

Evcik, D., Kavuncu, V., Cakir, T., Subasi, V., & Yaman, M. (2007). Laser therapy in the treatment of carpal tunnel syndrome: a randomized controlled trial. Photomed Laser Surg, 25(1), 34–39.

Fusakul Y., Aranyavalai T., Saensri, P., & Thiengwittayaporn, S. (2014). Low-level laser therapy with a wrist splint to treat carpal tunnel syndrome: a double-blinded randomized controlled trial. Lasers Med Sci, 29(3), 1279-1287.

Halac, G., Demir, S., Yucel, H., Niftaliyev, E., Kocaman, G., Duruyen, H., … Asil, T. (2015). Splinting is effective for night-only symptomatic carpal tunnel syndrome patients. J. Phys. Ther Sci, 27(4), 993–996.

Hashmi, J. T., Huang, Y. Y., Osmani, B. Z., Sharma, S. K., Naeser, M. A., & Hamblin, M. R. (2010). Role of low-level laser therapy in neurorehabilitation. PMR, 2(12-Suppl.2), 292–305.

Hegedus, B., Viharos, L., Gervain, M., & Galfi, M. (2009). The effect of low-level laser therapy in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomed Laser Surg, 27, 577–584.

Hode, L. (2007). Lasers that heal. Stockholm: Swedish Laser-Medical Society Publishers.

Hopkins, J. T., McLoda, T. A., Seegmiller, J. G., & David Baxter, G. (2004). Low-level laser therapy facilitates superficial wound healing in humans: a triple-blind, sham-controlled study. J Athl Train, 39(3), 223–229.

Huang, Y. C., Tran, N., Shumaker, P. R., Kelly, K., Ross, E. V., Nelson, J. S., & Choi B. (2009). Blood flow dynamics after laser therapy of port wine stain birthmarks. Lasers Surg Med, 41(8), 563–571.

Irvine, J., Chong, S. L., Amirjani, N., & Chan, K. M. (2004). Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome. Muscle Nerve, 30(2), 182–187.

Karu, T. I. (2008). Mitochondrial signaling in mammalian cells activated by red and near-IR radiation. Photochem Photobiol, 84(5), 1091–1099.

Kimman, M., Vathesatogkit, P., Woodward, M., Tai, E. S., Thumboo, J., Yamwong, S., … Sritara, P. (2013). Validity of the Thai EQ-5D in an occupational population in Thailand. Qual Life Res, 22(6), 1499-1506.

Konstatinovic, L. M., Cutavic, M. R., & Milovanovic, A. N. (2010) Low level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study. Pain Med, 1, 1169–1178.

Kuryliszyn-Moskal, A., Kita, J., Dakowicz, A., Chwieśko-Minarowska, S., Moskal, D., Kosztyła-Hojna, B., … Klimiuk, P. A. (2015). The influence of Multiwave Locked System (MLS) laser therapy on clinical features, microcirculatory abnormalities and selected modulators of angiogenesis in patients with Raynaud’s phenomenon. Clin Rheumatol, 34(3), 489–96.

Levine, D. W., Simmons, B. P., Koris, M. J., Daltroy, L. H., Hohl, G. G., Fossel, A. H., & Katz, J. N. (1993). A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am, 75(11), 1585–1592.

Muller, M., Tsui, D., Schnurr, R., Biddulph-Deisroth, L., Hard, J., & MacDermid, J. C. (2004). Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review. J Hand Ther, 17(2), 210–228.

Nobuta, S., Sato, K., Nakagawa, T., Hatori, M., & Itoi, E. (2008). Effects of Wrist Splinting for Carpal Tunnel Syndrome and Motor Nerve Conduction Measurements. Upsala J Med Sci, 113(2), 181–192.

O'Connor, D., Marshall, S. C., & Massy-Westropp, N. (2003). Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 1, CD003219. Retrieved from http://www.cochrane.org/reviews/en/ab003219.html

Pavot, W. G., & Diener, E. (1993). Review of the satisfaction with life scale. Psychological assessment, 5(2), 164-172.

Piazzini, D. B., Aprile, I., Ferrara, P. E., Bertolini, C., Tonali, P., Maggi, L., … Padua, L. (2007). A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil, 21(4), 299–314.

Shooshtari, S. M., Badiee, V., Taghizadeh, S. H., Nematollahi, A. H., Amanollahi, A. H., & Grami, M. T. (2008). The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome. Electromyogr Clin Neurophysiol, 48(5), 229–231.

Stevens, J. C. (1997). AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve, 20(12), 1477–1486.

Suwannawong, N., Teeranet, G., & Rukhamet, B. (2001). The prevalence of impaired sensory conduction of the median nerve at the carpal tunnel in computer occupational setting people. J Thai Rehabil, 10, 100-5.

Tascioglu, F., Degirmenci, N. A., Ozkan, S., & Mehmetoglu, O. (2012). Lowlevel laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation. Rheumatol Int, 32(2), 409–415.

Thomsen, J. F., Hansson, G. A., Mikkelsen, S., & Lauritzen, M. (2002). Carpal tunnel syndrome in repetitive work: a follow-up study. Am J Ind Med, 42, 344-53.

Upatham, S., & Kumnerddee, W. (2008). Reliability of Thai version Boston questionnaire. J Med Assoc Thai, 91(8), 1250–1256.

Wu, S., Xing, D., Gao, X., & Chen, W. R. (2009). High fluence low-power laser irradiation induces mitochondrial permeability transition mediated by reactive oxygen species. J Cell Physiol, 218(3), 603–611.

Yagci, I., Elmas, O., Akcan, E., Ustun, I., Gunduz, O. H., & Guven, Z. (2009). Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome. Clin Rheumatol, 28(9), 1059–1065.

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Published

2016-03-23

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Research Articles