Carpal Tunnel Syndrome

Introduction

A friend of mine, a dentist, came to me, numbness on her right hand as the chief complaint. That is a very specific injury to whom who uses hand, especially the wrist, rhythmic and for a long time. It usually occurs in people who work as a dentist (like my friend), somebody who works a lot using computer, or in Indonesia, during fasting month, housewives suffer from Carpal Tunnel Syndrome (CTS) due to their repeated work of making “sambal” using “cobek”. Apparently, CTS is one of ladies’ disease.

Published data in Minnesota shows the ratio of CTS incidence between male : female = 5 : 14. In Cipto Mangunkusumo Hospital, the number of CTS cases found was 238 in the year of 2001 and 149 cases in 2002. The patients’ age ranges between 25 – 35 years old. In Washington, the chief complaint reported was tingling and pain .

Pathogenesis:

CTS is caused by impingment of the median nerve inside the carpal tunnel. As tension inside the tunnel increases, perineural edema occurs, and causes damage to the nerve. This event will release serotonin and prostaglandin, and impair microcirculation. This is the mechanism which stimulate the pain.

Laser therapy:

I gave her diode laser (15 mW for 15 minutes) with trans-cutaneous application. The day after her first visit, she told me that after the treatment she felt an “uncomfortable sensation” in her injured hand. I decided to decrease the dosage of laser therapy to 10mW for 15 minutes. She felt comfortable with this regiment and could work as usual. Orthose also given to fixate the wrist at zero degree position.

Research

A research on CTS has been conducted at the Physical Medicine and Rehabilitation Department in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The hypothesis was, “Application of plaster of Paris & and Low Level Laser Therapy (LLLT) are more effective than plaster of Paris only for pain reduction in Carpal Tunnel Syndrome”. Is there any additional effect to plaster of Paris fixation by LLLT compared with fixation only in reducing Carpal Tunnel Syndrome pain? It was the question tried to be answered.

There were two groups, LLLT combined with plaster of Paris, and the other as control only using plaster of Paris.

The subjects were homogenous among those groups. It was conducted for a period of two weeks, and Visual Analog Scale (VAS) was used as outcome assessment for pain.

Conclusion: Application of plaster of Paris and Low Level Laser Therapy has an additional effect for pain reduction in comparison to plaster of Paris only

Discussion:

The effect of Low Level Laser Therapy as anti inflammatory and pain reliever worked in this case of CTS.

Acknowledgement:
This story is dedicated to Mrs. Hermina., a friend of mine who is such a beautiful dentist.

(Hi, Mrs Hermina, , your visit to my office reminded me to share this kind of problem to others. Thank you)

Sciatica pain –- low level laser approach

A person seeks for help, sometimes due to pain. This the one reason patients come to a Physical Medicine & Rehabilitation specialist. Now, I’m running my own private clinic, using low level laser as the major equipment.

Last Wednesday, a patient came to me due to pain felt from her back downward. It was sciatica pain. I have given her ILIB (Intravascular Laser Irradiation on Blood) for 20 minutes, and diode laser applied to 10 points. Immediately after the treatment, the pain had gone, and she could walk properly.

Discussion:

Low power laser has physiological effect to relieve pain. Low power laser equipments are relatively easy to be applied. Just turn on the power, and follow the merchant's instruction. But, in practice, it is not that simple. As a doctor, diagnosis is the most important point. For this lady, the therapy must be followed by the use of orthose for the lumbosacral and exercise.

Low Level Laser in Rheumatoid Arthritis

Tiur Farida*, Nury Nusdwinuringtyas*, Satrio Tjondro*,,Yoga Iwanoff Kasjmir**, ,Sumedi Sudarsono,***

*Physical Medicine & Rehabilitation Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

** Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

*** YARSI Medical School, Jakarta, Indonesia

Objective : To evaluate the influence of low level LASER therapy, isometric hand strengthening and routine medications in patient with hand rheumatoid arthritis (RA) to reduce pain and increase the range of motion of the metacarpophalanges (MCP)

Design : Pre and post treatment

Setting : Medical Rehabilitation policlinic, Physical Medicine and Rehabilitation Department, Cipto Mangunkusumo Hospital, Jakarta

Participants : Twenty five female patients with hand rheumatoid arthritis in Cipto Mangunkusumo Hospital. Six subjects did not meet the inclusion criteria, two subjects dropped out from the study

Intervention : Between July and November 2004, seventeen female patients with hand rheumatoid arthritis, who were classified in the inclusion criteria were given low level LASER therapy, isometric hand strengthening exercise and routine medications for four weeks.

Results : After four weeks of intervention there was significant decrease on MCP joint pain, marked by decrease in Visual Analog Scale (VAS) (p<0,001)>

Conclusion : Low level LASER therapy combine with isometric hand strengthening exercise can reduce pain and increase the MCP range of motions in patients with hand rheumatoid arthritis

Keyword : RA hand – LASER therapy – Visual analog scale – isometric hand strengthening exercise – range of joint motion

What do "rehabilitation" and "physical medicine" mean?

Traditionally, the central concern of rehabilitation has been the restoration of function so that persons can perform to their fullest physical, emotional, social, and vocational potential. From another perspective, rehabilitation involves behavioral changes and emphasizes coping with a physical impairment caused by disease or injury and learning to adapt in one's own environment.

The terms "rehabilitation" and "physical medicine" are often used synonymously. In fact, they share much in common but are not identical. Physical medicine traditionally has been concerned with the diagnosis and treatment of physical disorders, with special emphasis on the use of neurodiagnostic techniques such as electromyography and the therapeutic application of physical agents such as heat, cold, water, and electricity. Rehabilitation, a broader term, has been associated more with the diagnosis and treatment of functional disorders, with emphasis on the practical, functional assessment of motor, sensory, and cognitive skills and treatment aimed at enhancing function and altering behavior.