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

Abstract

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.

Timing of extracorporeal shock wave therapy in rabbits with carpal tunnel syndrome

“…To the best of our knowledge, this is the first study to investigate electrophysiological and histological changes according to the different timing of ESWT in a rabbit model with dextrose‐induced CTS. Previous clinical studies have reported that the therapeutic effects of ESWT on CTS lasted at least 12 weeks after ESWT (Ke et al, ; Paoloni et al, ; Vahdatpour, Kiyani, & Dehghan, ). The difference in the duration of therapeutic effect after ESWT might be attributable to the different types of ESWT (radial or focused), the number of ESWT sessions, the intensity of ESWT, and the severity of the CTS.…”

“…In our study, ESWT was repeated three times at 1‐week interval. Previous clinical studies have used three sessions of ESWT for the treatment of CTS and spasticity (Ke et al, ; Park, Kwon, Park, & Lee, ). The cumulative effect on the free nerve endings of rats after multiple ESWT sessions resulted in a long‐term antinociceptive effect (Takahashi, Ohtori, Saisu, Moriya, & Wada, ).…”

Peripheral Nerve Entrapment and their Surgical Treatment

“…The compression can be due to the arcade of Frohse (tendinous border of the superficial layer of the SM), the superomedial border of the ECRB, the inferior border of the superficial layer of the SM, fibrous bands at the radio-humeral joint and some radial vessels with a recurrent direction and a fibrous septum between the BRM and BaM muscles [119,121,122]. The treatment is conservative [123] avoiding the movements that induce pain but if it persists surgical exploration may be justified [124].…”

Radial Extracorporeal Shock Wave Therapy for Relief of Arthralgia in Rheumatoid Arthritis

“…Multiple research studies have proved that ESWT improves the microcirculation, inhibits the inflammatory response, promotes neural functional recovery, and stimulates osteoblast and the chondrocyte activity. rESWT has been used to treat chronic pain associated with diseases such as plantar fasciitis, carpal tunnel syndrome, chronic distal biceps tendinopathy, and lateral epicondylitis . Although rESWT is now an accepted therapeutic method to relive pain associated with nonimmune damage, its use in the treatment of RA has not been reported.…”