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I came across an interesting study yesterday comparing the use of ultrasound vs. low level laser therapy in treating Carpal Tunnel Syndrome.  The study was published in 2004 and conducted by Amir H. Bakhtiary and Ali Rashidy-Pour, Rehabilitation Faculty in the Physiology Department at Semnan Medical Sciences University, Iran. The study, entitled Ultrasound and laser therapy in the treatment of carpal tunnel syndrome, was published in the Australian Journal of Physiotherapy.

5770147_aad5619c5f1It is important for continued research such as this to be done. Low level laser therapy and other forms of light therapy have burst onto the scene over the last several years, particularly in the United States and so continued study as to their efficacy is important. Furthermore, carpal tunnel syndrome can be a debilitating condition and further studies to help provide quality treatment for those with CTS is important.

This study is of particular interest to me because as an athletic trainer in the industrial setting, this is a condition I see plenty of. Secondly, this is of interest because I have extensively used both treatments in the past to treat carpal tunnel syndrome and I was interested to see the results. This particular study concluded:  “Our clinical trials showed that ultrasound treatment is more effective than low level laser treatment in patients with mild to moderate carpal tunnel syndrome.”

The study had a sample group of 50 patients and a total of 90 wrists were treated. Each wrist was treated exclusively with either ultrasound or laser treatment. Patients were treated daily over a three week period for a total of 15 treatments.

The part that I found most interesting however involved the treatment parameters and this is probably where I have the most questions with the study. Ultrasound was delivered at a dosage of 1.0 W/cm2 for a total of 15 minutes per treament. The low lever laser treatment on the other hand was delivered at a total of 9 Joules over 5 points along the median nerve. This dosage equates, according to the study, to 1.8 Joules per treatment point.

According to the study, the results overwhelmingly favored ultrasound as a superior treatment based upon pre and post-treatment measurements.

As someone who has treated CTS for over the last 15 years utilizing each of these modalities, I observed the following in regards to this study:

  • Ultrasound was delivered at an intensity of 1.0 W/cm2. This seems to be reasonable. I may tend to use a slightly higher intensity personally (1.25 W/cm2) but this is dependent upon several factors and for the sake of the study, this seems fair.
  • Ultrasound was delivered at a treatment time of 15 minutes per treatment. This treatment time seems to be on the excessive side. (Now, on the flip side – if this did have positive results, maybe we need to reexamine our treatment times regarding ultrasound – but that is for another discussion.) Typical treatment times for the administration of ultrasound is generally 5-10 minutes, wouldn’t you agree? So, using ultrasound for 15 minutes per treatment seems to be in excess of what would be considered normal.
  • According to the study, laser was delivered at 1.8 Joules x 5 treatment sites for a total of 9 Joules. While the treatment dosage of ultrasound may be excessive, the treatment dosage for the laser treatment seems to be extremely low. The laser that we use at our facility utilizes three infrared diodes that each deliver 1 Joule of energy per treatment cycle. So for every 33 second cycle that we administer treatment, 3 Joules of energy are delivered per site. We typically will treat each site with 3 treatments and then treat a total of 3-5 sites at the wrist and hand. (Treatment is based upon manufacturer’s recommendations). So each site will receive 9 Joules of energy and this would again be repeated at 3-5 sites. This is a significant contrast to the treatment dosages used in the study.

Studies in this vain are important and I applaud those who conducted this study. Having said that, I am not sure that you can make the conclusion that ultrasound is a more effective treatment in mild to moderate CTS cases based upon the above observations. I do find the results, particularly with the ultrasound, interesting and definitely worth more investigation. I am just not completely sure, based upon what I read in the study, that the treatment dosages were “equitable”.

Am I incorrect in my observations? What are your thoughts? I am interested to hear what you think.

Photo Credit,  mrebert

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In the industrial athletic training setting, one of the more common injuries or conditions that I come across is carpal tunnel syndrome. This can certainly be a challenge to treat. One stretch that can be added to your arsenal in treating this, and other upper extremity injuries for that matter, is a stretch of the brachial plexus. Brachial Plexus Stretch

One little success story to share with you (results not guaranteed) involved a woman with chronic CTS. Her symptoms had been at a relatively dull roar for a while until she started experiencing increased numbness and tingling that were not going away. The symptoms were probably present for a couple of weeks and when I finally showed her this stretch. Her symptoms were gone within a day and she continues to implement this stretch in her normal stretching routine.

Again – taking in the total context – this may be a stretch that you can implement as part of your treatment regime. This stretch is also certainly not just limited to CTS sufferers. This can be used with general upper extremity tightness and more. As always, exercise care when instructing your patients of this stretch and be mindful of any situations that may cause this stretch to be not used in the first place or discontinued.

A couple final thoughts. As you can see from the picture, a small swiss ball was used. I like using the ball because it gives the patient a little flexibility in how they position the hand in order to get the best stretch. The ball provides a little more alterationability (if that’s a word) than using the wall as an anchor. A patient can simply use a ball from around the house to replicate this stretch at home. If they don’t have a ball, try a plastic mixing bowl and placing this against the wall. This will give a similar effect.

Make sure to keep the shoulder at “shoulder level” or lower so as not to aggravate the shoulder or any additional conditions.

Finally, you’ll notice in the picture that I am turing away from the wall. This again is a tweak to the stretch that will allow you to feel this stretch a little bit more. Turn away as much or as little as you wish in order to customize this stretch to personal preference.

Quite honestly this was not a “standard stretch” that I always gave to CTS patients (although one may argue it should have been). The point is – I tried this out one day thinking that it may benefit the patient and sure enough it did. This stretch and others for that matter won’t benefit you gathering dust in the bottom of your “toolbox”. Give it a try – you might be pleased with the results.

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