Treatment of repetitive use carpal tunnel syndrome

Smith CF, Vangsness CT, Anderson T & Good W (1995)

Proceedings SPIE (1995) 2395; 658-661.

A randomized, double-blind study was initiated in 1990 to evaluate an eight-point conservative treatment program in carpal tunnel syndrome. 160 patients were delineated with symptoms of carpal tunnel syndrome and these patients were then divided into two groups. Both groups were subjected to an ergonomically correct eight-point work modification program. A counterfeit LLLT unit was used in Group A, while an actual LLLT unit was used in Group B. Groups A and B were statistically significantly different in terms of return to work, conduction study improvement, and certain range of motion.

Noninvasive laser neurolysis in carpal tunnel syndrome

Weintraub MI, MD, FACP

Muscle Nerve (1997) 20:1029-1031.

The peripheral nervous system is photosensitive, the scientific rationale for this study which determines the efficacy and safety to laser light exposure in 30 cases with CTS. Nine joules of energy over 5 points (7-15 treatments) reversed CTS in 77% of cases with three-fold normalization of CMAP. A photobiologic response was seen in 80%. This unique and novel approach is cost-effective and has a role in future management of CTS.

Treatment of medial and lateral epicondylitis - tennis and golfer's elbow - with LLLT: a multicenter double blind, placebo-controlled clinical study on 324 patients.

Simunovic Z, Trobonjaca T, Trobonjaca Z

Journal of Clinical Laser Medicine and Surgery (Jun 1998) 16(3):145-151.

LLLT has been promoted as a highly successful method for treating medial and lateral epicondylitis. This clinical study assessed the efficacy of LLLT using trigger points (TPs) and scanner application techniques under placebo-controlled conditions. The study was completed at two Laser Centers in Locarno, Switzerland and Opatija, Croatia: a double-blind, placebo controlled, crossover clinical study. The patient population (n=324), with either medial epicondylitis (Golfer's elbow; n=50) or lateral epicondylitis (Tennis elbow; n=274), was recruited. Unilateral cases of either type of epicondylitis (n=283) were randomly allocated to one of three treatment groups according to the LLLT technique applied: (1) Trigger points; (2) Scanner; (3) Combination Treatment (i.e., TPs and scanner technique). Laser devices used to perform these treatments were infrared (IR) diode laser (GaAIAs) 830 nm continuous wave for treatment of TPs and He-Ne 632.8 nm combined with IR diode laser 904 nm, pulsed wave for scanner technique. Energy doses were controlled and measured in Joules/cm2 either during TPs or scanner technique sessions in all groups of patients. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: (1) short form of McGill's Pain Questionnaire (SF-MPQ); (2) visual analogue scales (VAS); (3) verbal rating scales (VRS); (4) patient's pain diary; and (5) hand dynamometer. Total relief of the pain with consequently improved functional ability was achieved in 82% of acute and 66% of chronic cases. Best results were obtained by a combination treatment (i.e., TPs and scanner technique). Under-and over irradiation dosage result in the absence of positive therapy effects or even opposite, negative (e.g., inhibitory) effects. The data shows the efficacy of LLLT in the management of lateral and medial epicondylitis.

Wound healing of animal and human body sport and traffic accident injuries using low-level therapy treatment; a randomized clinical study of seventy-four patients with control group.

Simunovic Z, Ivankovich AD, Depolo A.

Journal of Clinical Laser Medicine and Surgery (2000) Apr;18(2):67-73

The main objective was to assess the efficacy of low level laser therapy (LLLT) on wound healing in rabbits and humans. The initial research was a randomized controlled animal study, to evaluate the effects of laser irradiation on the healing of surgical wounds in rabbits. The application of LLLT on the human body is analogous to those of similar physiologic structure in animal tissue. This study was continued on humans, 74 patients with injuries to the following anatomic locations: ankle and knee, bilaterally, Achilles tendon; epicondylitis; shoulder; wrist; interphalangeal joints of hands, unilaterally. All patients has surgery prior to LLLT. Two laser devices were used: infrared diode laser (GaAIAs) 830 nm continuous wave for treatment of trigger points (TPs) and HeNe 632.8 nm combined with diode laser 904 nm pulsed wave for scanning procedure. Both were applied as monotherapy during the study. Results were observed and measured according to these clinical parameters: redness, heat, pain, swelling and loss of function, and finally submitted to statistical analysis via chi2 test. Results: After comparing the healing process between two groups of patients, the following results were noted: wound healing was significantly accelerated (25%-35%) in the patients treated with LLLT. Pain relief and functional recovery of those treated with LLLT were significantly improved compared to untreated patients. In addition to accelerated wound healing, LLLT for postoperative sport-and traffic-related injuries avoids side effects of drugs, accelerates functional recovery, allows earlier return to work, training and sport competition.

