Article

Clinical and Radiographic Alterations in Bilateral Avascular Necrosis of the Femoral Head Following Laser Acupuncture: A Case Report

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Abstract

Introduction: Avascular necrosis (AVN) of the femoral head is an increasingly common cause of musculoskeletal disability with unknown etiology. Traumatic and non-traumatic factors can be effective in its occurrence. About 50% of cases are bilateral. The underlying treatment is prosthetic replacement surgical procedure. Case Presentation: We report a case of bilateral AVN of femoral heads who was a candidate for prosthetic replacement surgery but improved significantly, using laser acupuncture. The patient was a 55-year-old woman with a diagnosis of bilateral osteonecrosis of the femoral head for five years. As the patient declined the surgical option, laser acupuncture was started for pain control. Regarding the signs of bilateral femoral head recovery (according to the MRI scan criteria), a total of 3 courses of laser acupuncture (each course was 20 sessions) with 2 months intervals was performed. Ten acupuncture points: Li4, Li11, St36, SP6, LIV3, GB4, GB5, GB6, GB13, GB14, GB20, GB30, GB31, GB34, were irradiated bilaterally using red 650 nm laser, 100 mW, 1505 Hz frequency, duty cycle 50 3 J/point and near infrared 810 nm laser, 100 mW, 1705 Hz frequency, duty cycle 50 3 J/point, for 2 minutes. The patient received 3 laser therapy courses. During the first-course, laser therapy was done every other day to reduce pain. For the second and third courses, according to pain decrease, therapy was done every week. Results: The results of the MRI scans and x-ray studies show progressive regeneration of the right femoral head from VI to B II and of the left from V to C II (based on the standard table of Pennsylvania). Conclusion: It seems that this procedure may be mentioned in future research projects, especially in cases with high risks of surgery.

