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Ghasemi A, Olyaei GR, Bagheri H, Hadian MR, Jalaei S, Otadi K, Malmir K. A randomized clinical trial on the changing of median nerve cross-sectional area and pain after extracorporeal shock wave and low-level laser therapy added to conventional physical therapy in patients with mild-to-moderate carpal tunnel syndrome. J Hand Ther 2024:S0894-1130(23)00197-7. [PMID: 38278695 DOI: 10.1016/j.jht.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/07/2023] [Accepted: 12/28/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common mononeuropathy in the upper limb. It remains uncertain whether adding extracorporeal shockwave therapy (ESWT) or low-level laser therapy (LLLT) to conventional treatment benefits CTS patients. PURPOSE This study aimed to compare the effectiveness of ESWT and LLLT in conjunction with conventional treatments (including carpal mobilization, transcutaneous electrical nerve stimulation, and ultrasound) on the cross-sectional area (CSA) of the median nerve and pain in mild-to-moderate CTS patients. STUDY DESIGN This was a single-blinded randomized clinical trial with registration number IRCT20220504054734N1. METHODS Thirty-six patients were randomly assigned using block balanced randomization to receive either four sessions of ESWT or 10 sessions of LLLT in addition to 10 sessions of conventional treatments over 2 weeks. Patients received numbered closed envelopes indicating their treatment group. CSA (primary) and pain (secondary) in 18 patients who completed the treatment were assessed at baseline and after 2 weeks by a blinded assessor. Paired and independent sample t-tests were used for analyses due to the normal distribution of data was checked by Kolmogorov-Smirnoff. Cohen's d effect size was used to assess the intervention's magnitude. RESULTS Both ESWT and LLLT groups showed significant improvements in CSA (p = 0.002) and pain (p < 0.001) from baseline to posttreatment. CSA improvement was moderate for ESWT (mean difference: 1.2, 95% CI 0.51-1.9) and mild for LLLT (mean difference: 0.76, 95% CI 0.4-1.14). Conversely, pain improvement was substantial in both groups (ESWT: mean difference 4.4, 95% CI 3.6-5.3; LLLT: mean difference 4.4, 95% CI 3.7-5.2). No substantial differences between ESWT and LLLT were observed, highlighting their comparable efficacy. CONCLUSION The addition of either LLLT or ESWT to conventional treatment effectively reduced pain and median nerve CSA in mild-to-moderate CTS. The absence of significant differences between ESWT and LLLT indicates their comparable efficacy in pain relief and CSA reduction.
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Affiliation(s)
- Amirhossein Ghasemi
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Olyaei
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Bagheri
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Hadian
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaei
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Otadi
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kazem Malmir
- Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Mao B, Li Y, Yin Y, Zhang Z, Li J, Fu W. Local corticosteroid injection versus physical therapy for the treatment of carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Asian J Surg 2024; 47:89-99. [PMID: 37147265 DOI: 10.1016/j.asjsur.2023.04.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/22/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
The comparative effect of commonly used conservative treatments for carpal tunnel syndrome remained controversial. The purpose of this study was to compare the clinical effect of local corticosteroid injection and physical therapy for the treatment of carpal tunnel syndrome. A systematic literature search of PubMed, EMBASE, and Cochrane library was conducted to identify relevant randomized clinical trials published before 21st Mar 2023. Two independent reviewers assayed quality of included studies using the Cochrane collaboration risk of bias tool. Relevant data were extracted and pooled analyses were conducted. Outcome measurements included Boston Carpal Tunnel Syndrome Questionnaire, visual analogue scale and some electrophysiology tests, while the former two were set as the primary outcomes. Subgroup analysis and sensitive analysis were performed and publication bias was evaluated. Heterogeneity among the included studies was examined using the I2 statistic. After selection, 12 studies were identified eligibility for inclusion. Only one study was found to have a high risk of bias. Pooled data of primary outcomes did not show any differences between treatments, and subgroup analysis supported the results. However, patients treated with local corticosteroid injection showed better improvement in distal motor latency (p = 0.002) and compound muscle action potential (p = 0.04). Some studies failed to pass the sensitive analysis, indicating the related analysis might be not so stable. A slight publication bias was observed in subgroup analysis of function scales, among three publication bias test. In conclusion, compared to physical therapy, local corticosteroid injection might have better treatment effects on carpal tunnel syndrome.
