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

Ming-Jen Ke, Liang-Cheng Chen, Yu-Ching Chou, Tsung-Ying Li, Heng-Yi Chu, Chia-Kuang Tsai, Yung-Tsan Wu, Ming-Jen Ke, Liang-Cheng Chen, Yu-Ching Chou, Tsung-Ying Li, Heng-Yi Chu, Chia-Kuang Tsai, Yung-Tsan Wu

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.

Figures

Figure 1. Timeline of treatment session with…
Figure 1. Timeline of treatment session with data collection in the three groups.
Group A patients received one session of radial extracorporeal shock wave therapy (rESWT) per week for 3 consecutive weeks; Group B patients received a single session of rESWT; Group C patients received one session of sham rESWT per week for 3 consecutive weeks. The night splint was given in all patients since first-session of rESWT. Evaluations were performed before the first rESWT treatment, and at 4, 10, and 14 weeks after the first session of rESWT in each group.
Figure 2. CONSORT flow diagram.
Figure 2. CONSORT flow diagram.
Figure 3. Mean change from baseline in…
Figure 3. Mean change from baseline in Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) in all groups in patients with mild CTS (mean ± standard error).
(A) BCTQ of severity: Group A had significant improvement compared with group C until week 10. (B) BCTQ of function: Group A had significant improvement compared with group C until week 4. Although a tendency towards reduced BCTQ (severity and function) was found in group A vs B, and group B vs. C, the discrepancy did not reach significance. (*p < 0.05, One-way ANOVA followed by the Bonferroni post hoc tests was used).
Figure 4. Mean of change from baseline…
Figure 4. Mean of change from baseline in Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) in all groups in patients with moderate CTS.
(A) BCTQ of severity: Group A had significant improvement compared with group B and group C until week 10 and week 14 respectively. (B) BCTQ of function: Group A had significant improvement compared with group B and group C until week 10 and week 14 respectively. Although a tendency toward a reduced BCTQ (severity and function) was found in group B compared with group C, the discrepancy did not reach significance. (*p < 0.05, **p < 0.01 mean Group A vs. C; +p < 0.05 mean Group A vs. B. One-way ANOVA followed by the Bonferroni post hoc tests was used).

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