· Advances in Medical Sciences · Vol. 56 · 2011 · pp 270-274 · DOI: 10.

2478/v10039-011-0041-z
© Medical University of Bialystok, Poland

Comparison of the long - term effectiveness

of physiotherapy programs with low - level laser
therapy and pulsed magnetic field in patients
with carpal tunnel syndrome
Dakowicz A1, Kuryliszyn-Moskal A1*, Kosztyła – Hojna B2, Moskal D2, Latosiewicz R3
1 Department of Rehabilitation, Medical University of Bialystok, Bialystok, Poland
2 Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok, Bialystok, Poland
3 Department of Rehabilitation, Medical University of Lublin, Bialystok, Poland

* CORRESPONDING AUTHOR:
Department of Rehabilitation, Received 27.10.2010
Medical University of Bialystok, Accepted 25.07.2011
M. Skłodowskiej-Curie Street 24 A Advances in Medical Sciences
15-274 Bialystok, Poland Vol. 56 · 2011 · pp 270-274
Tel/Fax: +48 85 746 8315 DOI: 10.2478/v10039-011-0041-z
e-mail: akuryl@umwb.edu.pl (Anna Kuryliszyn-Moskal) © Medical University of Bialystok, Poland

ABSTRACT
Purpose: The aim of the study was to compare the long term effects of low - level laser therapy (LLLT) and pulsed magnetic
field (PMF) in the rehabilitation of patients with carpal tunnel syndrome (CTS).
Methods: The study included 38 patients with idiopathic CTS, confirmed by electroneurographic (ENG) examination. All
patients were randomly assigned to 2 groups: group L (18 patients) treated with LLLT and group M (20 patients) with PMF
therapy. Clinical assessment, including day and night pain, the presence of paresthesia, functional tests (Phalen, Tinel, armband
tests) and pain severity according to the Visual Analogue Scale (VAS) was conducted before treatment, after the first series of
10 sessions, after a two-week break, after the second series of 10 sessions and six months after the last series.
Results: After LLLT a significant reduction of day and night pain was observed at each stage of treatment and 6 months after
the last series (p<0.05). However, in group M, a significant reduction of both day and night pain was demonstrated only after
the second series (p<0.05). A reduction of the incidence of Phalen’s symptoms were noticed in both groups, however, only in
group L the improvement was significant (p<0.05). In groups L and M a significant reduction of pain intensity was observed at
every stage of treatment (p<0.05).
Conclusions: Although after LLL as well as PMF therapy clinical improvement was observed, the most significant differences
were registered after the second series and persisted for up to 6 months in both groups.

Key words: low - level laser therapy, pulsed magnetic field, carpal tunnel syndrome, physiotherapy

