Description
Low-level laser therapy has been proposed as a treatment of carpal tunnel syndrome and other painful musculoskeletal disorders such as temporomandibular joint disfunction and low back pain.
Carpal tunnel syndrome is the most common entrapment neuropathy and the most commonly performed surgery of the hand. The syndrome is related to the bony anatomy of the wrist. The carpal tunnel is bound dorsally and laterally by the carpal bones and ventrally by the transverse carpal ligament. Through this contained space run the nine-flexor tendons and the median nerve. Therefore any space-occupying lesions can compress the median nerve and produce the typical symptoms of carpal tunnel syndrome: pain, numbness, and tingling in the distribution of the median nerve. Symptoms of more severe cases include hypesthesia, clumsiness, loss of dexterity, and weakness of pinch. In the most severe cases, patients experience marked sensory loss and significant functional impairment with thenar atrophy.
A variety of etiologies have been associated with the carpal tunnel syndrome. Nonspecific flexor tenosynovitis is the most common cause and is in turn typically associated with occupationally associated repetitive motion. A variety of space-occupying lesions can compress the median nerve, including benign tumors, or anatomic anomalies. Pregnancy has been associated with carpal tunnel syndrome, presumably as a result of hormone-mediated edema. Carpal tunnel syndrome can also be one of the clinical manifestations of the following medical conditions: rheumatoid arthritis, diabetes, post-traumatic wrist deformities, polymyalgia rheumatica, mucopolysaccharidoses, amyloidosis, myxedema, or acromegaly.
Mild to moderate cases of carpal tunnel syndrome are usually first treated conservatively with splinting and cessation of aggravating activities. Other conservative therapies include oral steroids, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), and steroid injections into the carpal tunnel itself. Those patients who do not respond to conservative therapy or who present with severe carpal tunnel syndrome with thenar atrophy may be considered candidates for surgical release of the carpal ligament, using either an open or endoscopic approach.
There has been interest in using low-level, non-thermal lasers as a conservative alternative. Low-level lasers refer to the use of red-beam or near-infrared lasers with a wavelength between 600 and 1000 nm and Watts from 5-500 milliwatts. (In contrast, lasers used in surgery typically use 300 Watts.) When applied to the skin, these lasers produce no sensation and do not burn the skin. Because of the low absorption by human skin, it is hypothesized that the laser light can penetrate deeply into the tissues where it has a photobiostimulative effect. The exact mechanism of its effect on carpal tunnel is unknown: hypotheses have included improved cellular repair and stimulation of the immune, lymphatic, and vascular systems.
One low-level laser device, the MicroLight 830 Laser, has received clearance for marketing from the U.S. Food and Drug Administration (FDA) specifically for the treatment of carpal tunnel syndrome. In the data submitted to the FDA as part of the FDA 510(k) approval process, the treatment consisted of application of the laser over the carpal tunnel three times a week for five weeks. The labeling states that the "MicroLight 830 Laser is indicated for adjunctive use in the temporary relief of hand and wrist pain associated with carpal tunnel syndrome." Other protocols have used low-level laser energy applied to acupuncture points on the fingers and hand. This technique may be referred to as "laser acupuncture."
Policy
Low-level laser treatment is considered experimental/investigational for all indications, including but not limited to carpal tunnel syndrome and other pain disorders, edema, and to enhance wound healing due to the lack of sufficient studies and published scientific literature.
CPT/HCPCS Code
97039
S8948Published in the March 1, 2004 Blue Shield Report. January 12, 2007 added HCPCS code S8948 as recommended by the Medical Director.
(Web updated 3/2007)
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