Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that occurs as a result of median nerve compression at the wrist. Extracorporeal shock wave therapy (ESWT) is specified as a treatment with high amplitude acoustic waves that focus on a region of the body. While ESWT is frequently used to treat musculoskeletal disorders such as plantar fasciitis and tendinitis, in recent years ESWT has become a new treatment option in CTS. Positive results have been reported from limited number of studies which were assessed efficacy of ESWT in CTS treatment. On the other hand it is noteworthy that the number of patients in these studies is not high and there is no clear consensus on the concept of shock wave energy density and frequency due to lack of experience (1,2,3).
Objectives: To evaluate the efficacy of ESWT in CTS and compared to wrist splint treatment in this prospective, randomized double-blind, placebo-controlled trial.
Methods: One hundred eighty-nine patients with mild/moderate CTS were included. Patients were assigned to 4 different treatment groups (1-Splint, 2-Splint+ ESWT, 3-ESWT, 4-Splint+ placebo ESWT) by using stratified randomization to ensure balance of the treatment groups respect to the various combinations of the prognostic variables in terms of in terms of age, gender, and severity of CTS. 168 patients completed the study at third month. ESWT was performed on the area included 2 cm proximal to the pisiform bone. It was applied with 1000 shots, 0.05 mJ/mm2 intensity of energy and frequency of 5 Hz. (3 weeks, once a week). Wrist splint with suitable size and neutral position was suggested. Patients were evaluated at baseline, first and third month. Pain, finger pinch strength, Boston Carpal Tunnel Questionnaire (BCTQ), Leeds Neuropathic Symptom and Finding Assessment (LANSS) and electrophysiological examination were assessed.
Results: Demographics, clinical characteristics of the patients are shown in table 1. Significant pain and functionality improvement was found in all groups (p<0.05) at first and third months. The improvements in clinical and electrophysiological variables were compared between four groups In group 2, baseline- first month finger pinch increase was higher than groups 1 and 4, and the baseline- third month finger pinch increase was higher than group 4. In group 2, the increase in mMNCV was higher than group 1.
Conclusions: In the group with ESWT and using wrist splint together, it was found that the improvement of hand function and electrophysiological measures was higher than other groups. ESWT, a valuable and practical treatment modality without serious side effects, reduces pain, neuropathic symptoms, disability and improves electrophysiological findings for patients with mild to moderate CTS.
References 1. Seok H, Kim SH. The effectiveness of extracorporeal shock wave therapy vs. local steroid injection for management of carpal tunnel syndrome: a randomized controlled trial. Am J Phys Med Rehabil2013;92:327–34.
2. Vahdatpour B, Kiyani A, Dehghan F. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome. Adv Biomed Res. 2016;29:120.
3. Ke MJ, Chen LC, Chou YC, et al. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial. Sci Rep2016;6:38344.
Disclosure of Interest: None declared
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