The use of Laser Therapy for treatment of Carpal Tunnel Syndrome:

A Literature Review

Alex Gentile, Dipal Patel

Melissa Wolfe, Jacob Van Timmeren
PTH 645- Patient Care
Dr. Zipple
November 9, 2015

Carpal tunnel syndrome (CTS) is considered the most common compression neuropathy
of the upper limb, according to the National Institute of Neurological Disorders and Stroke.1 CTS
is a neuronal disease that occurs when the median nerve is compressed within the transverse
carpal tunnel ligament and can be caused by trauma, repetitive wrist or hand motions, or
rheumatoid arthritis.2 Common symptoms include burning pain, tingling and numbness, and
muscle weakness in the hand and forearm muscles. Carpal tunnel syndrome can negatively affect
work productivity and lifestyle activities and it is more commonly found in women than in men.2
Research has shown that surgical release (severing of the transverse carpal ligament to allow
for decreased compression) is one of the most effective ways to treat carpal tunnel syndrome,
however, other non-surgical and less invasive treatments are often considered for alternative
options to surgery.1 Oral medication, splinting, and corticosteroid injections are common nonsurgical procedures used to treat carpal tunnel syndrome and have been shown effective in some
people.1 One of the more recent interventions being studied to treat CTS is low-level laser
therapy.
Low-level laser therapy (LLLT) consists of applying a laser beam close to the surface of the
skin using a specific time and dosage (0.5-30 J/cm2). Recent studies have shown that low-level
laser therapy can decrease pain and inflammation around the carpal tunnel region.3 Low-level
laser therapy may be a cheaper and more conservative way to reduce or eliminate CTS, however
LLLT has shown both effective and ineffective outcomes in recent studies.3,4 This paper will
discuss the effectiveness of laser therapy treatments on carpal tunnel syndrome.
The use of LLLT has been proven effective to treat CTS. A study conducted by Chang et
al shows the benefits of using low-level laser therapy for the treatment of CTS compared to a

placebo group. This study used patients who were diagnosed with mild to moderate CTS.2 To be
included in the study, the patients had to have symptoms for over a year with no previous surgery
or laser treatment.2 These requirements allowed for a controlled group to ensure that the results
were as accurate as possible. This test was set up as a double-blind experiment with the patients
divided into two groups. One group received LLLT and the other received a placebo sham laser
treatment which emitted a light, but had no real laser effects.2 The treatment period for this
specific study was for two weeks, in which the patients received laser therapy five days a week.
Chang et al says that, assessments were made prior to treatment, immediately after the 2-wk
treatment period, and after another 2-wk follow-up.2
Assessments are critical to determine if a study was successful, and if the treatment
creates significant differences. To determine outcomes, the assessments need to be quantifiable
so that there is something to compare. Outcomes were assessed using a visual analog scale
(VAS) to determine pain, hand and finger grip strength using a Jamar Hydraulic Hand
Dynamometer, as well as questionnaires to self-assess symptom severity and nerve conduction.2
The initial test is used to create a baseline that can be referenced in future tests. Those in the
group receiving LLLT had the same parameters given to them. The wavelength was set to
830nm, with output frequency at 10 Hz and power setting to 60mW. The treatment dose was
9.7J/cm. The laser was applied to the skin covering the flexor retinaculum.2 Significance for a
result was determined when the p < 0.05. There were no statistically significant differences in
nerve conduction velocity. However, at the two week checkup, there was a significant difference
in hand and finger grip strength, but there wasnt a difference before treatment and once
treatment had finished.2 When looking at the pain using the VAS, there was significant
differences between the placebo group and LLLT group. A higher number indicated a higher