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Affiliation(s)
- BeiNi Mao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi Li
- Department of Rehabilitation, Chengdu Second People's Hospital, Chengdu, 610000, China
| | - YuLing Yin
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhong Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of Orthopaedics, the Third People's Hospital of Chengdu, Chengdu, 610000, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - WeiLi Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Zong Y, Zhang H, Xu P, Chen M, Xie Q, Zhou P. Electrophysiological assessment of radial shock wave therapy for carpal tunnel syndrome. Front Neurosci 2023; 17:1251807. [PMID: 38027488 PMCID: PMC10643864 DOI: 10.3389/fnins.2023.1251807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
This study presents an electrophysiological assessment of radial extracorporeal shock wave therapy on patients with carpal tunnel syndrome (CTS). Sixteen CTS subjects received radial extracorporeal shock wave therapy once a week for five consecutive weeks. Outcome performance was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ) and electrodiagnostic measurements including a nerve conduction study of the median nerve and a compound muscle action potential (CMAP) scan of the abductor pollicis brevis muscle. The BCTQ and the sensory conduction test measurements were all statistically improved after the treatment. However, the motor conduction test measurements were not significantly different before and after the treatment. The CMAP scan examination revealed MScanFit motor unit number estimation (MUNE) was significantly higher after the treatment, while no significant change was found in StairFit MUNE and step index. These results confirmed the effectiveness of shock wave therapy for treating CTS symptoms and the associated sensory property changes. The reasons for the inconsistencies from different CMAP scan processing methods are worthwhile targets for further investigation.
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Affiliation(s)
- Ya Zong
- Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Zhang
- Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peipei Xu
- Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Maoqi Chen
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Qing Xie
- Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Zhou
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
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Gholipour M, Bonakdar S, Gorji M, Minaei R. Synergistic effect of LCI with ESWT on treating patients with mild to moderate CTS: a randomized controlled trial. J Orthop Surg Res 2023; 18:478. [PMID: 37393244 DOI: 10.1186/s13018-023-03940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/18/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Applying radial extracorporeal shock wave therapy (R-ESWT) with LCI(local corticosteroid injection) in carpal tunnel syndrome (CTS) management is gaining momentum. The objective is to actualize the topic of this study. METHODS In this prospective randomized controlled trial, forty patients with mild to moderate CTS are divided into two sham- R-ESWT and R-ESWT groups subject to LCI(local corticosteroid injection). The first group received four sessions of sham-ESWT weekly, which involved sound but no energy; the second group received R-ESWT at equal intervals and were assessed for pain score (VAS score) and symptoms (GSS) baseline, 1st month, 3rd month, and 6th month. RESULTS A considerable improvement is observed in both groups for pain at (P < 0.05) and symptoms at (P < 0.05) in the 3rd month. The second group revealed more significant symptom improvement at (P < 0.05) in the 6th month. CONCLUSION The R-ESWT + LCI combined therapy course is the first line of treatment in patients with mild to moderate symptoms and leads to control and reduction of symptoms and the need for surgery, thus a primary concern in CTS treatment with an orthopedist.
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Affiliation(s)
- Morteza Gholipour
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sona Bonakdar
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Gorji
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Minaei
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Panathoop A, Saengsuwan J, Vichiansiri R. Effects of repetitive peripheral magnetic stimulation vs. conventional therapy in the management of carpal tunnel syndrome: a pilot randomized controlled trial. PeerJ 2023; 11:e15398. [PMID: 37220528 PMCID: PMC10200096 DOI: 10.7717/peerj.15398] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Background Carpal tunnel syndrome (CTS) is a prevalent entrapment neuropathy resulting in hand pain, numbness and/or weakness, which significantly impairs hand function in daily activities. Repetitive peripheral magnetic stimulation (rPMS) is a potential therapeutic option for focal peripheral nerve disease and may be beneficial for CTS treatment. We aimed to compare the effects of rPMS and conventional therapy in the management of CTS. Methods A blinded assessor randomly assigned 24 participants with electrodiagnostically-confirmed mild or moderate CTS to either rPMS or conventional therapy. Both groups were briefed on disease progression and tendon-gliding exercises. In the intervention group, the rPMS protocol, five sessions of rPMS-with a frequency of 10 Hz, 10 pulses/train, and 100 trains/session-were performed over a period of 2 weeks, with three sessions in the first week and two sessions in the second week. At baseline and the end of the second week, the Boston Carpal Tunnel Questionnaire, pinch strength, and electrodiagnostic results were evaluated. Results The rPMS group demonstrated significantly greater within-group improvement in symptom severity scores (2.3 vs. 1.6, p = 0.009) and pinch strength (10.6 lbs vs. 13.8 lbs, p < 0.001). Regarding electrodiagnostic parameters, sensory nerve action potential (SNAP) amplitude was significantly increased (8.7 µV vs. 14.3 µV, p = 0.002) within the group treated with rPMS. With conventional therapy, there were no statistically significant within-group differences. Multiple linear regression models showed that there were no significant differences in other outcomes in between-group comparisons. Conclusions Five sessions of rPMS resulted in significant reduction in symptom severity, improvement in pinch strength and increase in SNAP amplitude. Future research should investigate the clinical utility of rPMS using a larger sample and longer treatment and follow-up durations.
