Skip to main content
Top
Published in: Lasers in Medical Science 6/2017

01-08-2017 | Review Article

Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis

Authors: Amira Hassan Bekhet, Basma Ragab, Abdelrahman Ibrahim Abushouk, Ahmed Elgebaly, Olfat Ibrahim Ali

Published in: Lasers in Medical Science | Issue 6/2017

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
2.
3.
go back to reference Lee D, van Holsbeeck MT, Janevski PK et al (1999) Diagnosis of carpal tunnel syndrome: ultrasound versus electromyography. Radiol Clin N Am 37:859–872CrossRefPubMed Lee D, van Holsbeeck MT, Janevski PK et al (1999) Diagnosis of carpal tunnel syndrome: ultrasound versus electromyography. Radiol Clin N Am 37:859–872CrossRefPubMed
4.
go back to reference Prakash KM, Fook-Chong S, Leoh TH et al (2006) Sensitivities of sensory nerve conduction study parameters in carpal tunnel syndrome. J Clin Neurophysiol 23:565–567CrossRefPubMed Prakash KM, Fook-Chong S, Leoh TH et al (2006) Sensitivities of sensory nerve conduction study parameters in carpal tunnel syndrome. J Clin Neurophysiol 23:565–567CrossRefPubMed
6.
go back to reference Werner RA, Andary M (2002) Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 113:1373–1381CrossRefPubMed Werner RA, Andary M (2002) Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 113:1373–1381CrossRefPubMed
7.
go back to reference Rempel DM, Diao E (2004) Entrapment neuropathies: pathophysiology and pathogenesis. J Electromyogr Kinesiol 14:71–75CrossRefPubMed Rempel DM, Diao E (2004) Entrapment neuropathies: pathophysiology and pathogenesis. J Electromyogr Kinesiol 14:71–75CrossRefPubMed
8.
go back to reference Hirata H, Nagakura T, Tsujii M et al (2004) The relationship of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol 204:605–612CrossRefPubMed Hirata H, Nagakura T, Tsujii M et al (2004) The relationship of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol 204:605–612CrossRefPubMed
9.
go back to reference Tucci MA, Barbieri RA, Freeland AE (1996) Biochemical and histological analysis of the flexor tenosynovium in patients with carpal tunnel syndrome. Biomed Sci Instrum 33:246–251 Tucci MA, Barbieri RA, Freeland AE (1996) Biochemical and histological analysis of the flexor tenosynovium in patients with carpal tunnel syndrome. Biomed Sci Instrum 33:246–251
10.
go back to reference Muller M, Tsui D, Schnurr R et al (2004) Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review. J Hand Ther 17:210–228CrossRefPubMed Muller M, Tsui D, Schnurr R et al (2004) Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review. J Hand Ther 17:210–228CrossRefPubMed
11.
go back to reference Padua L, Padua R, Aprile I et al (2001) Multiperspective follow-up of untreated carpal tunnel syndrome a multicenter study. Neurology 56:1459–1466CrossRefPubMed Padua L, Padua R, Aprile I et al (2001) Multiperspective follow-up of untreated carpal tunnel syndrome a multicenter study. Neurology 56:1459–1466CrossRefPubMed
13.
go back to reference Padua L, Padua R, Aprile I, Tonali P (1998) Noninvasive laser neurolysis in carpal tunnel syndrome. Muscle Nerve 21:1232–1233CrossRefPubMed Padua L, Padua R, Aprile I, Tonali P (1998) Noninvasive laser neurolysis in carpal tunnel syndrome. Muscle Nerve 21:1232–1233CrossRefPubMed
14.
go back to reference Weintraub MI (1997) Noninvasive laser neurolysis in carpal tunnel syndrome. Muscle Nerve 20:1029–1031CrossRefPubMed Weintraub MI (1997) Noninvasive laser neurolysis in carpal tunnel syndrome. Muscle Nerve 20:1029–1031CrossRefPubMed
15.
go back to reference Chang W-D, Wu J-H, Jiang J-A et al (2008) Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament. Photomed Laser Surg 26:551–557CrossRefPubMed Chang W-D, Wu J-H, Jiang J-A et al (2008) Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament. Photomed Laser Surg 26:551–557CrossRefPubMed
