Shoulder:

Rotator Cuff (supraspinatus/infraspinatus)

Recommendation

Haslerud et al. (2015) performed a review of the randomized controlled trials of LLLT in shoulder tendonopathy. They found that significant and clinically important pain relief was found with LLLT when used as a stand alone treatment over placebo,  and when LLLT was used as adjunct to exercise therapy. Global improvements were statistically significant for laser alone or as an adjunctive in a physiotherapy regime. Secondary outcome measures of shoulder function were only significantly in favor of LLLT when used alone. They did find that trials performed with inadequate laser doses were ineffective across all outcome measures.

Desmeules et al.  (2015) set out to assess the literature on the efficacy of therapeutic ultrasound for rotator cuff tendinopathy. During the review they found that LLLT showed good evidence for pain relief. 

In a longer term follow up study (3 months and 6 months) Elsodany et al. (2018) found that pain was significantly decreased after treatment and at follow-up points, while ROM and shoulder functions were significantly improved after treatment and at follow-up intervals. The improvement was more significant in the treatment group than in the control group post treatment and at follow-up intervals using a pulsed Nd:YAG laser combined with an exercise program.

It would appear once again that the effectiveness of treatment is dose dependent.

Frozen shoulder:

In a review article in 2014 Page et al. found in adhesive capsulitis (frozen shoulder) low-level laser therapy (LLLT) was effective when compared to placebo.

Low quality evidence from one trial (40 participants) indicated that LLLT for six days may result in improvement at six days. Eighty per cent (16/20) of participants reported treatment success with LLLT compared with 10% (2/20) of participants receiving placebo. No participants in either group reported adverse events.

Moderate quality evidence from one trial (63 participants) indicated that LLLT plus exercise for eight weeks probably results in greater improvement when measured at the fourth week of treatment. The mean pain score at four weeks was 51 points with placebo plus exercise, while with LLLT plus exercise the mean pain score was 32 points on a 100 point scale (mean difference (MD) 19 points). The mean function impairment score was 48 points with placebo plus exercise, while with LLLT plus exercise the mean function impairment score was 36 points on a 100 point scale (MD 12 points). Mean active abduction was 70 degrees with placebo plus exercise, while with LLLT plus exercise mean active abduction was 79 degrees (MD 9 degrees). Once again no participants in either group reported adverse events.

LLLT’s benefits on function were maintained at four months.

The authors said that they were uncertain whether a diverse range of electrotherapy modalities (delivered alone or in combination with manual therapy, exercise, or other active interventions) were more or less effective than other active interventions (for example glucocorticoid injection).

They concluded that LLLT for six days may be more effective than placebo in terms of global treatment success at six days. LLLT plus exercise for eight weeks may be more effective than exercise alone in terms of pain up to four weeks, and function up to four months. 

In a later article Elhafez et al (2016) found laser when combined with ultrasound and home exercises improved shoulder function. They tested a conventional approach and using the electrotherapy from the axilla and found the axilla method more effective.

So it seems that ‘front loading’ the treatment may be effective in the short term, but treatment over 8 weeks with exercises may be more effective longer term, however, the improvements found were only ‘moderate’.

Sub acromial impingement or bursitis:

Laser has been used in the treatment of sub acromial bursitis for many years. Kelle and Kozanoglu (2014) compared low-level laser and local corticosteroid injection in the treatment of subacromial impingement syndrome. They found that:

“The effectiveness of low-level laser treatment was similar to that of local corticosteroid injection in patients with subacromial impingement syndrome. We concluded that both low-level laser treatment and corticosteroid injection were more effective than sham laser treatment.”

However, Aceituno-Gómez et al. (2019) found that high intensity laser did not produce positive results concluding:

“The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.”