Comparison of the effects of reswt with different pulses on pain, functionality, electrophysiological and ultrasonographic findings in patients with carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper limb. CTS is described by pain, numbness and tingling in the innervation site of the median nerve in the hand. Extracorporeal Shock Wave Therapy (ESWT), which has been started to treat muscle cell system diseases in recent years, has been developed as a new conventional treatment method in CTS. ESWT is a modality that acts by focusing the treatment of intense high sound waves. In the literature, studies investigating the effect of ESWT on CTS have applied different pulse numbers. In most of these research, it has been pointed that ESWT reduces the symptoms of CTS. However, there is no consensus on which pulse is more effective. Therefore, in order to investigate which pulse is more effective, the effects of low (1000 pulses) and high (2000 pulses) pulse values on CTS were compared. A total of 129 patients were examined to be included in the study. 31 patients who didn't have the inclusion criteria of the study were excluded. The patients were randomly distributed into three groups using the closed envelope method. Then patients were randomized into 3 groups. Group 1 received night splint tendon gliding exercises and 1000 pulses of rESWT (5Hz, 4 Bar), Group 2 received night splint tendon gliding exercises and 2000 pulses of rESWT (5Hz, 4 Bar), and Group 3 received only night splint tendon gliding exercises. Assessments were repeated before treatment (week 0), after treatment (week 4), and at week 12. Primary outcome measures were VAS and electrophysiological examinations, and Boston carpal tunnel questionnaire, median nerve ultrasonographic examination, and hand grip strength. As a result of our study, Group 1 and Group 2, who underwent rESWT, were found to be more effective in reducing CTS symptoms compared to Group 3, which received only splinting and exercises. Particularly, in the 2000-pulses rESWT group, pain and grip strength showed statistically significant differences between the groups. In terms of ultrasound findings, the median nerve cross-sectional area significantly decreased only in the 2000-pulses rESWT group after treatment. However, the median nerve flattening ratio, a desired parameter to decrease on ultrasound, showed a statistically significant increase in Group 3 compared to other groups. In light of these results, rESWT can be considered an effective method for reducing symptoms in the treatment of mild-to-moderate CTS, and a higher number of shots may lead to more effective outcomes in terms of recovery.