Efficacy of Laser Therapy in the Treatment of Shoulder Impingement Syndrome: A Systematic Review and Meta-Analysis

Abstract

Background Laser therapy is used as a noninvasive treatment for musculoskeletal diseases, including shoulder pain, but its efficacy in shoulder impingement syndrome remains controversial. This study aimed to systematically evaluate the efficacy and safety of laser therapy in shoulder impingement syndrome.

Methods The PubMed, Embase, and Cochrane Library databases were searched from its establishment to June 2021. Randomized controlled trials (RCTs) in shoulder impingement syndrome were included. The primary outcome was pain, and the secondary outcomes were function and range of motion. Meta-analysis was performed with RevMan 5.3.

Results A total of 12 RCTs and 669 participants were included. The results showed that laser therapy exhibited significant efficacy in shoulder impingement syndrome, especially in terms of pain release (MD=1.26, 95% CI=0.55–1.97, P=0.0005) and range of motion (MD=4.27, 95% CI=1.93–6.61, P=0.0003). However, the effect of shoulder function was uncertain (SMD=0.43, 95% CI=0–0.85, P=0.05). The subgroup analysis of pain showed that the efficacy of the laser therapy was related to the wavelength of the laser and the number of combined treatments. No adverse events were reported in the included trials.

Conclusions Laser therapy can significantly relieve pain in shoulder impingement syndrome and has no adverse reactions.

Zusammenfassung

Hintergrund und Ziel Die Lasertherapie wird als nicht invasives Verfahren zur Behandlung von Erkrankungen des Bewegungsapparats, u. a. auch Schulterschmerzen, eingesetzt. Allerdings ist die Wirksamkeit der Lastertherapie beim Schulter-Impingement-Syndrom weiterhin umstritten. Ziel der vorliegenden Studie war es, die Wirksamkeit und Sicherheit der Lasertherapie beim Schulter-Impingement-Syndrom systematisch zu prüfen.

Methodik Es erfolgte eine Literaturrecherche in den Datenbanken PubMed, Embase und Cochrane Library von deren Entstehung bis Juni 2021. Randomisierte kontrollierte Studien (RCT) zum Schulter-Impingement-Syndrom wurden in die Übersichtsarbeit eingeschlossen. Der primäre Endpunkt war Schmerz, die sekundären Endpunkte waren Funktion und Bewegungsumfang. Die Metaanalyse wurde mit RevMan 5.3. durchgeführt.

Ergebnisse Insgesamt wurden 12 RCT mit 669 Teilnehmern berücksichtigt. Die Ergebnisse zeigten, dass die Lasertherapie beim Schulter-Impingement-Syndrom signifikant wirksam war, insbesondere im Hinblick auf Schmerzerleichterung (MD=1,26, 95-%-KI=0,55–1.97, P=0.0005) und Bewegungsumfang (MD=4,27, 95-%-KI=1,93–6,61, P=0,0003). Allerdings war eine Wirkung auf die Schulterfunktion nicht eindeutig nachweisbar (SMD=0,43, 95-%-KI=0–0,85, P=0,05). In der Subgruppenanalyse zu Schmerz fand sich ein Zusammenhang zwischen der Wirksamkeit der Lasertherapie und der Wellenlänge sowie der Anzahl der zusammengefassten Behandlungen. In den einbezogenen Studien wurden keine unerwünschten Ereignisse berichtet.

Schlussfolgerung Die Lasertherapie kann Schmerzen in der Schulter signifikant reduzieren.

Key words

Laser therapy - Shoulder impingement syndrome - Systematic review - Meta-analysis

Schlüsselwörter

Lasertherapie - Impingement-Syndrom der Schulter - Schulterenge - systematisches Review - Metaanalyse

