Extracorporeal shock wave therapy as a conservative treatment option for carpal tunnel syndrome: A double-blind, prospective, randomized, placebo-controlled study

Abstract

Objectives This study aims to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in carpal tunnel syndrome (CTS) compared to the wrist splint treatment. Patients and methods Between April 2016 and March 2017, a total of 189 patients (22 males, 167 females, mean age 48.8±9.5 years, range, 24 to 70 years) with mild-to-moderate CTS were included in this double-blind, prospective, randomized, placebo-controlled study. The patients were divided into four treatment groups using stratified randomization: splint group (Group 1, n=47), splint+ESWT (Group 2, n=47), ESWT (Group 3, n=45), and splint+placebo ESWT (Group 4, n=50). All patients were evaluated at baseline, and one and three months. Pain using the Visual Analog Scale (VAS), finger pinch strength, Boston Carpal Tunnel Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and electrophysiological examination were assessed. Results A total of 168 patients completed the study. There was no significant difference among the four groups in terms of age, sex, comorbid diseases, symptom duration, VAS-pain, BCTQ, and LANSS scores (p>0.05). Pain and functionality significantly improved in all groups (p<0.05). In the group with ESWT and using wrist splint combined, a greater improvement of the hand function and electrophysiological measures was observed. Conclusion Our study results show that ESWT is a valuable and reliable treatment modality for mild-to-moderate CTS.

Extracorporeal Shock Wave Therapy Provides Limited Therapeutic Effects on Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

“…These seven trials were published between 2016 and 2020 and their sample sizes ranged from 20 to 97 patients. The vast majority of the baseline characteristics in each of the seven studies were balanced [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…Six out of seven studies provided datasets of the BCTQf at baseline and at 3–4, 8–10, and 12–14 weeks of follow-up between ESWT/night wrist splint group and night wrist splint alone group [ 15 , 16 , 18 , 19 , 20 , 22 ]. One study used Quick DASH [ 17 ].…”

Comparison of the Therapeutic Efficacy of Extracorporeal Shock Wave Therapy Versus Corticosteroid Iontophoresis in Carpal Tunnel Syndrome: A Prospective Randomized Study

“…There is currently no defined standard treatment protocol for the application frequency, the energy intensity and total shots for the use of ESWT in CTS. 15 Reported pulse repetition frequency varies between 3 Hz and 5 Hz, and practice with 5 Hz is more common. 9,15,16 Studies have demonstrated the intensity of energy and total shots in a range of 0.03 mJ/mm 2 to 0.15 mJ/mm 2 and 800 to 2,500 shots, respectively.…”

“…15 Reported pulse repetition frequency varies between 3 Hz and 5 Hz, and practice with 5 Hz is more common. 9,15,16 Studies have demonstrated the intensity of energy and total shots in a range of 0.03 mJ/mm 2 to 0.15 mJ/mm 2 and 800 to 2,500 shots, respectively. In the aforementioned studies, the ESWT group benefited clinically from all applications.…”

“…The treated area ranged from the pisiform level to 2 cm proximal to the median nerve, and from the scaphoid level to 2 cm proximal to the median nerve. 15 The patients received shockwaves of continuous frequency and intensity (1,000 shock waves, at an intensity of 1.5 bar and 5 Hz frequency) for three sessions at 1-week intervals. ESWT was applied using a 15 mm head by passing the probe.…”