16.
go back to reference Lazovic M, Ilic-Stojanovic O, Kocic M et al (2014) Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome. Photomed Laser Surg 32:336–344CrossRefPubMed Lazovic M, Ilic-Stojanovic O, Kocic M et al (2014) Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome. Photomed Laser Surg 32:336–344CrossRefPubMed
17.
go back to reference Shooshtari SMJ, Badiee V, Taghizadeh SH et al (2008) The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome. Electromyogr Clin Neurophysiol 48:229PubMed Shooshtari SMJ, Badiee V, Taghizadeh SH et al (2008) The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome. Electromyogr Clin Neurophysiol 48:229PubMed
18.
go back to reference Yagci I, Elmas O, Akcan E et al (2009) Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome. Clin Rheumatol 28:1059–1065CrossRefPubMed Yagci I, Elmas O, Akcan E et al (2009) Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome. Clin Rheumatol 28:1059–1065CrossRefPubMed
19.
go back to reference 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 29:1279–1287CrossRefPubMed 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 29:1279–1287CrossRefPubMed
20.
go back to reference Tascioglu F, Degirmenci NA, Ozkan S, Mehmetoglu O (2012) Low-level laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation. Rheumatol Int 32:409–415CrossRefPubMed Tascioglu F, Degirmenci NA, Ozkan S, Mehmetoglu O (2012) Low-level laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation. Rheumatol Int 32:409–415CrossRefPubMed
21.
go back to reference Rayegani SM, Bahrami MH, Eliaspour D et al (2013) The effects of low intensity laser on clinical and electrophysiological parameters of carpal tunnel syndrome. J Lasers Med Sci 4:182PubMedPubMedCentral Rayegani SM, Bahrami MH, Eliaspour D et al (2013) The effects of low intensity laser on clinical and electrophysiological parameters of carpal tunnel syndrome. J Lasers Med Sci 4:182PubMedPubMedCentral
22.
go back to reference Evcik D, Kavuncu V, Cakir T et al (2007) Laser therapy in the treatment of carpal tunnel syndrome: a randomized controlled trial. Photomed Laser Surg 25:34–39CrossRefPubMed Evcik D, Kavuncu V, Cakir T et al (2007) Laser therapy in the treatment of carpal tunnel syndrome: a randomized controlled trial. Photomed Laser Surg 25:34–39CrossRefPubMed
26.
go back to reference Medrado ARAP, Pugliese LS, Reis SRA, Andrade ZA (2003) Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers Surg Med 32:239–244CrossRefPubMed Medrado ARAP, Pugliese LS, Reis SRA, Andrade ZA (2003) Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers Surg Med 32:239–244CrossRefPubMed
27.
go back to reference Boschi ES, Leite CE, Saciura VC et al (2008) Anti-inflammatory effects of low-level laser therapy (660 nm) in the early phase in carrageenan-induced pleurisy in rat. Lasers Surg Med 40:500–508CrossRefPubMed Boschi ES, Leite CE, Saciura VC et al (2008) Anti-inflammatory effects of low-level laser therapy (660 nm) in the early phase in carrageenan-induced pleurisy in rat. Lasers Surg Med 40:500–508CrossRefPubMed
28.
go back to reference Ferreira DM, Zângaro RA, Villaverde AB et al (2005) Analgesic effect of He-Ne (632.8 nm) low-level laser therapy on acute inflammatory pain. Photomed Laser Surg 23:177–181CrossRefPubMed Ferreira DM, Zângaro RA, Villaverde AB et al (2005) Analgesic effect of He-Ne (632.8 nm) low-level laser therapy on acute inflammatory pain. Photomed Laser Surg 23:177–181CrossRefPubMed
29.
go back to reference Jarvis D, MacIver MB, Tanelian DL (1990) Electrophysiologic recording and thermodynamic modeling demonstrate that helium-neon laser irradiation does not affect peripheral Aδ- or C-fiber nociceptors. Pain 43:235–242CrossRefPubMed Jarvis D, MacIver MB, Tanelian DL (1990) Electrophysiologic recording and thermodynamic modeling demonstrate that helium-neon laser irradiation does not affect peripheral Aδ- or C-fiber nociceptors. Pain 43:235–242CrossRefPubMed
