Cold Laser for Carpal Tunnel

posted by Apollo Lasers on Friday, October 24, 2014

Repetitive strain injuries are the most common—and most costly—occupational health problem in the U.S., leading to surgery, lengthy recovery and days lost from work. Studies suggest, however, that low-level laser therapy could be part of an effective conservative treatment plan to reduce pain related to CTS, without surgery or taking medications. Robin Hocevar of Advance for Physical Therapy and Rehab Medicine explains how cold lasers can be an effective complement to manual therapy for CTS.

Cold laser use for carpal tunnel syndrome (CTS) has been a mainstay at chiropractors' offices for years, but is increasingly being adopted by physical therapists as an adjunct to traditional treatments.

CTS is the most common repetitive stress injury that damages tissue and nerves in the hand and arm. Carpal tunnel syndrome was one of the cumulative trauma disorders reportedly responsible for 30-40 percent of workers' compensation claims in the early 1990s.

Almost half of all carpal tunnel syndrome cases result in 31 days or more of work loss in the U.S. The field of healthcare responded to this affliction with hand clinics designed to rehabilitate disabled workers.

The first device to use cold light lasers (CLLs) to reduce inflammation and pain was developed in the early 1990s, but wasn't FDA-approved until 2002. The light beam treatment is offered at countless chiropractors' office and is now making its way into PT practices.

Though many insurance companies don't reimburse patients for laser treatments, word is spreading that low-level laser treatment is an effective (approximately 15 minutes per treatment) way to treat pain without surgery or taking medications.

The non-invasive laser therapy's big break came when General Motors conducted a 36-week, double-blind study featuring 166 afflicted workers. Those treated with CLLs showed improvement in grip strength and range of motion when compared to workers treated with placebo lasers.

During the same time period, a Houston medical school revealed a 70-percent improvement in CTS when CLLs were utilized. Thus, a medical trend emerged.

Broad Patient Spectrum

Jon Schult, PT, Work Systems Rehabilitation & Fitness in Des Moines, IA, started offering cold laser therapy for carpal tunnel last summer, after conducting extensive research. He classified the treatment as presenting "a pretty good resolution of symptoms."

Schult was even surprised when one patient with diabetes and hyperthyroidism who worked in an industrial setting and was troubled with tingling in his hand benefited from the CLL treatment.

Another patient was disturbed by constant hot sensations in the leg. Though his EMG was normal, Schult applied the cold laser treatment and said his patient was thrilled to experience a cold sensation on the affected leg.

Though his patients have been pleased with the results, Schult was careful to note that it's only a complement to his services.

"It's definitely an adjunct to manual therapy," he remarked. "I use acupuncture spots and have a lot of success on the trigger. I use the same spots in hand, forearm and upper extremities. Numbness and tingling can be coming from the neck or forearm. You definitely have to treat a number of areas to get to the root cause."

Since every patient is different, the number of treatments required varies from person to person depending on age, co-morbidities, current work or sports movements and so on. In acute cases, two or three treatments can resolve the pain. Other patients with more chronic problems require 12 to 14 CLL sessions.

The low-level lasers are also effective on patients who've already undergone surgery for carpal tunnel. It's safe for post-treatment edema and no side effects have been documented. It's impossible to overdose and the lasers can be used over prosthetics or other hardware. Additionally, Schult sees an emerging market with fibromyalgia or other trigger points in the muscle.

When active tumors or cancerous growths are present, PTs work with the referring doctor or cancer specialist. Though Schult cautioned that CLL treatment isn't a miracle treatment, he said it helps patients resolve pain issues and move on to other therapies.

"The patients I've had success with are those who have been through conventional therapy and are still in pain with range-of-motion deficits," he said. "They still want to be active or work out and don't like taking medication."

Equipment Selection

With increasing numbers of patients asking PTs about cold laser treatments, more are augmenting their practice with the necessary devices, even at a hefty upfront cost. According to a leading manufacturing company, machines that administer CLL treatment run from $3,000 to more than $10,000.

Jim Strandy, PT, CHT, CEA, Summit Rehabilitation Associates in Spokane, WA, selected a cold laser with an 830 nanometer wavelength that penetrates two inches below the skin's surface to produce chromophores. The energy of laser photons prompts these structures to dramatically accelerate natural healing in compromised cells, normalizing pain thresholds, optimizing cellular function and increasing micro-vascularization and speeding the rate of tissue repair.

Though he had to authorize $8,000 for the purchase, Strandy feels it's a good investment when used as an adjunct. The treatment was so popular at his practice that he wore out the first laser machine. The manufacturer charged him 10 percent of the cost to replace it, and he chose a standalone unit for the second one.

"This one plugs into the wall so I don't have to have a charger going or remove a battery pack several times a day," he said. "But it's not portable."

Schult has the battery-operated version of the same model, which he selected after conversations with trusted colleagues and a review of PubMed.gov research.

In the eyes of both PTs, the investment has paid off. Strandy said "patients swear by it" and are further reassured to learn he performs the treatment on himself.

"In my experience, this gets people back to work more quickly," said Schult. "Our visits are scrutinized by insurance. This accelerates healing and gets patients back to doing conditioning more quickly. No one works through a lot of pain and if they see you're helping alleviate it, they're more willing to work through it."