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... [10] A variety of management options are available for the treatment of this condition. [11][12][13][14][15][16][17][18] These options include medications, surgical treatments, and other alternative interventions, such as Chinese herbal medicine, acupuncture, rest, extracorporeal shock wave therapy, and electrical stimulation. [11][12][13][14][15][16][17][18] However, these options still suffer from limited efficacy, and even very server adverse events (AEs) and complications. ...
... [11][12][13][14][15][16][17][18] These options include medications, surgical treatments, and other alternative interventions, such as Chinese herbal medicine, acupuncture, rest, extracorporeal shock wave therapy, and electrical stimulation. [11][12][13][14][15][16][17][18] However, these options still suffer from limited efficacy, and even very server adverse events (AEs) and complications. Thus, alternative candidates with few AEs are urgently needed to treat this condition. ...
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Our understanding of idiopathic necrosis of the femoral head depends upon two fundamental concepts. The fi rst is that a standard radiograph shows only the shadow of the mineralised portion of a bone. The radiographic appearance of living bone is the same as that of dead bone of Egyptian mummies or prehistoric skeletons. Consequently, bone necrosis has no specifi c radiographic appearance of living bone and a normal radiograph does not necessarily mean a normal hip. A standard radiograph cannot help with early diagnosis, and every case of bone necrosis must pass through a preradiological stage. When radiographic changes do appear, they are due to the reaction of living tissue to the ischaemia. The second fundamental concept is that bone necrosis is the end result of severe and prolonged ischaemia. This again presupposes an initial stage in which vascular and medullary abnormality passes undetected by routine radiography These concepts point to the need for other methods of investigation, especially in early cases. These methods include scintimetry and the study of the haemodynamics of the medullary circulation, termed the functional exploration of bone (FEB).
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Legg-Calve-Perthes disease (LCPD) is a rare temporary hip joint deformity mostly effecting young children from 4-10 years of age. It involves mainly the head of the femur, which softens and breaks down due to interruption of blood supply (avascular necrosis). We report a case of LCPD that was treated late and had a poor prognosis, but improved significantly during a prolonged course of acupuncture. A 12-year-old boy reported to an orthopaedic clinic in 2006 with limping and was diagnosed with LCPD. Surgeons applied orthosis without improvement and decided to perform surgery in 2008. However, the parents declined the surgical option and took the boy to an acupuncture clinic the same year. Needle acupuncture for 20 min and laser acupuncture locally on the hip joint area for 5 min were applied. After 30 sessions of acupuncture, the boy started to improve clinically. Imaging studies showed that new bone cells started to develop in the femoral head. After 130 sessions in 2010 the radiographic appearance showed almost 90% improvement, and after 196 sessions, in August 2012, he was fully recovered. Needle acupuncture treatment combined with laser acupuncture may be an option for the management of LCPD.
Article
Low level laser therapy (LLLT) is a promising tool for rheumatic diseases, and a systematic Cochrane review suggests that LLLT could be considered in rheumatoid arthritis management due to positive outcomes for pain and morning stiffness. The possible mechanisms behind LLLT are moving from myth to reality through an increasing number of controlled LLLT trials. A literature search revealed 82 laboratory trials and 11 randomized controlled clinical trials reporting about LLLT effects in inflammatory processes and impaired metabolism of ligament, tendons and muscle. 71 laboratory trials provided positive outcomes for one or more parameters, and 7 clinical trials yielded positive results for reduction PGE2 levels, reduction of edema inflammatory cell infiltration and reduction of ESR levels. In 4 head-to-head comparisons with non-steroidal anti-inflammatory drugs (NSAIDs), there were no significant difference between NSAIDs and LLLT. The observed LLLT effects occurred locally and distinct dose-response patterns and therapeutic windows were found for anti-inflammatory effects (1 to 12 Joules), fibroblast stimulation (0.2 to 4 Joules) and fibroblast inhibition (above 6 Joules). A possible systemic effect cannot be ruled out, but with the application techniques and doses used in the published material, the effect size seem small and of doubtful clinical value. Bearing in mind, that the laboratory trials were performed mainly in rats and mice, clinical use of LLLT should take into account energy loss if depth from skin surface is larger than 2-3 mm and that most of the pathological organ needs to be irradiated. Given the dual possibility of reducing inflammation alongside with the promotion of tissue repair and the superior safety of LLLT over NSAIDs, LLLT can be adopted in the clinical management of rheumatic diseases.
Article
Abstract Introduction Diabetic foot ulcers, being notoriously difficult to cure, are one of the most common health problems in diabetic patients. There are several surgical and medical options already introduced for treatment of diabetic foot ulcers. Low-level laser therapy (LLLT) has been suggested as a promising treatment option for open wounds. However, there is very little work on the efficacy of low-level laser therapy for this type of open wounds. We report herein seven cases of grades II and III diabetic foot ulcer completely treated with LLLT. Materials and methods Seven Type 2 diabetic patients (four males: mean age, 63 years; three females: mean age, 61.14 years) with grades II and III diabetic foot ulcers were treated with low-level laser therapy. The mean duration of diabetes was 10.5 years and the ulcers were present from average 6.5 months ago. The mean value for glycosylated hemoglobin (HbA1C) also was 8.14mg/dl (range: 6–12.2) and foot blood flow in Doppler ultra-sonography were normal. We used low-level laser therapy through local irradiation of the ulcer bed with red light (660nm; power: 25MW; 0.6–1J/cm2) and ulcer margins with infrared laser (980nm; power: 200MW; 4–6J/cm2), along with intravenous laser irradiation with red light laser (650nm; power: 1.5MW) for 15–20min, in addition to laser acupuncture with infrared laser (1J/cm2) for LI-11, LI-6, SP-6, PC-6, ST-36 and GB-34 points. Sessions were every other day for 10–15 sessions (Route 1) and then continuing the course twice weekly (Route 2) until complete recovery was achieved. Results After approximately 19 sessions (mean Route 1 sessions ≈15; mean Route 2 sessions ≈10), complete recovery was achieved in all cases and there was no relapse or other problem with ulcers after approximately 6 months (range: 2–10 months) of follow-up. With this treatment regimen, there were no side-effects reported by the patients. Conclusion Low-level laser therapy could be a safe and effective method for treatment of diabetic foot ulcers. Clinical trials with higher sample size are proposed to more evaluate the efficacy of low-level laser therapy in treatment of this type of wounds.
Article
Forty-nine patients suffering from lateral humeral epicondylalgia were enrolled in a double-blind study to observe the effects of Ga-As laser applied to acupuncture points. The Mid 1500 IRRADIA laser machine was used, wavelength: 904 nm, mean power output: 12 mW, peak value: 8.3 W; frequency: 70 Hz (pulse train). Localization of points: LI 10, 11, 12, Lu 5 and SJ 5. Each point was treated for 30 sec resulting in a dose of treatment of 0.36 J/point. The patients were treated 2-3 times weekly with 10 treatments in all. Follow-ups were done after 3 months and 1 year. No significant differences were observed between the laser and the placebo group in relation to the subjective or objective outcome after 10 treatments or at the follow-ups.
Article
Thirty people with classical or definite rheumatoid arthritis received laser exposure to a Q-switch neodymium laser that operated at 1.06 micrometer with an output of 15 joules/cm2 for 30 nsec. One hand was lased at the proximal interphalangeal (PIP) and metacarpal phalangeal (MCP) joints, whereas the other hand was sham lased. The patient, physician, and occupational therapy evaluators did not know which hand was being lased. Twenty-one patients noted improvement of both their MCP and PIP joints of both hands during laser therapy. Twenty-seven noted improvement of their PIP joints and 26 noted improvement of the MCP joints during therapy. Heat, erythema, pain, swelling, and tenderness all improved with time in both hands, but the lased hand had more significant improvement in erythema and pain. There was also significant improvement in grasp and tip pressure on the lased side. The level of circulating immune complexes as measured by platelet aggregation decreased during lasing. The improvement may be related to laser exposure. The exact role that laser radiation has upon rheumatoid arthritis and its mechanism of action remain to be elucidated.
Article
Low-intensity laser radiation is characterized by its ability to induce athermic, nondestructive photobiological processes. Although it has been in use for more than 30 years, this phototherapy is still not an established therapeutic modality. We have summarized the main arguments being brought up against the use of this therapy and have reviewed the literature addressing both its in vitro and in vivo effects. We conclude that low-intensity laser irradiations might be of benefit in selected indications if the existing preliminary data can be confirmed by more prospective and well-controlled studies.
Effects of Low-Level Laser Therapy, 660 nm
  • B F Araujo
  • L I Silva
  • A Meireles
Araujo BF, Silva LI, Meireles A, et al. Effects of Low-Level Laser Therapy, 660 nm, in Experimental Septic Arthritis. ISRN Rheumatol. 2013;2013:341832. doi:10.1155/2013/341832