Extracorporeal shock wave therapy versus local corticosteroid injection for the treatment of carpal tunnel syndrome: a meta-analysis

Abstract

Background Many studies have demonstrated the effectiveness of extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) for the treatment of carpal tunnel syndrome (CTS), and some studies showed that the effect of ESWT was superior to LCI. We performed this meta-analysis to compare the clinical effects across the two therapies. Methods Relevant randomized controlled trials (RCTs) comparing ESWT and LCI for the treatment of CTS were searched in electronic database. The Cochrane risk bias tool was used for quality assessment. After data extraction and quality assessment of the included studies, a meta-analysis was performed using RevMan 5.3 software. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were analyzed. The protocol for this systematic review was registered on INPLASY (202080025) and is available in full on the inplasy.com (10.37766/inplasy2020.8.0025) Results A total of 5 RCT studies with 204 patients were included from the electronic database. The meta-analysis results showed that two therapies were not significantly different in terms of visual analog scale (VAS) score (P = 0.65), Boston Carpal Tunnel Questionnaire (BQ) score (P = 0.14), sensory distal latency (P = 0.66), and nerve conduction velocity (NCV) of the sensory nerve (P = 0.06). There were significant differences between the results of motor distal latency (P < 0.0001), compound muscle action potential (CMAP) amplitude (P < 0.00001), and sensory nerve action potential (SNAP) amplitude (P = 0.004). Conclusions In terms of pain relief and function improvement, the effects of ESWT and LCI are not significantly different. In terms of electrophysiological parameters, LCI has a stronger effect on shortening motor distal latency; ESWT is superior to LCI in improving action potential amplitude. ESWT is a noninvasive treatment with fewer complications and greater patient safety. In light of the heterogeneity and limitations, these conclusions require further research for definitive conclusions to be drawn.

ESWT Diminishes Axonal Regeneration following Repair of the Rat Median Nerve with Muscle-In-Vein Conduits but Not after Autologous Nerve Grafting

“…This study’s main hypothesis was that regeneration of the murine median nerve following reconstruction with ANGs, i.e., the gold-standard method, or with MVCs, i.e., nonneural tissue, can be enhanced by a single postoperative application of low-energy defocused ESWT. The pro-regenerative effects of ESWT have been shown in the context of various musculoskeletal and neurological diseases, including carpal tunnel syndrome [ 50 , 51 , 52 , 53 ], spinal cord injury [ 54 , 55 , 56 , 57 , 58 ] and PNI in vivo [ 17 , 19 , 20 , 27 , 58 , 59 , 60 ]. Of note, to the best of our knowledge, all the PNI studies were performed in the sciatic nerve model of the rat, and four of the seven studies we retrieved featured a sciatic crush injury [ 19 , 58 , 59 , 60 ], e.g., axonotmesis.…”

A Prospective Cohort Study: Platelet-Rich Plasma Combined with Carpal Tunnel Release Treating Carpal Tunnel Syndrome short (running) title: PRP-CTR Treating Carpal Tunnel Syndrome

“…Carpal tunnel syndrome (CTS) constitutes the commonest compressive neuropathy of the upper limbs, usually via the abnormal exor retinaculum thickening 1,2 . Pain, numbness, and muscle weakness caused by CTS seriously affect patients' function and quality of life 3 . Although splinting and corticosteroid injections were proven effective, strong evidence supported that the carpal tunnel release (CTR) decompresses the median nerve by dividing the transverse carpal ligament and should have a better treatment advantage at 6 and 12 months, especially in patients with moderate or severe symptoms [3][4][5] .…”

A prospective cohort study: platelet-rich plasma combined with carpal tunnel release treating carpal tunnel syndrome

“…Carpal tunnel syndrome (CTS) constitutes the most joint compressive neuropathy of the upper limbs, usually via the abnormal flexor retinaculum thickening [ 1 ]. Pain, numbness, and muscle weakness caused by CTS seriously affect patients’ function and quality of life [ 2 ].…”

“…Consequently, this must be included in CTS pathogenesis [ 3 , 4 ]. Although splinting and corticosteroid injections were proven adequate, strong evidence supported that the carpal tunnel release (CTR) decompresses the median nerve by dividing the transverse carpal ligament and should have a better treatment advantage at 6 and 12 months, especially in patients with moderate or severe symptoms [ 2 , 5 , 6 ].…”