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)