Carpal tunnel syndrome (CTS) is caused by the entrapment of the median nerve as it travels through the carpal tunnel in the wrist. Signs are pain, numbness and paresthesia in the thumb, index, middle and inside ring finger; increased pain and numbness at night due to prolonged wrist flexion; and if long standing, weakness in pinching and grip strength and atrophy of the hand muscles.
Causes of CTS include inflammatory conditions such as pregnancy, rheumatoid arthritis, hypothyroidism, diabetes, and obesity. Cumulative trauma from repetitive activities such as typing and guitar playing which puts the wrist into forced flexed positions are also implicated. History and clinical tests to stress the nerve give a diagnosis, with a nerve conduction study being conclusive.
Non surgical treatments have included night splints, NSAIDs, cortisone injections, ultrasound and modifying or changing certain activities. Cold laser, a new treatment now being offered at our clinic, has shown promise in treating CTS to reduce pain and inflammation, as well accelerate healing. Surgical release of the carpal ligament may be indicated if conservative treatment has failed, if so cold laser can also be used post surgically to assist in healing.
Several recent clinical trials have compared cold laser with sham laser, splinting and ultrasound. Results have shown cold laser to be effective in pain alleviation; reducing the numbness and paresthesia; improving hand grip strength and even improved EMG findings with no side effects, and to be superior to both splinting and ultrasound.
Sources: The effectiveness of conservative treatment of carpal tunnel syndrome: splinting, ultrasound, and low level laser therapies; Photomed Laser Surg, Feb 2009 and The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome; Electromyogr Clin Neurophysiol; June 2008
