The Effectiveness of Extracorporeal Shock Wave Therapy vs. Local Steroid Injection for Management of Carpal Tunnel Syndrome

Seok, Hyun; Kim, Sang Hyun

doi:10.1097/phm.0b013e31826edc7b

Cited by 49 publications

(80 citation statements)

References 6 publications

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“…A few studies have tried to apply ESWT as an alternative management for treating peripheral neuropathy, for example interdigital neuroma28, stump neuroma29, distal symmetric polyneuropathy30, and CTS131415, with inspiring results. In 2013, Seok et al 13. first reported that one-session fESWT could be as useful as corticosteroid injection for relieving symptoms of CTS (n = 15 vs. n = 16 respectively), and that the effect could persist for at least 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…This might explain why we did not observe a noteworthy benefit after single-session rESWT compared with sham rESWT, although much greater improvements in BCTQ, most SNCV and CSA were observed. Most previous studies applied 3 sessions of ESWT in treating CTS except the study by Seok et al 13,. which used single-session fESWT.…”

Section: Discussionmentioning

confidence: 99%

“…The ESWT would stimulate the production of endothelial nitric oxides (NO), angiogenesis, and neurogenesis through vascular endothelial growth factor (VEGF)3839404142. Moreover, ESWT might reduce calcitonin gene–related peptide (CGRP) with accompanying anti-inflammatory effects in the median nerve and its surrounding soft tissue111343. Moreover, the temporarily reduced SNCV soon after rESWT in both groups A and B compared with group C may prove the hypothesis that rapid degeneration of intracutaneous nerve fibers might result in pain relief after ESWT34.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, both fESWT and rESWT have received increased attention as being a safe and novel therapy for CTS11131415. In 2015, we reported the first prospective, randomized, double-blind, placebo-controlled study, and revealed the effective benefit of rESWT for treating CTS after 3 months follow-up11.…”

mentioning

confidence: 99%

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The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial

Chou

et al. 2016

Sci Rep

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Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial

Chou

et al. 2016

Sci Rep

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“…In two case reports on patients treated with SW for CTS, the authors found a clinical and electromyographic improvement. 5 A clinical trial on 36 patients affected with CTS 6 verified that ESWT can be as useful as a CS injection for relieving symptoms of CTS. Furthermore, in contrast to the CS injection, it has the merit of being non-invasive.…”

Section: Introductionmentioning

confidence: 99%

Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome

Notarnicola

Maccagnano

Tafuri

et al. 2015

Int J Immunopathol Pharmacol

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Even though the initial treatment of carpal tunnel syndrome (CTS) is conservative, knowledge of the clinical effects of supplements and of some methods of physiotherapy is still preliminary. Many biological mechanisms can support the administration of shock wave therapy (ESWT) or of alpha lipoic acid (ALA) based nutraceutical, conjugated linoleic acid (GLA), anti-oxidants and Echinacea angustifolia for CTS. The shock waves reduce the nerve compression, produce an anti-inflammatory action, and accelerate the regeneration of neuropathy. ALA and GLA induce antioxidant protective actions, reduce inflammation, promote neuroregeneration, and decrease pain. The Echinacea modulates the endogenous cannabinoid system.The aim of study is to verify the efficiency of shock wave therapy versus nutraceutical composed of ALA, GLA, and Echinacea in CTS. Sixty patients were enrolled in this study and they were randomly assigned to one of two treatments. Both groups showed significant improvements in pain, symptoms' severity and functional scores, and electrodiagnostic results until the sixth month. We verified a trend to a better pain regression in the nutraceutical group. The presence of the medicinal Echinacea represents an added value to the antioxidant effect in ALA and GLA, which can justify this result. ESWT or the association of ALA, GLA, and Echinacea proved to be two effective treatments for controlling symptoms and improving the evolution of CTS.

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Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double‐blind, placebo‐controlled trial

Chou

et al. 2015

Journal Orthopaedic Research

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Three recent studies demonstrated the positive effect of extracorporeal shock wave therapy (ESWT) for treating carpal tunnel syndrome (CTS). However, none have entirely proved the effects of ESWT on CTS because all studies had a small sample size and lacked a placebo-controlled design. Moreover, radial ESWT (rESWT) has not been used to treat CTS. We conducted a prospective randomized, controlled, double-blinded study to assess the effect of rESWT for treating CTS. Thirty-four enrolled patients (40 wrists) were randomized into intervention and control groups (20 wrists in each). Participants in the intervention group underwent three sessions of rESWT with nightly splinting, whereas those in the control group underwent sham rESWT with nightly splinting. The primary outcome was visual analog scale (VAS), whereas the secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. Evaluations were performed before treatment and at 1, 4, 8, and 12 weeks after the third rESWT session. A significantly greater improvement in the VAS, BCTQ scores, and CSA of the median nerve was noted in the intervention group throughout the study as compared to the control group (except for BCTQ severity at week 12 and CSA at weeks 1 and 4) (p < 0.05). This is the first study to assess rESWT in a randomized placebo-controlled trial and demonstrate that rESWT is a safe and effective method for relieving pain and disability in patients with CTS. Keywords: extracorporeal shock waves; carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy involving the compression of the median nerve in the carpal tunnel. The average prevalence of CTS in the entire population is 3-4%, and it is predominantly observed in females (7% female and 1% male). 1 CTS is characterized by numbness, tingling, pain, or a burning sensation of at least two of the three digits supplied by the median nerve, although thenar muscle atrophy can also occur in the later stages. 2The risk factors for CTS include repetitive wrist stress, obesity, and pregnancy, whereas secondary causes include lesions within the carpal tunnel, metabolic causes, and infection.2 Unlike other progressive diseases, CTS is characterized by remission and recurrence; hence, its prognosis is often uncertain. Although there are many conservative forms of management, such as wrist splint, steroid injections, and therapeutic ultrasound, their effectiveness is typically insignificant or short-lived.3 Moreover, Gerritsen et al. 4 revealed a failure rate of 69% for wrist splinting in patients with CTS after a 12-month follow-up period. Moreover, 60-70% of conservatively treated patients with CTS remained symptomatic after 18 months. Extracorporeal shock waves (ESWs) are defined as a sequence of acoustic pulses characterized by a high peak pressure (100 MPa), fast pressure increase (<10 ns), short duration (...

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The Effectiveness of Extracorporeal Shock Wave Therapy vs. Local Steroid Injection for Management of Carpal Tunnel Syndrome

Abstract: ESWT can be as useful as CS injection for relieving symptoms of carpal tunnel syndrome. Furthermore, in contrast to CS injection, it has the merit of being noninvasive.

Cited by 49 publications

References 6 publications

The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial

The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial

Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome

Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double‐blind, placebo‐controlled trial

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