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Padua L, Cuccagna C, Giovannini S, Coraci D, Pelosi L, Loreti C, Bernabei R, Hobson-Webb LD. Carpal tunnel syndrome: updated evidence and new questions. Lancet Neurol 2023; 22:255-267. [PMID: 36525982 DOI: 10.1016/s1474-4422(22)00432-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting quality of life for many people. Although it is a well recognised condition, new insights into epidemiology, diagnosis, and treatment have emerged in the past 6 years. The availability of disease-modifying treatments for rare systemic disorders associated with carpal tunnel syndrome (eg, amyloidosis) should alert clinicians to these diagnostic possibilities. Besides clinical evaluation and electrophysiology, the role of ultrasonography as a diagnostic tool has been confirmed and new ultrasound techniques have been applied, the clinical use and feasibility of which require further investigation. Surgical and non-surgical interventions are beneficial for the treatment of carpal tunnel syndrome and several treatment options are now available, giving clinicians the possibility to choose the best approach for every patient. New diagnostic and therapeutic techniques require further validation.
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Affiliation(s)
- Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
| | - Cristina Cuccagna
- UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua, Italy
| | - Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University, Durham, NC, USA
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Yeom JW, Cho JH, Kim SJ, Lee HI. Cross-Sectional Area of the Median Nerve as a Prognostic Indicator in Carpal Tunnel Syndrome Treated With Local Steroid Injection. J Hand Surg Am 2023; 48:85.e1-85.e10. [PMID: 34839963 DOI: 10.1016/j.jhsa.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/15/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Local steroid injection is an effective treatment modality for carpal tunnel syndrome. This study aimed to investigate the success rate of ultrasonography-guided local steroid injection and determine the prognostic value of the cross-sectional area (CSA) of the median nerve for steroid injection. METHODS We retrospectively evaluated 40 patients with carpal tunnel syndrome whose median nerve CSA was >15 mm2 (large-CSA group; n = 16) or ≤15 mm2 (small-CSA group; n = 24). The CSA was measured using ultrasonography, and all the patients were treated with ultrasonography-guided corticosteroid injection. Demographic characteristics, symptoms, initial QuickDASH score, Boston Carpal Tunnel Questionnaires, and results of the nerve conduction study were assessed at baseline. Treatment success was defined in this study as the absence of symptom recurrence within the entire follow-up period. RESULTS The treatment success rate was 45% (n = 18) after an average follow-up of 16 months. Overall, 11 patients (28%) underwent carpal tunnel release on an average of 11 months after steroid injection. The large-CSA group showed a significantly worse grade of electrodiagnostic testing at baseline than did the small-CSA group; however, there was no significant difference in final Boston Carpal Tunnel Questionnaires symptom score (1.7 vs 1.8, respectively) and the rate of continued treatment success at the last follow-up (42% vs 50%, respectively). The proportions of patients who required carpal tunnel decompression were 29% and 25% in the small-CSA and large-CSA groups, respectively. CONCLUSIONS Local steroid injection for carpal tunnel syndrome has an overall success rate of 45% after a mean follow-up of 16 months. Preinjection CSA was not associated with whether the steroid injection was considered successful. This indicates that increased median nerve CSA does not preclude the possibility of symptomatic relief after a local steroid injection. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ji Woong Yeom
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea of Republic
| | - Jin-Ho Cho
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea of Republic
| | - Seung Joo Kim
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea of Republic
| | - Hyun Il Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea of Republic.
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Guo J, Hai H, Ma Y. Application of extracorporeal shock wave therapy in nervous system diseases: A review. Front Neurol 2022; 13:963849. [PMID: 36062022 PMCID: PMC9428455 DOI: 10.3389/fneur.2022.963849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Neurological disorders are one of the leading causes of morbidity and mortality worldwide, and their therapeutic options remain limited. Recent animal and clinical studies have shown the potential of extracorporeal shock wave therapy (ESWT) as an innovative, safe, and cost-effective option to treat neurological disorders. Moreover, the cellular and molecular mechanism of ESWT has been proposed to better understand the regeneration and repairment of neurological disorders by ESWT. In this review, we discuss the principles of ESWT, the animal and clinical studies involving the use of ESWT to treat central and peripheral nervous system diseases, and the proposed cellular and molecular mechanism of ESWT. We also discuss the challenges encountered when applying ESWT to the human brain and spinal cord and the new potential applications of ESWT in treating neurological disorders.