INTRODUCTION The etiopathogenesis of the syndrome is associated with

Carpal tunnel syndrome (CTS) is considered the most common
compression neuropathy of the upper extremity with a 10%
lifetime risk of development [1]. CTS as a leading cause
of work disability and functional impairment is a serious
problem for relatively young and healthy population of people
over thirty, with a prevalence ranging from 2% to 4% in men
and 3% to 5% in women, rising with age [2]. The results
of epidemiological studies confirm the role of risk factors,
such as mechanical load of the wrists, rheumatoid arthritis,
osteoarthritis, obesity metabolic syndrome and diabetes in the
involvement of CTS [3-5].
compression of the median nerve in the carpal canal, which
leads to aggravated venous blood flow, edema, microcirculation
disturbance, and consequently – segmental hypoxia axons of
the nerve cells that cause a number of disorders of metabolic
processes [6].
Low - level laser therapy (LLLT) and pulsed magnetic
field (PMF) due to their antiodematous, analgetic and
anti-inflammatory effects, belong to the most commonly
recommended physiotherapeutic methods of CTS treatment
[7, 8, 9]. At the tissular level the LLLT radiation significantly
increases microcirculation, activates angiogenesis, stimulates
Dakowicz A et al.
Table 1. Clinical characteristics of patients with carpal tunnel
syndrome treated with low - level laser (group L) and pulsed
magnetic field (group M).
Characteristics Group L(n=18) Group M(n=20)
Age, years (mean ± SD) 53.1 ± 9.1 48.5 ± 11.8
Female/Males 17/1 18/2
Number of treated wrist 27 34
Disease duration (mean ± SD) 22.5 ± 20.1 32.4 ± 21.9
immunological processes and nerve regeneration. Moreover, it
is analgetically active through the growth of endorphins [10].
The aim of this study was to compare the efficiency of long
- term rehabilitation with the use of low - level laser therapy
and pulsed magnetic field in CTS treatment.
MATERIAL AND METHODS
The study included 38 patients (35 females and 3 males),
aged between 20 and 74 years (mean 50.8±10.3), with
diagnosed idiopathic carpal tunnel syndrome, confirmed by
electroneurographic (ENG) examination. The patients were
treated in the Department of Rehabilitation of the Medical
University of Bialystok with the consent of the Bioethics
Committee. Informed consent was obtained from all the
participants. All CTS patients were classified into two groups:
the first group was treated with low - level laser (18 persons)
and the second group was treated with pulsed electromagnetic
field (20 persons). The detailed clinical characteristics of both
groups are presented in Tab. 1.
Patients with a history of double crush syndrome,
distal radius fracture, wrist fracture cervical radiculopathy,
fibromyalgia, diabetes mellitus, and inflammatory rheumatic
diseases in the course of which carpal tunnel syndrome might
develop were excluded from the study. The CTS diagnosis was
based on characteristics symptoms such as: day and night pain,
the presence of paresthesia, pain severity rating on the Visual
Analogue Scale (VAS) and physical examination including
functional tests such as Phalen’s, Tinel’s and the armband test.
Moreover, the diagnosis was confirmed with ENG examination
and the patients were classified as mild or moderate CTS
according to the American Association of Electrodiagnostic
Medicine guidelines [11]. Patients with chronic CTS were
included in the study according to Rosenbaum classification
[12].
Clinical assessment was conducted in the following stages:
before treatment, after the first series consisting of 10 sessions,
after a two-weeks break between the series, after the second
series of 10 sessions, and six months after the last series. Both
series of sessions were performed daily with one weekend
break.
All patients were randomly assigned to 2 groups: group
L (18 patients) was treated with low - level laser, and group
M (20 patients) had pulsed magnetic field therapy. LLLT
271
Figure 1. Percentage of CTS patients with day pain before
and after treatment with low - level laser (group L) and pulsed
magnetic field (group M).
Significance of differences between percent of patients with day pain
before and after treatment is expressed as: * p<0.05
was performed using Ga-As (Galium Arsenide) laser device
Physioter D-50 (ZEM MARP Electronic Krakow, Poland),
beam class 3B with the following parameters: pulsed
emission (200 ns), wave length 904 nm, power density 150
mW, frequency 10 000 Hz. The average diode power of laser
applicator LAI-71 was 75 W. The total energy per treatment
was 50 J, dose per point - 6.0 J/cm2, and the duration of
one session was 5 minutes and 33 seconds, according to the
manufacturer’s instruction.
The patients in group M received in one session 15 minutes
of the PMF therapy with the use of device Magnetronic MF-10
( Elektronika i Elektromedycyna Otwock, Poland) with the
use of sinusoidal field with low frequency of 10 – 40 Hz,
induction 1.0 - 5.0 mTesla – mT.
In the statistical analysis, Student’s t-test was used and p
values <0.05 were considered statistically significant.
RESULTS
Day and night paresthesia. Although a reduction of day
and night paresthesia after each series of treatment and six
months after the last series was observed in both groups of
patients, statistically significant differences were found only in
the group treated with the magnetic field (group M) after two
weeks of treatment and six months after therapy (p<0.05).
Day and night pain. After LLLT a significant reduction
of day and night pain was observed at each stage of treatment
and 6 months after the last series (p<0.05). However, in group
M, a significant reduction of both day and night pain was
demonstrated after the second series and a decrease only in
day pain was registered 6 months after the last series (p<0.05)
(Fig. 1, Fig. 2).
Moreover, a significant improvement referring to night
pain was observed after 2 weeks of PMF therapy (p<0.05)
(Fig. 2).
272 Comparison of the long - term effectiveness of physiotherapy programs with low - level laser therapy and pulsed magnetic field in patients with carpal tunnel syndrome
Figure 2. Percentage of CTS patients with night pain before
and after treatment with low - level laser (group L) and pulsed
magnetic field (group M).
Significance of differences between percent of patients with night pain
before and after treatment is expressed as: * p<0.05
Table 2. Percentage of CTS patients with positive Phalen’s test
treated with low - level laser (group L) and pulsed magnetic field
(group M).
Phase of treatment Low level Pulsed magnetic p
laser (group field (group M)
L)n=18 n=20
Before treatment 88% 85%
After the first series 56% 58%
After the second series 37% 53%
Six months after 67% 63%
therapy
NS- not significant, a significance level p<0.05
