Evaluation of the efficacy of radial extracorporeal shock wave therapy (rESWT) in patients with carpal tunnel syndrome and comparison with the effectiveness og local corticosteroid injection: A prospective randomized controlled trial

Carpal tunnel syndrome (CTS) is a clinical manifestation of symptoms caused by compression of the median nerve in the carpal tunnel at the wrist and is the most common trap neuropathy. Although CTS is due to idiopathic and secondary causes, the pathophysiology of its is not fully understood. Treatment of CTS varies according to CTS degree. Different conservative treatment modalities are used in the treatment of mild to moderate CTS. The most commonly used methods are splint, local corticosteroid injection (LCI), nonsteroidal antiinflammatory drugs and conventional treatment agents (TENS, hotpack, US). Recently, studies showing that ESWT is effective in the treatment of CTS are published. This study was planned as a randomized controlled trial to compare the clinical and electrophysiological effects of rESWT and LCI in the treatment of idiopathic CTS. A total of 72 patients (51 women, 21 men, total 109 hands) with idiopathic mild and moderate CTS were included in the study. Patients were randomized to 3 groups. rESWT group (26 patients, 37 hands), the treatment of neutral wrist splint and rESWT (1 session per a week, total of 3 sessions) was given; LCI group (23 patients, 35 hands) was given neutral wrist splint and local corticosteroid injection treatment; the control group received only a neutral wrist splint treatment. rESWT (4 bar, 5 Hz frequency, 2000 beat) 1 session per week and 3 sessions in total 3 weeks. 40 mg methylprednisolone was administered as local corticosteroid injection. Splint treatment was applied for 2 months during the night and during the day when they did not use their hands. The patients were evaluated with pre-treatment, 1 week after treatment, and 12 weeks after treatment (VAS-Pain, VAS- Numbness, Boston-SSS, Boston-FDS, hand grip strength). In addition, patients were evaluated by EMG before treatment and 12 weeks after treatment. Significant differences were observed between the groups in terms of mDSAP, mDDL, mMDL and mDSI before treatment (p <0.05). The reason for this was thought to be more mild CTS patients in the control group. In the rESWT group, VAS-P, VAS-N, Boston-SŞS and hand grip strength were significantly improved at 1 week week after treatment; VAS-P, VAS-N, Boston-SŞS and Boston-FDS scores were significantly improved at 12 weeks of treatment compared to pretreatment (p <0.05). In the LCI group, there was a significantly improvement in all clinical parameters (VAS-P, VAS-N, Boston-SS, Boston-FDS, hand grip strength) at 1 week after treatment and 12 weeks after treatment compared to pretreatment (p <0.05). In the control group, VAS-P, VAS-N, Boston SŞS scores were significantly improved at 1 week after treatment; VAS-P, VAS-N, Boston-SŞS and Boston-FDS scores were significantly improved at 12 weeks of treatment compared to pretreatment (p <0.05). When EMG measurements were compared, a significantly improvement was found in favor of improvement in mSDL and mSNCV levels in rESWT group at 12th week after treatment (p<0.05); mSNAP amplitudes, mSDL, mMDL and mSNCV levels in LKE group at 12th week after treatment (p<0.05); mSDL, mMDL and mSNCV in the control group at 12th week after treatment (p<0.05). VAS-P, VAS-N, Boston-SŞS and Boston-FDS scores at 1 week after treatment were significantly lower in the LKE group compared to the other 2 groups (p <0.05). VAS-P and Boston-FDS scores at 12 weeks after treatment were significantly lower in the LCI group compared to the other 2 groups (p <0.05). CTS severity of the patients were reevaluated according to EMG after treatment. There was no significantly difference between the groups according to the number of patients whose CTS degree improved. As a result, it was observed that all 3 treatment modalities (rESWT, LCI, splint) were effective in the treatment of CTS and this effect continued until the 3rd month. It was thought that LCI is more effecitve than rESWT. Further work on rESWT activity is required.