30.
go back to reference Brosseau L, Robinson V, Wells G et al (2004) Low level laser therapy (classes I, II and III) for treating osteoarthritis. Cochrane Libr Brosseau L, Robinson V, Wells G et al (2004) Low level laser therapy (classes I, II and III) for treating osteoarthritis. Cochrane Libr
31.
go back to reference Bingöl Ü, Altan L, Yurtkuran M (2005) Low-power laser treatment for shoulder pain. Photomed Laser Ther 23:459–464CrossRef Bingöl Ü, Altan L, Yurtkuran M (2005) Low-power laser treatment for shoulder pain. Photomed Laser Ther 23:459–464CrossRef
32.
go back to reference Lowe AS, Baxter GD, Walsh DM, Allen JM (1992) Low intensity laser irradiation of the human median nerve: effect of energy density upon conduction and skin temperature. Proceedings, second meeting international laser therapy Association 83 Lowe AS, Baxter GD, Walsh DM, Allen JM (1992) Low intensity laser irradiation of the human median nerve: effect of energy density upon conduction and skin temperature. Proceedings, second meeting international laser therapy Association 83
33.
go back to reference Jablecki CK, Andary CMT, So YT et al (1993) Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 16:1392–1414CrossRefPubMed Jablecki CK, Andary CMT, So YT et al (1993) Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 16:1392–1414CrossRefPubMed
34.
go back to reference Naeser MA (2006) Photobiomodulation of pain in carpal tunnel syndrome: review of seven laser therapy studies. Photomed Laser Ther 24:101–110CrossRef Naeser MA (2006) Photobiomodulation of pain in carpal tunnel syndrome: review of seven laser therapy studies. Photomed Laser Ther 24:101–110CrossRef
35.
go back to reference Mester E, Mester AF, Mester A (1985) The biomedical effects of laser application. Lasers Surg Med 5:31–39CrossRefPubMed Mester E, Mester AF, Mester A (1985) The biomedical effects of laser application. Lasers Surg Med 5:31–39CrossRefPubMed
36.
go back to reference Beckerman H, De Bie RA, Bouter LM et al (1992) The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials. Phys Ther 72:483CrossRefPubMed Beckerman H, De Bie RA, Bouter LM et al (1992) The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials. Phys Ther 72:483CrossRefPubMed
37.
go back to reference Gür A, Karakoc M, Nas K et al (2002) Effects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: a single-blind, placebo-controlled trial. Rheumatol Int 22:188–193CrossRefPubMed Gür A, Karakoc M, Nas K et al (2002) Effects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: a single-blind, placebo-controlled trial. Rheumatol Int 22:188–193CrossRefPubMed
38.
go back to reference Naeser MA, Hahn K-AK, Lieberman BE, Branco KF (2002) Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: a controlled study. Arch Phys Med Rehabil 83:978–988CrossRefPubMed Naeser MA, Hahn K-AK, Lieberman BE, Branco KF (2002) Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: a controlled study. Arch Phys Med Rehabil 83:978–988CrossRefPubMed
39.
go back to reference Bakhtiary AH, Rashidy-Pour A (2004) Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Phys 50:147–151 Bakhtiary AH, Rashidy-Pour A (2004) Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Phys 50:147–151
Metadata
Title
Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis
Authors
Amira Hassan Bekhet
Basma Ragab
Abdelrahman Ibrahim Abushouk
Ahmed Elgebaly
Olfat Ibrahim Ali
Publication date
01-08-2017
Publisher
Springer London
Published in
Lasers in Medical Science / Issue 6/2017
Print ISSN: 0268-8921
Electronic ISSN: 1435-604X
DOI
https://doi.org/10.1007/s10103-017-2234-6

Other articles of this Issue 6/2017

Lasers in Medical Science 6/2017 Go to the issue