LLLT with trigger points technique: clinical study on 243 patients

Simunovic Z

Journal of Clinical Laser Medicine and Surgery (Aug. 1996) 14(4):163-167.

Among the various methods of application techniques in LLLT (He-Ne 632.8 nm visible red or infrared 820-830 nm continuous wave and 904 nm pulsed emission) there are very promising "trigger points", i.e., myofascial zones of particular sensibility and of highest projection of focal pain points, due to ischemic conditions. The effect of LLT and the results obtained after clinical treatment of >200 patients (headaches and facial pain, skeletomuscular ailments, myogenic neck pain, shoulder and arm pain, epicondylitis, tenosynovitis, low back and radicular pain, Achilles tendonitis) to whom the "trigger points" were applied were better than expected. It was also observed that rigidity decreases, mobility is restored (functional recovery), and spontaneous or induced pain decreases or even disappears, by movement. LLLT improves local microcirculation and it can also improve oxygen supply to hypoxic cells in the treated areas and can remove collected waste products. Normalization of the microcirculation interrupts the "circulus vitiosus" of the origin of the pain and its development (Melzak: muscular tension->pain->increased tension->increased pain, etc.). Results measured according to VAS/VRS/PTM: in acute pain, diminished >70%; in chronic pain >60%. Clinical effectiveness depends on correctly applied energy dose - over/under dosage produces opposite, negative effects on cellular metabolism. No negative effects were noted and the use of analgesic drugs could be reduced or completely excluded. LLLT may be used as monotherapy or as a supplement to other therapeutic procedures for pain treatment.

Laser-Accelerated INFLAMMATION/PAIN REDUCTION AND HEALING

by Richard Martin, BS, CLT

Practical Pain Management, Nov/Dec 2003

Injured cells and tissues have greater affinity for LLLT than healthy cells and tissues. LLLT in the treatment of inflammation, pain and healing is a highly integrated process, but the author separates those processes categorically for identification.

Acute Inflammation Reduction (flowchart provided in the original article) - After injury, tissues initiate a series of biological responses and cellular membrane reactions which manifest in a combination of edema, inflammation, pain and functional debility. LLLT mediates by: (1) Stabilizing cellular membranes; (2) Enhancing molecule ATP production and synthesis; (3) Stimulating vasodilation via increased Histamine, Nitric Oxide and Serotonin; (4) Accelerating leukocytic activity; (5) Increasing Prostaglandin synthesis; (6) Reducing Interleukin-1; (7) Enhancing lymphocyte response; (8) Increasing angiogenesis; (9) Modulation temperature; (10) Enhancing superoxide dismutase levels; and (11) Decreasing C-reactive protein and neopterin levels.

Pain Reduction (flowchart provided in the original article) - Evidence justifies a conclusion that LLLT reduces pain by combination of processes: (1) Increase in b-Endorphins; (2) Blocked depolarization of C-fiber afferent nerves; (3) Increased nitric oxide production; (4) Increased nerve cell action potential; (5) Axonal sprouting and nerve cell regeneration; (6) Decreased Bradykinin levels; (7) Increased release of acetylcholine; and (8) Ion channel normalization.

Tissue Healing - LLLT enhances wound healing by: (1) Enhanced leukocyte infiltration; (2) Increased macrophage activity; (3) Increased neovascularization; (4) Increased fibroblast proliferation; (5) Keratinocyte proliferation; (6) Early epithelialization; (7) Growth factor increases; (8) Enhanced cell proliferation and differentiation, and (9) Greater healed wound tensile strength.

Laser and Sports Medicine in Plastic and Reconstructive Surgery.

Junichiro Kubota M.D. Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan.

Flap survival with diode laser therapy: Skin flap or graft surgery are major procedures in plastic and reconstructive surgery. Skin flap necrosis has been a problem. The author reported on the enhanced blood flow following the low reactive laser therapy in skin flaps. The 830 nm diode laser (20 - 60 mw) irradiated flaps showed a greater perfusion, a greater number of blood vessels, and a higher rate of survival areas than the control flaps in the rat models and clinical cases. Improvement of wound healing with diode laser therapy: Diode laser therapy was indicated for traumatic skin ulcers from sport activities and traffic accidents which were resistant to conservative treatment. The diode laser system with a wavelength of 830 nm. and output power of 150or 1000mw in continuous wave was applied with the non-contact method to the area on the wound for one minute once a day every day during the treatment period. The diode laser was used successfully for the rapid enhanced healing of traumatic skin ulcers.

Discussion: Most injured patients hope to avoid a surgical operation, trying instead conservative treatments. The diode laser therapy improved the flap circulation and wound healing of severe skin ulcers. This therapy has been applied for temporomandibular joint pain and favorable results were obtained. The diode laser therapy proved to be particularly effective for pain attenuation. The diode laser therapy offers an additional convenient, safe, and side-effect free method. On the other hand, the Q-switched Nd:YAG laser system consistently achieved good results concomitant with easy and safe operation, with lightening of the target lesions.

