Efficacy of Focused Shockwave Therapy in Patients With CTS

Mahidol University24 enrolled

Overview

Carpal tunnel syndrome (CTS) is the most common entrapment of upper extremity. Patients with CTS will experience symptoms of pain, numbness of tingling sensation along the median nerve distribution. In more severe case, patients may have difficult manipulating objects that disturb function and patient's quality of life. Extracorporeal Shockwave Therapy (ESWT) is one of physical modalities that uses to treat many musculoskeletal disorders. For CTS, previous evidence showed that ESWT can improve symptoms, function as well as electrophysiologic parameters. However, standardized guidelines as well as the study in patients with moderate to severe CTS has not been established. Thus, the objective of the present study was to evaluate efficacy of ESWT in term of symptoms, function, electrophysiologic parameters, as well as sonography of median nerve in patients with moderate to severe CTS.

* The present study was a single-blinded randomized controlled trial comparing the efficacy of focused ESWT (F-ESWT) to conservative treatment in patients with CTS. * 24 patients who was diagnosed as CTS based on symptoms of CTS and physical examination. They were randomly allocated into two groups (21 patients per group), mainly F-ESWT plus conservative treatment and conservative treatment only. * Outcome measures were BCTQ including symptom and function subscales, electrophysiologic parameters, and sonography to evaluate cross-sectional area (CSA) of the median nerve. All measures were recorded at baseline, 3 weeks and 6 weeks of treatment. * Statistical analysis was performed to determine changes within the same group and compare difference between the two groups.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Interventions

Focused ESWTDEVICE

F-ESWT (dose 0.01-0.15 mJ/mm2, frequency 4-5 Hz, 1500 shocks) was applied perpendicular to the palmar side of the wrist which was done once a week for a total of three sessions plus conservative treatment.

ControlBEHAVIORAL

Participants in the control group received only conservative treatment including disease education, advice about proper posture and activity, night wrist splint and nerve gliding exercise.

Eligibility

Sex: FEMALEMin age: 20 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Participants who were diagnosed as CTS based on the American Academy of neurology 2. Participants who have electrodiagnostic evidence of CTS according to American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines for diagnosis of CTS. The severity of median nerve compression at wrist was moderate to severe degree. 3. Patients who were not treated by NSAIDs within 2 weeks prior to participating in the study. Exclusion Criteria: The below exclusion criteria were applied only on the affected hand that were enrolled to the study 1. History of previous carpal tunnel release. 2. Receiving steroid injections for the treatment of CTS 3. History of infection or severe inflammation on the wrist 4. Contraindications for focused ESWT, such as arrhythmias, pacemakers, bleeding disorders, pregnancy, severe osteoporosis, and cancer. 5. Participants who refused or requested withdrawal from the study.

Outcomes

Primary Outcomes

Thai version of Boston Carpal Tunnel Questionnaire (T-BCTQ)

T-BCTQ was used to assess symptom severity and hand function in patients with CTS. This questionnaire consists of two parts, mainly BCTQ symptom severity (BCTQs) and BCTQ functional status (BCTQf). Total questions for each part were 11 and 8 questions, respectively with scores raging from 1-5.

Time frame: BCTQs and BCTQf were assessed changes from baseline to at 6 weeks of treatment.

Secondary Outcomes

Electrodiagnostic parameters: Distal Sensory Latency (DSL)

DSL was evaluated using Cadwell Sierra Summit model IEC601-1.

Time frame: Changes of DSL was assessed from baseline to at 6 weeks of treatment.

Electrodiagnostic parameters: Distal Motor Latency (DML)

DML was evaluated using Cadwell Sierra Summit model IEC601-1.

Time frame: Changes of DSL was assessed from baseline to at 6 weeks of treatment.

Electrodiagnostic parameters: Sensory Nerve Action Potential (SNAP) amplitude

Sensory nerve action potential (SNAP) amplitude was evaluated using Cadwell Sierra Summit model IEC601-1.

Time frame: SNAP amplitude was assessed from baseline to at 6 weeks of treatment.

Electrodiagnostic parameters: Compound Muscle Action Potential (CMAP) amplitude

CMAP amplitude was evaluated using Cadwell Sierra Summit model IEC601-1.

Time frame: Changes of CMAP amplitude was assessed from baseline to at 6 weeks of treatment.

Electrodiagnostic parameters: Total area under curve (TAUC)

TAUC was evalauted using Cadwell Sierra Summit model IEC601-1.

Time frame: Changes of TAUC was assessed from baseline to at 6 weeks of treatment.