perceived pain. The LLLT group had an average pain level before treatment of roughly 6, a score
of 3 after treatment, and an average score of 1 on the VAS scale at the two week checkup. The
placebo group saw little to no change in pain between before and after treatments.2 There were
also significant increases in functional scale scores for the experimental group receiving LLLT,
where there were nearly no changes with the control group.2
Treatment dose is something that can change depending on what is being treated. In this
particular study, the parameters used seem to be effective in treating CTS. There were significant
differences between the experimental group and placebo group showing LLLT. Based on the
results of this study conducted, LLLT was effective in alleviating pain and symptoms, and
improving functional ability, as well as finger and hand strength.2 It is important to set
parameters that are appropriate. According to Chang et al, stimulation that is too strong may
have inhibitory effectsdifferent types of lasers may have differing penetration depths and
treatment effects.2 A physical therapist needs to be mindful of this while choosing which
instrument and parameters to use.
Splinting of the wrist and hand is a common method of treatment used for CTS. Fusakul
et. al performed an experiment comparing the effects of splinting alone and splinting with LLLT.5
Patients with mild to moderate CTS were included in the study and those with severe CTS were
excluded. Patients were also excluded if they had a carpal tunnel release among other diagnoses
or procedures.5 Sixty-six patients were included in the study and were randomly split up into two
groups. One group received laser treatment with a splint, and the other group received a placebo
laser treatment while also wearing a splint.5 Each patient in the study received fifteen treatments
over a five week span. The individuals were examined upon completion of treatment, as well as
at five and twelve weeks after treatment had been concluded. The individuals were also tested

before treatment began to achieve a baseline score.5 By doing this, researchers were able to
determine the long term and lasting effects of the treatment.
The parameters set for modalities depend upon what the target tissue is. In this case, the
median nerve is being impinged and pressed on, leading to the symptoms of CTS. For this study,
Fusakul et al used a laser with a wavelength of 810nm and a power output of 50mW. The dose
treatment was 18 J/session and was placed 10cm away from the skin at the distal crease of the
wrist.5 The patients tested with the splint and laser showed significant improvements five weeks
post treatment in VAS scale, functional scale, symptom severity scale, nerve conduction scale,
and hand grip test. The parameters were also found to significantly improve even further after
twelve weeks.5 After five weeks, the control group that received a placebo treatment with a splint
also saw significant improvements in all categories, except hand grip. The statistically significant
difference noticed between the two groups was the symptom severity scale with a p-value of
0.031.5 Although splinting has been found to be effective and showed statistically significant
statistics, laser therapy in addition to splinting, has shown to increase hand strength. According
to Fusakul et al, both LLLT and splints improved the clinical parameters of our study, but LLLT
was electorneurophysiologically superior to splints with regard to the conduction of the median
nerve fibers.5
A similar study was conducted comparing the use of splinting and splinting with lowlevel laser therapy (SLLLT). The parameters of this study were different from that of the
previous experiment. Yagci et al used a wavelength of 830nm and a power output of 30mW and
was applied perpendicular to the points of where the median nerve is located. The dose over the
wrist was 8.1 J.6 According to Yagci et al, The complete recovery rate was greater in SLLLT
group but did not reach any statistical significance.6 Both splinting alone and splinting with

LLLT provided improvements in patients, but when the laser therapy was used with splinting, it
was electrophysiologically superior to splinting alone.6 Due to these results, laser therapy would
be considered effective in mild to moderate CTS for treatment. It is important to take into
consideration the effects of each modality that a physical therapist uses. Some treatments may be
helpful for one patient, but not another.
There are both invasive and noninvasive treatments that can be used for CTS. LLLT
would be considered a noninvasive treatment, which is helpful in healing and reducing the
symptoms of CTS. Elwakil et al conducted a study comparing standard open carpal tunnel
release with that of laser therapy.3 Sixty hands were used and randomly divided in this study. One
group received open release, and the other received LLLT.3 The instrument used for the LLLT
had a program preset for CTS, where a power of 12mW was used and the instrument
administered 3 J/cm.3 Each patient received two treatments twice a week for six weeks.3 Patients
in both groups were evaluated before treatment to collect data including age, subjective
complaints on the hand and wrist, as well as objective findings.3 These were done to have a
baseline to compare post treatment results to know how effective the laser therapy or open tunnel
release was.
All patients were re-evaluated each month for the following six months. Each group,
whether having surgery or LLLT were able to return to full work duty six weeks after treatment.
Elwakil et al, wrote In the present study there were three hands (10%) and only one hand
(3.33%) among groups A [LLLT] and B [carpal tunnel release], respectively, who experienced
residual and/or recurrent symptoms after treatment.3 There were some scar-related
complications with the carpal tunnel release group which lead to scar tenderness and
hypersensitivity to touch and cold or heat.3 This would be a significant advantage of LLLT as

