Effects of Focused ESWT in Moderate Degree Carpal Tunnel Syndrome: A Preliminary, Randomized Double-Blinded Controlled Trial

Cherdpong  Pimubol; Jirapa Champaiboon; Jariya  Boonhong

Authors

Cherdpong Pimubol Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University
Jirapa Champaiboon Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University
Jariya Boonhong Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University

Keywords:

carpal tunnel syndrome, extracorporeal shockwave therapy, Boston carpal tunnel syndrome questionnaire, electrodiagnosis

Abstract

Objectives: To study the effects of focused extracorporeal shockwave therapy (f ESWT) combined with night splint and compare 4 and 10 treatment sessions in patients with moderate carpal tunnel syndrome (CTS)

Study design: A randomized, double-blinded, controlled trial

Setting: An outpatient rehabilitation clinic in King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Subjects: Patients with a diagnosis of moderate CTS

Methods: Patients were randomly assigned to one of two groups. The intervention group received ESWT once a week for ten consecutive weeks, while the comparison group received sham ESWT for the first four weeks and real ESWT for the subsequent six weeks. All patients were advised to wear a night splint. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and the electrodiagnostic study were evaluated at baseline, 4, and 10 weeks.

Results: The f ESWT group improved significantly in both BCTQ symptoms (p = 0.022) and BCTQ function (p-value 0.025), whereas the comparison group improved only in BCTQ symptoms (p = 0.028). At 4 weeks, the f ESWT group showed statistically significant improvement in distal sensory latency (p-value 0.019) and sensory nerve conduction velocity across the wrist (p = 0.028) compared to the comparison group. Over the course of ten sessions of ESWT, clinical outcomes and neurophysio-logic parameters continued to improve. However, the number of patients exceeding the minimal clinically important difference in BCTQ did not change after the first 4 sessions.

Conclusions: This preliminary study shows that adding f ESWT to a night splint is safe and effective for improving symptoms, function, and neurophysiologic parameters in moderate CTS. In terms of cost-effectiveness, four sessions may be more appropriate.

References

Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol [Internet]. 2016 [cited 2024 Mar 23];15(12):1273–84. Available from: https://pubmed.ncbi.nlm.nih.gov/27751557/

Huisstede BM, Hoogvliet P, Franke TP, Randsdorp MS, Koes BW. Carpal tunnel syndrome: Effectiveness of physical therapy and electrophysical Modalities. An updated systematic review of randomized controlled trials. Arch Phys Med Rehabil [Internet]. 2018 [cited 2024 Mar 23];99(8):1623–34.e23. Available from: https://pubmed.ncbi.nlm.nih.gov/28942118/ doi:10.1016/j.apmr.2017.08.482

Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes: a prospective, randomized, placebo-controlled trial. Am J Sports Med [Internet]. 2003 [cited 2024 Mar 23];31(2):268–75. Available from: https://pubmed.ncbi.nlm.nih.gov/12642264/ doi: 10.1177/03635465030310021901

Mariotto S, de Prati AC, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Curr Med Chem [Internet]. 2009 [cited 2025 Jan 23];16(19):2366–72. Available from: https://pubmed.ncbi.nlm.nih.gov/19601786/ doi: 10.2174/092986709788682119.

Chung B, Wiley JP. Extracorporeal shockwave therapy. Sports Med [Internet]. 2002 [cited 2024 Mar 23];32(13):851–65. Available from: https://pubmed.ncbi.nlm.nih.gov/12392445/ doi: 10.2165/00007256-200232130-00004

Hausner T, Pajer K, Halat G, Hopf R, Schmidhammer R, Redl H, et al. Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat. Exp Neurol [Internet]. 2012 [cited 2025 Mar 23];236(2):363–70. Available from: https://pubmed.ncbi.nlm.nih.gov/22575596/ doi: 10.1016/j.expneurol.2012.04.019

Ohtori S, Inoue G, Mannoji C, Saisu T, Takahashi K, Mitsuhashi S, et al. Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibres. Neurosci Lett [Internet]. 2001 [cited 2024 Mar 23];315(1-2):57–60. Available from: https://pubmed.ncbi.nlm.nih.gov/11711214/ doi: 10.1016/s0304-3940(01)02320-5

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 [Internet]. 2013 [cited 2024 Mar 23];92(4):327–34. Available from: https://pubmed.ncbi.nlm.nih.gov/23044704/ doi: 10.1097/PHM.0b013e31826edc7b

Zhang L, Yang T, Pang L, Li Y, Li T, Zhang C, Yao L, Li R, Tang X. Effects of extracorporeal shock wave therapy in patients with mild-to-moderate carpal tunnel syndrome: An updated systematic review with meta-analysis. J Clin Med [Internet]. 2023 [cited 2025 Jan 23];12:7363. Available from: https://doi.org/10.3390/jcm12237363.

Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. Muscle Nerve [Internet]. 1997 [cited 2024 Mar 23];20(12):1477–86. Available from: https://pubmed.ncbi.nlm.nih.gov/3821791/ doi: 10.1002/mus.880100202

Robinson LR, Strakowski J, Kennedy DJ. Is the combined sensory (Robinson) index routinely indicated for all cases of suspected carpal tunnel syndrome undergoing electrodiagnostic evaluation? PM&R [Internet]. 2013 [cited 2024 Mar 23];5(5):433–7. Available from: https://pubmed.ncbi.nlm.nih.gov/23701980/ doi: 10.1016/j.pmrj.2013.04.007

Vahdatpour B, Kiyani A, Dehghan F. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome. Adv Biomed Res [Internet]. 2016 [cited 2024 Mar 23];5:120. Available from: https://pubmed.ncbi.nlm.nih.gov/27563630/ doi: 10.4103/2277-9175.186983

de Carvalho Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord [Internet]. 2006 [cited 2024 Mar 23];7(1):1–9. Available from: https://pubmed.ncbi.nlm.nih.gov/17054773/ doi: 10.1186/1471-2474-7-78

Fischer J, Thompson NW, Harrison JW. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. Classic Papers in Orthopaedics [Internet]. Springer; 2014 [cited 2024 Mar 23]. p. 349–51. Available from: https://pubmed.ncbi.nlm.nih.gov/8245050/ doi: 10.2106/00004623-199311000-00002

Yang L, Li X, Li S, Yang J, Meng D. Effect of extracorporeal shock wave therapy on nerve conduction: a systematic review and meta-analysis. Front Neurol [Internet]. 2024 [cited 2025 Jan 30] Nov 22;15:1493692. Available from: https://pubmed.ncbi.nlm.nih.gov/39650239/ doi:10.3389/fneur.2024.1493692.

Wu YT, Ke MJ, Chou YC, Chang CY, Lin CY, Li TY, et al. Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial. J Orthop Res [Internet]. 2016 [cited 2024 Mar 23];34(6):977–84. Available from: https://pubmed.ncbi.nlm.nih.gov/26610183/ doi: 10.1002/jor.23113

Ke MJ, Chen LC, Chou YC, Li TY, Chu HY, Tsai CK, 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 [Internet]. 2016 [cited 2024 Mar 23];6(1):1–10. Available from: https://pubmed.ncbi.nlm.nih.gov/27910920/ doi: 10.1038/srep38344

Paoloni M, Tavernese E, Cacchio A, D’orazi V, Ioppolo F, Fini M, et al. Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial. Eur J Phys Rehabil Med [Internet]. 2015 [cited 2024 Mar 23];51(5):521–8. Available from: https://pubmed.ncbi.nlm.nih.gov/25697763/

Aramrussameekul W, Narkdaeng P. Efficacy of single-session focused extracorporeal shockwave therapy in patients with moderate-degree carpal tunnel syndrome versus steroid injection therapy: A single-blind randomized controlled trial. ASEAN J Rehabil Med [Internet]. 2025 [cited 2025 Feb 7] ;35(1)2-7. Available from https://he01.tci-thaijo.org/index.php/aseanjrm/article/view/270464/185790

Atthakomol P, Manosroi W, Phanphaisarn A, Phrompaet S, Iammatavee S, Tongprasert S. 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 [Internet]. 2018[cited 2025 Jan 30];25;19(1):32. Available from https://pubmed.ncbi.nlm.nih.gov/29370788/ doi: 10.1186/s12891-018-1948-3

Sagir D, Bereket C, Onger ME, Bakhit N, Keskin M, Ozkan E. Efficacy of extracorporeal shockwaves therapy on peripheral nerve regeneration. J Craniofac Surg [Internet]. 2019 [cited 2024 Mar 23];30(8):2635–9. Available from: https://pubmed.ncbi.nlm.nih.gov/31577651/ doi: 10.1097/SCS.0000000000005671

Manente G, Torrieri F, Di Blasio F, Staniscia T, Romano F, Uncini A. An innovative hand brace for carpal tunnel syndrome: a randomized controlled trial. Muscle Nerve [Internet]. 2001 [cited 2024 Mar 23];24(8):1020–5. Available from: https://pubmed.ncbi.nlm.nih.gov/11439376/ doi: 10.1002/mus.1105

Page MJ, Massy WN, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev [Internet]. 2012 [cited 2024 Mar 23];(7):CD010003. Available from: https://pubmed.ncbi.nlm.nih.gov/22786532/ doi: 10.1002/14651858.CD010003

Park GY, Kwon DR, Lee SC. Timing of extracorporeal shock wave therapy in rabbits with carpal tunnel syndrome. J Tissue Eng Regen Med [Internet]. 2019 [cited 2024 Mar 23];13(6):1071–8. Available from: https://pubmed.ncbi.nlm.nih.gov/30964964/ doi: 10.1002/term.2862