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Carpal Tunnel: High Power Laser Therapy for Those Trying to Avoid Surgery

Carpal Tunnel Syndrome accounts for approximately 50% of all work related injuries.  Many patients affected by Carpal Tunnel Syndrome are not aware that High Power Laser Therapy is an effective and non invasive treatment option for those suffering with Carpal Tunnel Syndrome.  Dr. Nelson Mane is a board certified Chiropractic Orthopedist Neurologist in Tampa and states “After performing many examinations and electro diagnostic test (EMG, NCV) on patients with Carpal Tunnel Syndrome it is surprising to see how many patients qualify and could benefit from this treatment but are not even aware it exist”.  We still occasionally refer someone for Carpal Tunnel surgery but over the last 2 ½ years our experience and advanced clinical methods have allowed us to be able to handle more difficult cases.  We have performed over 5000 High Power Laser Therapy treatments and have made considerable adaptations to our technique in order to improve our results.

Laser therapy has been shown to increase bone cartilage repair, reduce scar tissue, reduce inflammation, increase circulation, increase angiogenesis (new blood vessels formed), and regenerates nerve fibers as well as increase ATP production (energy).  This unique aspect of the High Power Laser Therapy is its ability to penetrate deep enough to treat the target tissue (disc and spinal nerves).  The procedure is non invasive and pain free.  No preparation in needed for the procedure.  The patient drives to the office to get their treatments and drives home.

Most physicians are not aware that this treatment exist and therefore can not recommend it.  Let’s look at some recent articles in the scientific literature.

Shiraz University of medical science, Shiraz, Iran. Jazayeri1335@yahoo.com

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.

PMID: 18754533 [PubMed - indexed for MEDLINE]

Shiraz University of medical science, Shiraz, Iran. Jazayeri335@yahoo.com

Unit of General Surgery, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt. tfelwakil@hotmail.com

Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist. It is one of the most common peripheral nerve disorders. The cause of idiopathic CTS remains unclear. The diagnosis of CTS is still mainly clinical. Open carpal tunnel release is the standard treatment. The present study was conducted to evaluate the effectiveness of low level laser treatment (LLLT) for CTS in comparison to the standard open carpal tunnel release surgery. Out of 54 patients, 60 symptomatic hands complaining of CTS were divided into two equal groups. Group A, was subjected to LLLT by Helium Neon (He-Ne) laser (632.8 nm), whereas group B was treated by the open approach for carpal tunnel release. The patients were evaluated clinically and by nerve conduction studies (NCSs) about 6 months after the treatment. LLLT showed overall significant results but at a lower level in relation to surgery. LLLT showed significant outcomes in all parameters of subjective complaints (p < or = 0.01) except for muscle weakness. Moreover, LLLT showed significant results in all parameters of objective findings (p < or = 0.01) except for thenar atrophy. However, NCSs expressed the same statistical significance (p < or = 0.01) after the treatment by both modalities. LLLT has proven to be an effective and noninvasive treatment modality for CTS especially for early and mild-to-moderate cases when pain is the main presenting symptom. However, surgery could be preserved for advanced and chronic cases. Refinement of laser tools and introduction of other wavelengths could make LLLT for CTS treatment a field for further investigations.

PMID: 17334675 [PubMed - indexed for MEDLINE]

Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Uskudar, Istanbul, Turkey.

Abstract Objective: The objective of this study was to investigate the effectiveness of splinting, ultrasound (US), and low-level laser therapy (LLLT) in the management of carpal tunnel syndrome (CTS). Background Data: CTS is the entrapment mononeuropathy most frequently seen in clinical practice, and is caused by compression of the median nerve at the wrist. Although several treatment modalities are routinely in use, there is no consensus about the best way to treat CTS. Materials and Methods: Patients were randomly allocated to three groups and the following treatment protocols were used in each group: splinting only, splinting plus US, and splinting plus LLLT. The patients were assessed with the Boston Questionnaire, patient satisfaction inquiry, visual analogue scale for pain, and by electroneuromyography. Results and Conclusion: The study was completed on a total of 100 hands of 50 woman patients with bilateral CTS at 3 months after beginning treatment. At the end of the follow-up period, the patients in the three groups had improved at different rates. The combination of both US and LLLT with splinting was more effective than splinting alone in the treatment of CTS. However, LLLT plus splinting was more effective than US plus splinting, particularly in reducing symptom severity, and for pain alleviation and patient satisfaction.

PMID: 19099386 [PubMed - in process]

High Power Laser Therapy allows for deeper penetration thereby allowing you to reach the target tissue you are treating.  The best physicians to evaluate you for this procedure are one who has 1.)  Evaluated Carpal Tunnel patients.  2) Can perform or is familiar with electrodiagnostics used for evaluations for Carpal Tunnel patients.   3) Has treated carpal tunnel patients with High Power Laser Therapy.  4) Has made surgical referrals when indicated.

Dr. Mane is a board certified chiropractic orthopedist and neurologist.

For more information about the treatment of Carpal Tunnel Syndrome or about Dr. Nelson Mane D.C. please visit our website at http://www.manecenter.com/neuropathy.htm. 

Dr. Mane offers one on one consultation for Carpal Tunnel Syndrome Sufferers.  If you are interested in scheduling a consultation please call 813-935-4744. 

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physics problem on em waves?

a small helium neon laser emits red visible light with a power of 3.20mW in a beam that has a diameter of 2.50mm.
What are the avg energy densities associated with the electric field and with the magnetic field?

u total= (1/2)e0E^2 +(1/2)e0E^2=e0E^2
now the energy density for the E field is the same as the B field.
I=.5e0cE^2 so E=sqrt(2I/e0c)=652w/m^2

so u(of E)=u( ofB)=(1/2)e0E^2 but your looking for the avg. which is half of the total so
u ave(of E)=u ave ( ofB)=(1/4)e0E^2
so u(ave)=1.09*10^-6j/m^3

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