opposed to open carpal tunnel release because there were no adverse effects noted in the study.
Not only is LLLT a good alternative, but it would allow for surgery to be an option in the future
if CTS were to progress.3 Laser therapy is still being adjusted for treatment conditions. There
may be more studies needed to determine the appropriate power, wavelength, and intensity.3
Overall, LLLT appears to be a useful treatment option for those who have CTS.
Studies have also shown to discredit the use of LLLT in treating CTS. According to
Tascioglu et al, the use of LLLT has been found to be no more effective than a placebo in treating
CTS.7 This was a double-blinded research study which looked at the efficacy of low level laser
therapy on carpal tunnel syndrome to clinically assess pain, grip strength, functional status score
(FSS) and symptom severity score (SSS).7 Sixty patients, between 28 and 68 years old, with CTS
were randomly assigned to one of the three treatment groups: active laser with a 1.2J/per painful
point dosage, active laser with a 0.6 J/per painful point dosage and placebo groups.7 Each group
was treated five times per week for three weeks. Five points across the median nerve were
exposed with a Ga1-A1-As diode laser which had a power output of 50 mV and wavelength of
830nm.7 The first group received a two minute exposure at each point, for a total of ten minutes.7
The second group received a one minute exposure at each point, for a total of five minutes.7 The
placebo group received a two minute exposure at each point; however, there were no laser beams
actually being transferred to the treated area.7 Tascioglu et al found that VAS scores prior to the
study were not different between the three groups and at the end of the study, pain scores
decreased in all three groups.7 Grip strength improved in each group (P<0.05) and SSS, FSS and
nerve conduction velocity measurements showed no significant difference among the groups.7
Essentially, Tascioglu et als research not only showed that LLLT given at two different dosages

did not result in significantly different results, but also that these two different dosages were not
any more effective in improving CTS symptoms than the placebo.7
Similarly, a study conducted by Irvine et al found that there was no symptomatic
improvement between the active group and control group when using LLLT on patients with
CTS and that LLLT exposure did not change peripheral nerve function.8 This particular doubleblinded study had fifteen CTS patients, ages between 34 and 67 years old.8 There were eight
patients in the control group and seven patients in the active group and both groups received
treatment three times per week for five weeks.8 The active group was treated with an 860nm
Ga1-A1-As laser with a 6 J/cm2 dosage over the carpal tunnel and the control group received
sham laser.8 The Levine CTS questionnaire scores between the two groups showed no significant
difference at baseline or end of treatment.8 Furthermore, electrophysiological abnormalities were
similar at baseline and were not found to change after treatment.8 Hence, the results of this study
indicated that the symptoms improved similarly in both the control and active groups, concluding
that LLLT is not more effective for improving CTS symptoms than sham treatment.
Research done by Bakhtiary and Rashidy-Pour compared the efficacy of ultrasound and
laser treatment for mild to moderate carpal tunnel syndrome in fifty patients.9 One group
received ultrasound treatment at 1 MHz, 1.0 W/cm2 , pulse 1:4 for 15 minute sessions and the
other group received LLLT at 9 J at 830nm at five points for five sessions a week for three
weeks.9 Measurements of pain assessment with a VAS, pinch and grip strength and
electroneurographic measurements were taken prior to, after treatment and four weeks later.9 The
results found indicated that improvements in pain relief, electroneurographic measurement, and
pinch strength were higher in the group that received ultrasound than those who received LLLT.9

