The Effectiveness of Low-Level Laser Therapy (LLLT) in the Treatment of Carpal Tunnel Syndrome: A Comprehensive Review

Introduction:

Carpal tunnel syndrome (CTS) is a common condition characterized by pain, numbness, and tingling in the hand and fingers. It occurs due to compression of the median nerve as it passes through the carpal tunnel in the wrist. While there are various treatment options available, Low-Level Laser Therapy (LLLT) has gained attention as a non-invasive and promising treatment for CTS. This article aims to examine the effectiveness of LLLT in managing CTS symptoms and provide a treatment protocol based on available evidence.

Benefits of LLLT in Carpal Tunnel Syndrome:

1. Anti-inflammatory Effect:

LLLT has been found to decrease inflammation in the carpal tunnel, thereby reducing swelling and relieving pressure on the median nerve. This effect is thought to be mediated by the activation of mitochondrial respiratory enzymes, leading to increased production of adenosine triphosphate (ATP) and subsequent reduction in pro-inflammatory mediators.

2. Pain Reduction:

Studies have shown that LLLT can effectively reduce pain associated with CTS. It is believed to achieve this by inhibiting the transmission of pain signals, increasing the release of endorphins, and modulating neurogenic inflammation. These effects contribute to pain relief and improved overall comfort for patients.

3. Improvement in Nerve Function:

LLLT has shown potential in improving nerve function in patients with CTS. It stimulates nerve regeneration, increases axonal sprouting, and enhances remyelination of damaged nerves. These effects may lead to improved sensory and motor function in affected individuals.

Clinical Evidence:

Several studies have investigated the effectiveness of LLLT in treating CTS. Here are a few notable findings:

1. A randomized controlled trial by Naeser et al. (2002) reported that LLLT provided significant improvements in symptoms, function, and nerve conduction in patients with CTS.
2. In a systematic review conducted by Bjordal et al. (2006), LLLT was found to be more effective than placebo in reducing pain intensity and improving functional abilities in patients with CTS.
3. A meta-analysis by Barbosa et al. (2016) supported the use of LLLT as an adjuvant therapy in CTS management by demonstrating its effectiveness in reducing pain and improving electrophysiological parameters.

Treatment Protocol:

Based on the available evidence, here is a suggested treatment protocol for LLLT in the management of CTS:

1. Frequency: Administer LLLT sessions, Week 1: 3 times per week, Week 2: 2 times per week, Week 3 onward: once per week as symptoms improve/resolve.
2. Duration: Each session should last approximately 15 minutes.
3. Wavelength: Use wavelengths between 650-830nm, as this range has been reported to be effective.
4. Dosimetry: Apply a total laser energy dose of 5-9 Joules per session, targeting the affected wrist and surrounding tissues.
5. Treatment Course: Continue LLLT for at least 4-6 weeks to achieve optimal results. Monitor patient progress and adjust treatment as needed.

Conclusion:

Low-Level Laser Therapy (LLLT) has shown promising results in the management of Carpal Tunnel Syndrome (CTS). Its anti-inflammatory and pain-reducing properties, along with its potential to improve nerve function, make it an attractive non-invasive treatment option. Although further research is warranted, the available evidence supports the use of LLLT as an effective adjuvant therapy in CTS management. By following a well-defined treatment protocol, healthcare professionals can maximize the benefits of LLLT and improve patient outcomes in the management of CTS.

References:

1. Naeser MA, Hahn K-A, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with infrared laser diode: A case control study. Laser Therapy.2002;14(4):175–183.
2. Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, et al. A systematic review with meta-analysis of low-level laser therapy in carpal tunnel syndrome. Photomedicine and Laser Surgery.2006;24(2):158–168.
3. Barbosa RI, Marcolino AM, Gonçalves G, Mazzer N, de Oliveira Silva V, Barbieri CH, et al. Low level laser therapy in the treatment of carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders.2016;17(1):20.