Efficacy of extracorporeal shock wave therapy in carpal tunnel syndrome: A prospective randomized controlled trial

Purpose: The aim of this study was to evaluate the efficacy of radial ESWT in patients with carpal tunnel syndrome, combined with home exercise program and splint usage, on the patients' hand numbness, functional status, hand and hand finger grip strength and median nerve diameter change. Methods: In our prospective, single-blind, randomized controlled trial, 29 patients (33 wrists) with EMG confirmed diagnosis of carpal tunnel syndrome were included. The patients were randomized into two groups: the treatment group (n = 14 patients, 16 wrists) and the control group (n = 15 patients, 17 wrists). All patients were given a home exercise program for 12 weeks of treatment and follow-up periodalong with the recommendation of a neutral static wrist splint. In addition, a total of 3 sessions of radial ESWT treatment (2 bar, 5 Hz, 2000 shock) were administered to the patients in the treatment group for 3 weeks as 1 session per week. A total of 3 sessions of sham ESWT were administered to the control group at the same time and frequency. Boston Carpal Tunnel Syndrome Questionnaire was used for functional status evaluation and symptom severity and VAS (pain/numbness) scale was used as primary outcomes. Secondary outcomes were median nerve cross-sectional area measurement, hand grip strength by Jamar dynamometer and finger grip strength by pinchmeter. The assessments were performed at baseline, 1 week after the treatment, 4 weeks later and 12 weeks later. Results: No significant difference was found between the two groups in terms of demographic characteristics and baseline evaluations. In the hand numbness score evaluated with VAS, there was a significant decrease in the treatment group compared to the control group (p <0,05) but this difference was eliminated in the subsequent evaluations (p> 0,05). The change in Boston symptom severity score was found to be higher in the treatment group than in the control group at the first week after the treatment, but this change was not statistically significant (p> 0,05). The change in Boston symptom severity score was higher in the treatment group than in the control group at the first week after treatment compared to the pretreatment, but this change was not statistically significant (p> 0,05). The difference was found to be significant in the control group compared to treatment group at the first month after treatment compared to the first week after treatment (p<0,05). The difference in Boston functional status score was found to be higher in the treatment group compared to the control group at 1 week and 1 month after the treatment, but this difference was not statistically significant (p> 0,05). In the first week after treatment, there was a significant decrease in nerve diameter in the treatment group compared to the control group (p<0,05), however, this difference has been eliminated in subsequent controls (p>0,05). There was a significant decrease in nerve diameter in the treatment group compared to the control group in the first week after treatment (p <0.05), but this difference was eliminated in subsequent controls (p> 0.05). There was a significant increase in the hand grip strength evaluated with Jamar in the treatment group compared the control group in the first month after treatment (p<0,05), but this difference was eliminated in subsequent controls (p> 0.05). On the other hand, finger grip strength was found to be significantly higher in the treatment group than in the control group at 1 month after treatment compared to 1 week after treatment and 1 week after treatment compared to pretreatment (p <0,05). Conclusions: In addition to home exercise program and splint usage in patients with carpal tunnel syndrome, radial ESWT treatment was more effective in short term in reducing VAS score and improving hand and finger grip strength, changing nerve diameter and Boston symptom severity score according to home exercise program and splint use alone. Keywords: Extracorporeal shock wave therapy, carpal tunnel syndrome, rehabilitation, physical therapy modalities