Radial shock wave therapy demonstrates significant improvement in pain & function for CTS

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: 1
Synopsis
34 patients (40 wrists) with carpal tunnel syndrome were randomized to receive either radial extracorporeal shock wave therapy (rESWT) or sham therapy as treatment. The purpose of this study was to determine if active rESWT was associated with significant improvement in pain and paresthesia, symptom severity, and function when compared to sham therapy at 1, 4, 8, and 12 weeks post-treatment. Results demonstrated that Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Tri-Service General Hospital
Conflicts: None disclosed
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Why was this study needed now?
Common modes of treatment for carpal tunnel syndrome include the use of a splint, steroid injections and therapeutic ultrasound, however these treatments have been noted to provide only short-term improvement in pain and function. Extracorporeal shock wave therapy (ESWT) have been shown to provide relief for a variety of musculoskeletal disorders. Additionally, recent study has suggested that ESWT may be a viable alternative method of treatment for peripheral neuropathy conditions, including carpal tunnel syndrome. Due to the lack of high-quality evidence investigating the benefits of radial extracorporeal shock wave therapy (rESWT), the current study was warranted.
What was the principal research question?
For patients with carpal tunnel syndrome (CTS), did radial extracorporeal shock wave therapy (rESWT) result in significantly improved digital pain and paresthesia when compared to sham therapy, up to 12 weeks post-treatment?
Population: 34 patients (40 wrists) with typical signs of carpal tunnel syndrome, including a positive Tinel’s sign or Phalen’s test with numbness/tingling in at least two of the first, second, or third digits. Diagnosis of carpal tunnel syndrome was confirmed by electrophysiological analysis.
Intervention: rESWT group: After location of the median nerve with musculoskeletal ultrasonography, radial extracorporeal shock wave therapy was conducted with 2000 shots (pressure of 4 Bar, frequency of 5 Hz) in the treated area (pisiform level to 2 cm proximal to the median nerve) (n=20 wrists, 20 completed follow-up; mean age= 54.70+/-7.96, 18F/2M).
Comparison: Control group: Procedure was conducted in identical measure as the rESWT group, except sham therapy did not include active transfer of energy (n=20 wrists, 20 completed follow-up; mean age= 57.80+/-6.51, 17F/3M).
Outcomes: The primary outcome measure was change in visual analogue scale (VAS) pain and paresthesia experienced in the affected digits within the last week. Secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve on ultrasound, sensory nerve conduction velocity (SNCV), and finger pinch strength.
Methods: RCT: prospective, double-blinded, placebo-controlled
Time: Outcomes of interest were evaluated at baseline (prior to treatment) and 1, 4, 8, and 12 weeks after the third rESWT session.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.