Therefore, although LLLT is an option available for treatment of CTS, there are other modalities,
such as ultrasound, that have been found to be more effective.
The comparative data shows that LLLT it is an effective modality for CTS. Although
some studies have shown that LLLT did not have a significant effect on treating CTS, stronger
evidence has been found in favor of treating CTS with LLLT. In the study performed by
Tascioglu et al, significantly lower dosages of treatment (1.2 J/cm & 0.6 J/cm) were used and
found to be no more effective than the placebo group.7 In the trials performed by Irvine et al, the
dosage of 6 J/cm was used only three times a week.8 In the trials done by Bakhtiary and
Rashidy-Pour, it was found that LLLT was not as effective as ultrasound therapy in treating
CTS.9 All three of these research studies either had lower doses, fewer treatments per week, or
didnt prove LLLT to be effective.
The trials that were found to have significant effects in treating CTS all used at least 8.0
J/cm for the dosages of the respective treatments. In the study done by Chang et al, the LLLT
treatment group had a significant decrease in pain levels throughout treatment and also increased
the functionality of the patients involved limb.2 Compared to Chang et als work, some of the
studies that disprove the use of LLLT for CTS had longer treatment periods and fewer visits per
week. In the study published by Fusakul et al, the researchers used splinting and LLLT in
combination.5 Fusakul et al found LLLT to be superior to splinting in terms of
electroneurophysiological differences.5 The LLLT was shown to enhance the effects of the
splinting by increasing conduction velocity in the median nerve and enhancing the grip strength
of the involved limb.5 Ewakil et als work showed that LLLT was just as effective at treating CTS
as the CTS release surgery.3 Though both of these treatments were effective, there were side
effects found with the CTS release that did not occur with LLLT. In the future, physical

therapists may be able to treat carpal tunnel syndrome more efficiently with the use of LLLT
because it is a non-invasive treatment that can be performed quickly. Patients may choose this
treatment over surgical options because it is less expensive and it is much less invasive. In the
rare chance that a patients CTS does worsen, there is still the option to elect for surgery. In
conclusion, LLLT is a safe and effective way to treat CTS that leaves all options of treatment
open to physical therapists.

References
1.Aziz Khan, Abdul et al. Outcome of Open carpal tunnel release surgery. Ayub Medical College
Abbottabad-Pakistan 27.3 (2015): 640-642. Print.
http://www.jamc.ayubmed.edu.pk/index.php/jamc
2.Chang WD, Wu JH, Jiang JA, Yeh CY, Tsai CT. Carpal tunnel syndrome treated with a diode
laser: a controlled treatment of the transverse carpal ligament. Photomedicine and Laser
Surgery. 2008;28(6):551-557. doi: 10.1089/pho.2007.2234.
3.Elwakil TF, Elazzazi A, Shokeir H. Treatment of carpal tunnel syndrome by low-level laser
versus open carpal tunnel release. Lasers Med Sci. 2007;22(4): 265-270. doi:10.1007/s10103007-0448-8.
4.De Lima Resende LA, Monteiro TA, Luvizutto GJ, et al. Treatment of the carpal tunnel
syndrome with laser. Neuro Open J. 2015; 2(2): 51-55.doi: 10.17140/NOJ-2-112
5.Fusakul Y, Aranyavalai T, Saensri P, Thiengwittayaporn S. Low-level laser therapy with a
wrist splint to treat carpal tunnel syndrome: a double-blinded randomized controlled trial. Laser
Med Sci. 2014;29(3):1279-1287. doi:10.1007/s10103-014-1527-2.
6.Yagci I, Elmas O, Akcan E, Ustun I, Gunduz OH, Guven Z. Comparison of splinting and
splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome. Clinical
Rheumatology. 2009;28(9):1059-1065. doi:10.1007/s10067-009-1213-0.
7.Tascioglu F, Degirmenci NA, Ozkan S, Mehmetoglu O. Low-level laser in the treatment of
carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation.
Rheumatology International. 2012;32(2):409-415. DOI 10.1007/s00296-010-1652-6.
8.Irvine J, Chong SL, Amirjani N, Chan KM. Double-blind Randomized Controlled Trial of
Low-level laser therapy in Carpal Tunnel Syndrome. Muscle and Nerve. 2004;30(2):182-187.
DOI:
10.1002/mus.20095.
9.Bakhtiary AH, Rashidy-Pour A. Ultrasound and laser therapy in the treatment of carpal tunnel
syndrome. Australian Journal of Physiotherapy. 2004;50(3):147-151. doi:10.1016/S00049514(14)60152-5.

10