Publikationsverlauf

Eingereicht: 16. Dezember 2021

Angenommen: 26. April 2022

Artikel online veröffentlicht:
07. Juni 2022

• References

• 1 Juel NG, Natvig B. Shoulder diagnoses in secondary care, a one year cohort. BMC Musculoskelet Disord 2014; 15: 89
• 2 Garving C, Jakob S, Bauer I. et al. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int 2017; 114: 765-776
• 3 Koester MC, George MS, Kuhn JE. Shoulder impingement syndrome. American journal of Medicine 2005; 118: 452-455
• 4 Diercks R, Bron C, Dorrestijn O. et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop 2014; 85: 314-322
• 5 Song HJ, Seo HJ, Lee Y. et al. Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97: e13126
• 6 Boudreault J, Desmeules F, Roy JS. et al. The Efficacy of Laser Therapy for Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis. J Nov Physiother Phys Rehabil 2016; 3: 001-015
• 7 Haslerud S, Magnussen LH, Joensen J. et al. The efficacy of low-level laser therapy for shoulder tendinopathy: a systematic review and meta-analysis of randomized controlled trials. Physiother Res Int 2015; 20: 108-125
• 8 Pieters L, Lewis J, Kuppens K. et al. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther 2020; 50: 131-141
• 9 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
• 10 Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration. 2013
• 11 Dogan SK, Ay S, Evcik D. The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double-blind prospective study. Clinics (Sao Paulo) 2010; 65: 1019-1022
• 12 Yeldan I, Cetin E, Ozdincler AR. The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome. Disabil Rehabil 2009; 31: 935-940
• 13 Abrisham SM, Kermani-Alghoraishi M, Ghahramani R. et al. Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial. Clin Rheumatol 2011; 30: 1341-1346
• 14 Aceituno-Gómez J, Avendaño-Coy J, Gómez-Soriano J. et al. Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial. Clin Rehabil 2019; 33: 894-903
• 15 Alfredo PP, Bjordal JM, Junior WS. et al. Efficacy of low-level laser therapy combined with exercise for subacromial impingement syndrome: A randomised controlled trial. Clin Rehabil 2021; 35: 851-860
• 16 Bal A, Eksioglu E, Gurcay E. et al. Low-level laser therapy in subacromial impingement syndrome. Photomed Laser Surg 2009; 27: 31-36
• 17 Calis HT, Berberoglu N, Calis M. Are ultrasound, laser and exercise superior to each other in the treatment of subacromial impingement syndrome? A randomized clinical trial. Eur J Phys Rehabil Med 2011; 47: 375-380
• 18 Eslamian F, Shakouri SK, Ghojazadeh M. et al. Effects of low-level laser therapy in combination with physiotherapy in the management of rotator cuff tendinitis. Lasers Med Sci 2012; 27: 951-958
• 19 Kelle B, Kozanoglu E. Low-level laser and local corticosteroid injection in the treatment of subacromial impingement syndrome: a controlled clinical trial. Clin Rehabil 2014; 28: 762-771
• 20 Kibar S, Konak HE, Evcik D. et al. Laser Acupuncture Treatment Improves Pain and Functional Status in Patients with Subacromial Impingement Syndrome: A Randomized, Double-Blind, Sham-Controlled Study. Pain Med 2017; 18: 980-987
• 21 Pekyavas NO, Baltaci G. Short-term effects of high-intensity laser therapy, manual therapy, and Kinesio taping in patients with subacromial impingement syndrome. Lasers Med Sci 2016; 31: 1133-1141
• 22 Yılmaz M, Eroglu S, Dundar U. et al. The effectiveness of high-intensity laser therapy on pain, range of motion, functional capacity, quality of life, and muscle strength in subacromial impingement syndrome: a 3-month follow-up, double-blinded, randomized, placebo-controlled trial. Lasers Med Sci. 2021
• 23 Dundar U, Turkmen U, Toktas H. et al. Effectiveness of high-intensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study. Lasers Med Sci 2015; 30: 1097-1107
• 24 Kheshie AR, Alayat MS, Ali MM. High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci 2014; 29: 1371-1376
• 25 Chen AT, Shrestha S, Collins JE. et al. Estimating contextual effect in nonpharmacological therapies for pain in knee osteoarthritis: a systematic analytic review. Osteoarthritis Cartilage 2020; 28: 1154-1169
• 26 Bjordal MagnusJ. Low level laser therapy (LLLT) and World Association for Laser Therapy (WALT) dosage recommendations. Photomedicine & Laser Surgery 2012; 30: 61
• 27 Tumilty S, Munn J, McDonough S. et al. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg 2010; 28: 3-16
• 28 Tashjian RZ, Deloach J, Porucznik CA. et al. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg 2009; 18: 927-932
• 29 Walach H. The efficacy paradox in randomized controlled trials of CAM and elsewhere: beware of the placebo trap. J Altern Complement Med 2001; 7: 213-218
• 30 Hafliðadóttir SH, Juhl CB, Nielsen SM. et al. Placebo response and effect in randomized clinical trials: meta-research with focus on contextual effects. Trials 2021; 22: 493
• 31 Gutiérrez-Espinoza H, Araya-Quintanilla F, Cereceda-Muriel C. et al. Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: A systematic review and meta-analysis. Phys Ther Sport 2020; 41: 34-42
• 32 Steuri R, Sattelmayer M, Elsig S. et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med 2017; 51: 1340-1347
• 33 Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician 2004; 7: 395-399
• 34 Malanga GA. et al. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. POSTGRADUATE MEDICINE 2015; 127: 57-65
• 35 White PF, Elvir-Lazo OL, Hernandez H. A novel treatment for chronic opioid use after surgery. J Clin Anesth 2017; 40: 51-53