Effect of extracorporeal shockwave therapy on carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials

Ju Chan Kim, Se Hee Jung, Shi-Uk Lee, Sang Yoon Lee, Ju Chan Kim, Se Hee Jung, Shi-Uk Lee, Sang Yoon Lee

Abstract

Background: Although several trials have reported the use of extracorporeal shock wave therapy (ESWT) for mild to moderate carpal tunnel syndrome (CTS), little is known about the efficacy of ESWT. Thus, we performed a meta-analysis to evaluate whether ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in CTS.

Methods: Six randomized controlled trials investigating the effect of ESWT on CTS were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- or random-effects models.

Results: ESWT showed significant overall effect size compared to the control (overall Hedge g pooled standardized mean difference (SMD) = 1.447; 95% confidence interval [CI], 0.439-2.456; P = .005). Symptoms, functional outcomes, and electrophysiologic parameters all improved with ESWT treatment. However, there was no obvious difference between the efficacy of ESWT and local corticosteroid injection (pooled SMD = 0.418; 95% CI, -0.131 to 0.968; P = .135). A publication bias was not evident in this study.

Conclusion: Our meta-analysis revealed that ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in patients with CTS. Further research is needed to confirm the long-term effects and the optimal ESWT protocol for CTS.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic review and Meta-Analysis flow diagram detailing the relevant clinical study selection process.
Figure 2
Figure 2
Forest plot of the overall effect of extracorporeal shock wave therapy (ESWT) on carpal tunnel syndrome (CTS) determined by a random-effects meta-analysis. Effect sizes are indicated as Hedge g standardized mean differences and 95% confidence intervals (CI).
Figure 3
Figure 3
Forest plots of the effects of trial-level characteristics of extracorporeal shock wave therapy (ESWT) analyzed as outcome variables: (A) symptoms (primary outcome), (B) functional scores, (C) motor component, and (D) sensory component of electrodiagnostic study.
Figure 4
Figure 4
Forest plots of the subgroup analysis: (A) vs sham extracorporeal shock wave therapy (ESWT), (B) vs corticosteroid injection, (C) radial type ESWT, and (D) focused ESWT.

References

    1. Dawson DM. Entrapment neuropathies of the upper extremities. N Engl J Med 1993;329:2013–8.
    1. American Association of Electrodiagnostic Medicine AAoN, American Academy of Physical M, Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 2002;25:918–22.
    1. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 2002;113:1373–81.
    1. Gelberman RH, Hergenroeder PT, Hargens AR, et al. The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am 1981;63:380–3.
    1. Graham B, Peljovich AE, Afra R, et al. The American Academy of Orthopaedic Surgeons evidence-based clinical practice guideline on: management of carpal tunnel syndrome. J Bone Joint Surg Am 2016;98:1750–4.
    1. Scholten RJ, Mink van der Molen A, Uitdehaag BM, et al. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev 2007;CD003905.
    1. O’Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003;CD003219.
    1. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007;CD001554.
    1. Principles in the first aid competition for students in secondary medical school [in Czech]. Zdrav Prac 1975;25:73–5.
    1. Practice parameter for carpal tunnel syndrome (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1993;43:2406–9.
    1. Burger M, Kriel R, Damon A, et al. The effectiveness of low-level laser therapy on pain, self-reported hand function, and grip strength compared to placebo or “sham” treatment for adults with carpal tunnel syndrome: a systematic review. Physiother Theory Pract 2017;33:184–97.
    1. Romeo P, d’Agostino MC, Lazzerini A, et al. Extracorporeal shock wave therapy in pillar pain after carpal tunnel release: a preliminary study. Ultrasound Med Biol 2011;37:1603–8.
    1. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2016;354:i4086.
    1. Lai MH, Kwok OM. Estimating standardized effect sizes for two- and three-level partially nested data. Multivariate Behav Res 2016;51:740–56.
    1. Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods 2002;7:105–25.
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from .
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088–101.
    1. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–34.
    1. Atthakomol P, Manosroi W, Phanphaisarn A, et al. Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial. BMC Musculoskelet Disord 2018;19:32.
    1. Ke MJ, Chen LC, Chou YC, et al. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial. Sci Rep 2016;6:38344.
    1. Notarnicola A, Maccagnano G, Tafuri S, et al. Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome. Int J Immunopathol Pharmacol 2015;28:256–62.
    1. Raissi GR, Ghazaei F, Forogh B, et al. The effectiveness of radial extracorporeal shock waves for treatment of carpal tunnel syndrome: a randomized clinical trial. Ultrasound Med Biol 2017;43:453–60.
    1. Seok H, Kim SH. The effectiveness of extracorporeal shock wave therapy vs. local steroid injection for management of carpal tunnel syndrome: a randomized controlled trial. Am J Phys Med Rehabil 2013;92:327–34.
    1. Vahdatpour B, Kiyani A, Dehghan F. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome. Adv Biomed Res 2016;5:120.
    1. Ioppolo F, Tattoli M, Di Sante L, et al. Clinical improvement and resorption of calcifications in calcific tendinitis of the shoulder after shock wave therapy at 6 months’ follow-up: a systematic review and meta-analysis. Arch Phys Med Rehabil 2013;94:1699–706.
    1. Ciampa AR, de Prati AC, Amelio E, et al. Nitric oxide mediates anti-inflammatory action of extracorporeal shock waves. FEBS Lett 2005;579:6839–45.
    1. Mariotto S, Cavalieri E, Amelio E, et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide 2005;12:89–96.
    1. Hausner T, Nogradi A. The use of shock waves in peripheral nerve regeneration: new perspectives? Int Rev Neurobiol 2013;109:85–98.
    1. Tucci M, Freeland A, Mohamed A, et al. The role of proteoglycans in idiopathic carpal tunnel syndrome. Biomed Sci Instrum 2005;41:141–6.
    1. Wild C, Khene M, Wanke S. Extracorporeal shock wave therapy in orthopedics. Assessment of an emerging health technology. Int J Technol Assess Health Care 2000;16:199–209.
    1. Lohrer H, Nauck T, Dorn-Lange NV, et al. Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures. Foot Ankle Int 2010;31:1–9.
    1. Chang KV, Chen SY, Chen WS, et al. Comparative effectiveness of focused shock wave therapy of different intensity levels and radial shock wave therapy for treating plantar fasciitis: a systematic review and network meta-analysis. Arch Phys Med Rehabil 2012;93:1259–68.

Source: PubMed

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