BIOMODULATORY EFFECTS OF LLLT ON BONE REGENERATION

Antonio L.B. Pinheiro1, Marilia G. Oliveira2, Pedro Paulo M. Martins3, Luciana Maria Pedreira Ramalho4, Marcos A. Matos de Oliveira5, Aurel’cio Novaes Jœnior and Renata Amadei Nicolau 1 School of Dentistry, Department of Diagnostic and Therapeutics, Universidade Federal da Bahia, Salvador, BA, 40110-150,Brazil; 2 School of Dentistry, Post-Graduate Program on Oral and Maxillofacial Surgery, Pontif’cia Universidade Cat—lica do Rio Grande do Sul, Porto Alegre, RS, Brazil; 3School of Dentistry, University of Pernambuco, Camaragibe, 50000-000,Brazil; 4School of Dentistry, Laser Center, Universidade Federal da Bahia, Salvador, BA, 40110-150,Brazil; 5Lecture, Institute of Research and Development (IP&D) Universidade Vale do Para’ba (UNIVAP) - S‹o JosŽ dos Campos,SP, 12244-000, Brazil.

Low Level Laser Therapy (LLLT) for wound healing is effective in modulating both local and systemic response. Usually the healing process of bone is slower than that of soft tissue. Effects of LLLT on bone are still controversial. This paper reports observations on the effect of LLLT on bone healing. The amount of newly formed bone after 830nm laser irradiation of surgical wounds created in the femur of rats was evaluated morphometricaly. Forty Wistar rats were divided into four groups: group A (12 sessions, 4.8J/cm2 per session, 28 days); group C (three sessions, 4.8J/cm2 per session, seven days). Groups B and D acted as non-irradiated controls. Forty-eight hours after the surgery, the defects of the laser groups were irradiated transcutaneously with a CW 40mW 830nm diode laser, (f~1mm) with a total dose of 4.8J/cm2. Irradiation was performed three times a week. Computerized morphometry showed a significant difference between the areas of mineralized bone in groups C and D (p=0.017). There was no significant difference between groups A and B (28 days) (p=0.383). In a second investigation, the effects of LLLT on bone healing after the insertion of implants were determined. Dental implants need four and six months for fixation on the maxillae and on the mandible before loading. Ten male and female dogs were divided into two groups of five animals that received the implant. Two animals of each group were controls. Animals were sacrificed 45 and 60 days after surgery. The animals were irradiated three times a week for two weeks in a contact mode with a CW 40mW 830nm diode laser, (f ~1mm) with a total dose per session of 4.8J/cm2 and a dose per point of 1.2J/cm2. Better bone healing after irradiation with the 830nm diode laser were shown from the SEM study, suggesting that, under experimental conditions of the investigation, LLLT at 830nm significantly improves bone healing at early stages. and may increase bone repair at early stages of healing.

THE USE OF LASER THERAPY AND ADDITIONAL THERAPEUTIC MODALITIES AFTER ARTHROSCOPY OF THE KNEE AT ALPINE SKI TEAM

Lilic Alen, physiotherapist; 2Kozlevcar _ivec Maja, dr. med. spec.fiz.reh.med.; 3Marcan Radoslav, dr.med., spec.ortop 1FIZIO, Ilirska Bistrica, Slovenija, 2Iskra Medical, Ljubljana, Slovenija, 3Ortopedska bolni_nica Valdoltra, Slovenija.

We review different kinds of injuries in the alpine ski sport concentrate on the injuries of the ligamentar part of the knees and meniscs in slovenian ski team. After the description of the injuries is a detailed presentation of the rehabilitational procedures from the first day of the injury till the return in to the competition arena. We explain the modalities of the rehabilitational procedures and their influence in the tissues, their main and side effects. Our main attention is focused on the use of the biostimulative lasers of higher power - 1,2 W and wavelength of 830 nm and their influence speedy recovery of the patients and their success in later competitions.

Laser's effect on bone and cartilage change induced by joint immobilization: an experiment with animal model.

Akai M, Usuba M, Maeshima T, Shirasaki Y, Yasuoka S

Lasers Surg Med. 1997. 21(5): 480-4.

The influence of low-level (810 nm) laser on bone and cartilage during joint immobilization was examined. The hind limbs of 42 young Wistar rats were immobilized at the knee joint. They were sorted into three groups 1 wk after operation; irradiance 3.9 W/cm2, 5.8 W/cm2, and sham treatment. After 6 treatments for another 2 weeks both hind legs were prepared for 1) indentation of the articular surface of the knee (stiffness and loss tangent), and for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused regions. The indentation test revealed preservation of articular cartilage stiffness with 3.9 and 5.8 W/cm2 therapy. Low level laser treatment may possibly prevent biomechanical changes by immobilization.