Electrophysiological Effects of Adjunct Low-Level Laser Therapy and Median Nerve Mobilization After Carpal Tunnel Release (LL-CTR)

Electrophysiological Effects of Adjunct Low-Level Laser Therapy and Median Nerve Mobilization After Carpal Tunnel Release: A Randomized Controlled Study

This randomized controlled study investigated whether adding low-level laser therapy (LLLT) or median nerve mobilization after unilateral carpal tunnel release improves median nerve electrophysiological parameters compared with no adjunctive treatment. Forty-five patients were randomly assigned to receive LLLT, median nerve mobilization, or standard postoperative care. Interventions were delivered over six weeks, and nerve conduction studies were conducted before and after treatment to assess electrophysiological outcomes, with motor distal latency designated as the primary outcome measure.

Study Overview

• Status: Completed
• Conditions: Carpal Tunnel Syndrome (CTS)
• Intervention / Treatment: Other: Gallium Arsenide (GaAs) 904-nm Low-Level Laser Device; Other: Therapist-Supervised Median Nerve Neural Mobilization Exercises; Other: Standard Postoperative Care

Detailed Description

Carpal tunnel syndrome (CTS) is commonly managed surgically through carpal tunnel release (CTR); however, postoperative recovery may be accompanied by persistent neural dysfunction and delayed nerve conduction improvement. Adjunct rehabilitation strategies, such as low-level laser therapy (LLLT) and median nerve mobilization, have been proposed to enhance neural recovery, yet their electrophysiological effects following CTR remain insufficiently established.

This randomized controlled study aimed to examine and compare the effects of adjunct LLLT and median nerve mobilization on median nerve electrophysiological parameters after unilateral CTR. Forty-five patients diagnosed with unilateral CTS and treated surgically with CTR were recruited. Participants (aged 25-55 years) were randomly allocated into three equal groups. Group A received adjunct gallium arsenide (GaAs) infrared LLLT, Group B underwent median nerve mobilization exercises, and Group C received standard postoperative care without adjunctive therapy.

Both intervention protocols were applied three times per week for six consecutive weeks. Electrophysiological assessments were conducted at baseline (pre-intervention) and after six weeks using standardized nerve conduction studies. Measured parameters included motor distal latency (MDL), sensory distal latency (SDL), motor nerve conduction velocity (MCV), and compound motor action potential amplitude (CMAP), with MDL predefined as the primary outcome measure.

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Giza Governorate
    • Giza, Giza Governorate, Egypt, 00000
      • Faculty of Physical Therapy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Age between 25 and 55 years Clinical diagnosis of unilateral carpal tunnel syndrome Underwent surgical carpal tunnel release (transverse carpal ligament release)

Exclusion Criteria:

Rheumatoid arthritis Diabetes mellitus History of wrist fracture or other wrist joint trauma Current use of anti-inflammatory medications or other interfering medications Receipt of alternative treatments (e.g., acupuncture, physical therapy modalities) Use of wrist orthoses

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: LLLT (GaAs 904-nm Laser) Group; - Patients in group (A) had a regimen of infrared Gallium Arsenide low-level laser therapy (20 mW average power, 904 nm wavelength, laser probe diameter of 7 mm). The treatment was administered to the palmar region above the carpal tunnel and along the median nerve pathway, with a cumulative dosage of 4.8 J	Other: Gallium Arsenide (GaAs) 904-nm Low-Level Laser Device; Group A: GaAs diode laser, 904 nm, average power 20 mW, probe diameter 7 mm (spot size approximately 0.385 cm²), administered as 1.2 J per point at four standardized points (totaling 4.8 J per session); 60 seconds per point (totaling approximately 4 minutes per session). Over 18 sessions (3 per week for 6 weeks), the total energy administered per treatment cycle is 86.4 J. This methodology and point-based dosing method were chosen to align with prevalent CTS protocols utilizing identical device specifications and total-session dosage, while adhering to the required 904-nm dosing parameters
Experimental: Median Nerve Mobilization Group; Patients in the group (B) were instructed to do a series of movements that included the median nerve: lateral rotation of the shoulders, depression, wrist extension, supination, shoulder abduction, elbow extension, and bending the neck laterally to the other side.	Other: Therapist-Supervised Median Nerve Neural Mobilization Exercises; Patients in the group (B) were instructed to do a series of movements that included the median nerve: lateral rotation of the shoulders, depression, wrist extension, supination, shoulder abduction, elbow extension, and bending the neck laterally to the other side. They were directed to maintain the final posture for 20 seconds. Therapist-supervised median nerve mobilization was performed three sessions/week for 6 weeks; each session included three sets of 5 repetitions of the standardized sequence, with the end-position held for 20 seconds per repetition and ~10 seconds rest between repetitions (and ~60 seconds rest between sets). Total mobilization time was ~10-12 minutes per session, and all sessions were conducted under direct therapist supervision to ensure correct positioning and symptom monitoring
Experimental: Standard Care Control Group; Control group	Other: Standard Postoperative Care; Group C patients served as the comparison (control) group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Median Nerve Motor Distal Latency	Change in motor distal latency (milliseconds) of the median nerve from baseline (pre-treatment) to 6 weeks post-intervention, assessed using standardized nerve conduction testing (Neuropack) following American Association of Electrodiagnostic Medicine guidelines.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Median Nerve Sensory Distal Latency	Change in sensory distal latency (milliseconds) of the median nerve from baseline to 6 weeks post-intervention.	6 weeks
Change in Median Nerve Motor Conduction Velocity	Change in motor nerve conduction velocity (meters/second) of the median nerve from baseline to 6 weeks post-intervention.	6 weeks
Change in Compound Motor Action Potential Amplitude	Change in CMAP amplitude (millivolts) of the median nerve from baseline to 6 weeks post-intervention.	6 weeks

Collaborators and Investigators

• Sponsor: Galala University

Study record dates

Study Major Dates

• Study Start (Actual): January 4, 2023
• Primary Completion (Actual): January 19, 2024
• Study Completion (Actual): September 18, 2025

Study Registration Dates

• First Submitted: January 28, 2026
• First Submitted That Met QC Criteria: February 3, 2026
• First Posted (Actual): February 10, 2026

Study Record Updates

• Last Update Posted (Actual): February 10, 2026
• Last Update Submitted That Met QC Criteria: February 3, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Neuropathy; Low-level laser therapy; Carpal tunnel syndrome; Median nerve mobilization
• Additional Relevant MeSH Terms: Nervous System Diseases; Wounds and Injuries; Neuromuscular Diseases; Peripheral Nervous System Diseases; Median Neuropathy; Mononeuropathies; Nerve Compression Syndromes; Cumulative Trauma Disorders; Sprains and Strains; Carpal Tunnel Syndrome; gallium arsenide
• Other Study ID Numbers: Low-Level Laser Therapy -LLCTR; Galala University (Other Identifier: i am faculty of pharmacy galala university-This study was approved by the Ethical Committee of the Faculty of physical)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No