Pain intensity based on the VAS. In both groups,
statistically significant improvement in the level of pain
intensity after each series of treatment and six months after the
last series was observed (p< 0.05) (Fig. 3).
Phalen’s, Tinel’s and armband tests. After each series of
treatment and six months after the last series a reduction in the
percentage of patients with positive Phalen’s symptoms was
observed in both groups of patients. Although, only in group
L, after the second series of treatment the differences were
statistically significant (Tab. 2).
Moreover, in both groups of patients, the percentage
of patients with positive Tinel’s and armband tests was not
significantly different at every stage of treatment.
Electroneurographic evaluation (ENG examination) –
sensory and motor latency. In both patient groups, shorter
sensory and motor latency time after the first and second series
of treatment in comparison with values before therapy were
observed. However, the differences were not significant. After
a six-month period re-accumulation of both latencies was
registered, although the values were still lower in comparison
with the initial results. However, after six months of treatment
8 patients (21%) did not agree to the ENG examination.
Figure 3. Pain intensity according to the Visual Analogue Scale
(VAS) in CTS patients treated with low - level laser (group L) and
pulsed magnetic field (group M).
Significance of differences between pain intensity before and after
treatment is expressed as: * p<0.05
DISCUSSION
NS
NS Although new approaches to the early diagnosis of CTS
< 0.05 are continually improving [13], there are no specific
NS recommendations for the treatment of this syndrome [14].
As the procedures concerning the surgical treatment for CTS
are still controversial, non-operative methods are the main
subject of the debate on their usefulness and availability in the
conservative treatment of CTS [9,15,16].
Carpal tunnel syndrome as a result of compression of
the median nerve within the carpal tunnel leads to numerous
pathological consequences such as aggravation of venous
blood flow, edema, microcirculation disturbances and finally a
broad spectrum of clinical manifestations [14,17]. Therefore,
LLLT and pulsed magnetic field, improving microcirculation,
collagen tissue metabolism and indicating antiedematous, anti-
inflammatory and pro-angiogenous action are recommended
in the treatment of CTS [10,18]. However, the clinical
evidence for LLLT is controversial and consists of studies
presenting ambiguous conclusions [7,8,18-20]. Furthermore,
the therapeutic effect of LLLT is dose-dependent and it is
suggested that the optimal energy dose for anti-inflammatory
effects in clinical trials is 0.7 – 19 Joules [21]. Moreover,
many factors including age, sex, and the underlying disease
can affect the treatment outcome measures [22,23].
In the present study, the initial clinical examination
comprised the evaluation of systemic disorders and only mild
and moderate patients with idiopathic CTS were included in
the treatment groups. The beneficial effects of LLLT and PMF
referring to day and night paresthesia and pain, reduction in the
percentage of patients with positive Phalen’s test and shortening
Dakowicz A et al.
of sensory and motor latency time in the ENG examination
were observed. Although, the greatest improvement was noted
after two series of treatments, it was sustained even six months
after completion of therapy. It is noteworthy that, only in
patients treated with LLLT, statistically significant reduction
of day and night pain at each stage of treatment was observed.
Similarly, the percentage of patients with positive Phalen’s test
was significantly lower after the second series of treatment
with LLLT.
Several studies have documented the positive effects of
LLLT in CTS patients in comparison with placebo [24-26].
After two weeks of treatment and four weeks later a significant
reduction of day and night pain according to VAS was observed
[24]. However, after twelve weeks the clinical improvement
was not significant [24]. Authors of other studies observed
beneficial effects of three weeks of treatment of CTS patients
with LLLT, such as an improvement in day and night pain,
hand strength and increasing conduction of the median nerve
[26].
Only a few studies reported the long - term effects of
LLLT in CTS patients [8,26]. It is worth highlighting that a
comparison between LLLT and surgical treatment showed
an improvement in nerve conduction and decreasing of pain
within 6 months in both groups [8]. This is in agreement with
the opinion that non-surgical treatment should be performed as
an alternative method of CTS therapy [27].
In the present study, no significant differences in the
shortening of sensory and motor latency time in ENG
examination after 6 months in both CTS groups were observed,
although the values were still lower in comparison with the
results before treatment.
There are only a few studies on the effects of pulsed magnetic
field in the treatment of CTS [9,16,17,19,28]. Weintraub et
al. demonstrated electrophysiological improvement in distal
latency and pain relief after magnetic field exposure [19].
Moreover, it was shown that a combination of simultaneous
static and time–varying dynamic magnetic field stimulation to
the wrist 4 hours/day for two months can reduce subjective
neuropathic pain and improve objective neuronal functions in
CTS patients [9].
In the present study, after two weeks of treatment with
magnetic field and six months after the last series a statistically
significant reduction of day and night paresthesia as well as
significant improvement in the level of pain intensity after
each series of therapy and six months after the last series were
observed.
We demonstrated the beneficial clinical effects of LLLT
and pulsed magnetic field in CTS therapy, but we had some
limitations in our study. Patients with bilateral CTS were also
enrolled in the study, which might affect the clinical results.
Therefore further studies are needed to document the potential
role of LLLT and magnetic field in the treatment of CTS. A
deeper understanding of the influence of both methods on
electrophysiological parameters in patients with CTS may be
crucial for early non-invasive treatment of this syndrome.
273
CONCLUSIONS
The presented study demonstrated that a clinical improvement
in CTS patients was observed after LLL as well as PMF
therapy. However, the most significant differences were
registered after the second series and persisted for up to 6
months in both groups.
ACKNOWLEDGMENTS
We are grateful to Doctor Robert Pogorzelski from the
Department of Neurology, Medical University of Bialystok,
Poland for conducting the electroneurographic examination.
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