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

Abstract

Night wrist splinting has been a conservative treatment for carpal tunnel syndrome. The addition of extracorporeal shock wave therapy provides an alternative treatment. However, strong evidence on the clinical effectiveness of extracorporeal shock wave therapy for carpal tunnel syndrome is still lacking. This study aimed to investigate the effectiveness and safety of extracorporeal shock wave therapy compared with treatments of night wrist splints alone for patients with carpal tunnel syndrome. In this systematic review and meta-analysis, no limitation criteria were used for study selection. All available articles that compare the effectiveness between extracorporeal shock wave therapy combined with night wrist splint and night wrist splint alone for treating carpal tunnel syndrome published up to 20 January 2022 were identified from the databases of PubMed, Embase, and Cochrane Central Register of Controlled Trials Central. The primary outcomes were a standard mean difference with a 95% confidence interval on the improvement of symptom severity and functional impairment between the two groups. In an attempt to analyze trends over time in studies that report repeated measurements, an all time-points meta-analysis (ATM) was undertaken. Seven randomized controlled trials with a total of 376 participants were included in this study. Significant improvements in functional impairment and symptom remission were only observed in the extracorporeal shock wave group at four weeks post-treatment. Extracorporeal shock wave therapy did not demonstrate superior efficacy compared to treatment with night wrist splint alone at 8–10 and 12–14 weeks post-treatment, or through the ATM approach. In conclusion, the therapeutic effect of extracorporeal shock wave therapy is transient and mostly nonsignificant compared with using night wrist splint alone. No serious side effects were reported in all included studies. Other conservative treatments to ameliorate carpal tunnel syndrome symptoms are warranted.

Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review

“…Both interventions were reported to have similar effects in terms of improving pain, function and electrophysiological nerve parameters [91]. Another meta-analysis of seven clinical trials (376 patients) reported that adding shock wave therapy to a conservative treatment intervention such as a nocturnal wrist splint produced a transient improvement in pain and functional benefit for only four weeks [92].…”

Short‐term effectiveness of kinesio taping as therapeutic tool in conservative treatment of carpal tunnel syndrome: A systematic review and meta‐analysis

“…Therefore, kinesio taping appears to be a valid and recommended intervention complementary to other therapies to obtain greater effectiveness rather than a stand‐alone therapy in patients with CTS. Some of these conventional therapies comprise neurodynamic techniques for decreasing pain and functionality (de Arenas‐Arroyo et al., 2021), shock waves for functionality (with contradictory outcomes for pain at present) (Chen et al., 2022; Xie et al., 2020), the use of splints to improve functionality, severity, and the neurophysiological aspects studied in this pathology (Karjalainen et al., 2023). Therefore, the combination of techniques within a conventional treatment plan appears to be a valid approach to address all the clinical signs of this pathology whose beneficial effects have been shown to be only slightly inferior to those of surgical treatment (Shi et al., 2020).…”

“…Therefore, kinesio taping appears to be a valid and recommended intervention complementary to other therapies to obtain greater effectiveness rather than a stand-alone therapy in patients with CTS. Some of these conventional therapies comprise neurodynamic techniques for decreasing pain and functionality (de Arenas-Arroyo et al, 2021), shock waves for functionality (with contradictory outcomes for pain at present) (Chen et al, 2022;Xie et al, 2020), the use of splints to improve functionality, severity, and the neurophysiological aspects studied in this pathology (Karjalainen et al, 2023).…”

“…Among the options for treating this syndrome, conservative treatment is recommended for mild and moderate cases while surgery is the main choice for severe cases (Huisstede et al., 2014) of patients presenting reduced fine motor coordination, clumsiness, thenar atrophy, and severe sensitivity loss (Genova et al., 2020). The most used techniques among conservative treatments are manual therapy (weak evidence) (Erickson et al., 2019; Gräf et al., 2022; Hernández‐Secorún et al., 2021), neurodynamic techinques (de Arenas‐Arroyo et al., 2021), electrotherapy (Hernández‐Secorún et al., 2021), and pharmacological treatment (de Pablo & Katz, 2003; Hernández‐Secorún et al., 2021), which can be complemented with other interventions such as shock waves (Chen et al., 2022; Huisstede et al., 2018; Karjalanen et al., 2022; Xie et al., 2020), myofascial massage to active myofascial points (Huisstede et al., 2018), splints (Huisstede et al., 2018; Karjalanen et al., 2022), ultrasound (Huisstede et al., 2018; Karjalanen et al., 2022), microwaves (Huisstede et al., 2018), or pulsed radiofrequency (Huisstede et al., 2018), obtaining superior results with the joint application of these techniques (Talebi et al., 2018).…”

Synergistic effect of LCI with ESWT on treating patients with mild to moderate CTS: a randomized controlled trial

“…There is a lack in the literature of follow-up after ESWT treatments over the 6-month time [ 25 , 25 ]. In a recent systematic review and meta-analysis on ESWT [ 26 , 26 ] in carpal tunnel syndrome, on 376 patients, ESWT did not show superior efficacy compared to treatment with night wrist splint alone at 2 and 3 months follow-up. The effect of LCI in treating mild to moderate carpal tunnel syndrome is evident.…”