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Öztürk Durmaz H, Tuncay F, Durmaz H, Erdem HR. Comparison of Radial Extracorporeal Shock Wave Therapy and Local Corticosteroid Injection Effectiveness in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Study. Am J Phys Med Rehabil 2022; 101:685-692. [PMID: 35706121 DOI: 10.1097/phm.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome. DESIGN A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale-pain, a Visual Analog Scale-numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment. RESULTS Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale-pain, Visual Analog Scale-numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale-pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups. CONCLUSIONS Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection.
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Affiliation(s)
- Havva Öztürk Durmaz
- From the Ankara Şereflikoçhisar State Hospital, Ankara, Turkey (HÖD); Kirşehir Ahi Evran University Education and Research Hospital, Kirşehir, Turkey (FT); Ankara City Hospital, Ankara, Turkey (HD); and High Specialization University, Ankara, Turkey (HRE)
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Habibzadeh A, Mousavi-Khatir R, Saadat P, Javadian Y. The effect of radial shockwave on the median nerve pathway in patients with mild-to-moderate carpal tunnel syndrome: a randomized clinical trial. J Orthop Surg Res 2022; 17:46. [PMID: 35078486 PMCID: PMC8786622 DOI: 10.1186/s13018-022-02941-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aimed to evaluate the short-term effect of radial shockwave on the median nerve pathway as a new model method in patients with mild-to-moderate carpal tunnel syndrome.
Methods
In this randomized clinical trial, 60 patients were randomly allocated into three equal groups. The first group received 1500 shocks on the carpal tunnel, the second group received 1500 shocks on the carpal tunnel and median nerve pathways, and the third group was the control group. In all three groups, patients received conventional physiotherapy for ten sessions. In addition, patients in experimental groups received four sessions of radial shockwave. Pain and paresthesia intensity, sensory and motor distal latency were evaluated as primary outcomes. Boston carpal tunnel Questionnaire scores were evaluated as secondary outcomes. Evaluations were performed at baseline, 1 and 4 weeks after the end of the treatment.
Results
Pain and paresthesia intensity and Boston questionnaire score significantly decreased in all three groups, but the greater improvement was noted in shockwave groups. Sensory and motor distal latency were only improved in shockwave groups. In terms of clinical and electrophysiological parameters, two groups of shockwaves showed similar results.
Conclusions
Radial shockwave combined with conventional physiotherapy is an effective noninvasive treatment for mild-to-moderate carpal tunnel syndrome that produces greater and longer-lasting results than conventional physiotherapy alone. There were no differences observed between utilizing radial shockwave on the carpal tunnel or median nerve pathways on the palmar surface of the hand, in terms of clinical and electrophysiological measurements.
Clinical Trial registration number The study was registered at https://fa.irct.ir/user/trial/49490/view (20200706048028N1) in date of 08/24/2021.
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Badıl Güloğlu S, Bilgilisoy Filiz M, Kılıç KK, Koldaş Doğan Ş, Toslak İE, Toraman NF. Treatment of carpal tunnel syndrome by low-level laser therapy versus corticosteroid injection: a randomized, prospective clinical study. Lasers Med Sci 2022; 37:2227-2237. [PMID: 35022874 DOI: 10.1007/s10103-021-03489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022]
Abstract
To compare the effects of low level laser therapy (LLLT) and corticosteroid injection in patients with moderate carpal tunnel syndrome (CTS). Eighty-seven patients (143 wrists) with moderate CTS were randomized to the corticosteroid or LLLT groups. 40 mg of triamcinolone acetate solution was applied to carpal tunnel of 44 patients (74 wrist). LLLT was applied to 43 patients (70 wrist) five times a week, for a total of 15 sessions (fluence of 6 j/cm2 for 1 min per point at a wavelength of 830 nm). Outcome measures were numbness and pain, QuickDASH questionnaire, grasping tests, Tinel and Phalen tests, electrophysiological tests and MRI evaluations, which were tested at the baseline and 1st and 6th months after the treatment. Eighty patients (133 wrists) completed the study at the end of 6 months. VAS and Quick DASH scores were better in the corticosteroid group in the 1st month, but there were no significant differences between groups in the 6th month. Phalen and Tinel tests, strength tests, and motor distal latency improved significantly and similarly in both groups at the 1st and 6th months. Sensory distal latency and sensory nerve conduction velocity showed significant improvements in the 1st and 6th months only in the corticosteroid group. In both groups, median nerve intensity rate and palmary spring rate improved significantly after the treatment. Based on this study, corticosteroid injection and LLLT groups showed statistically significant difference at the 1st month (short-term), whereas there was no significant difference at the 6th month (intermediate-term).
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Affiliation(s)
- Sevtap Badıl Güloğlu
- Physical Medicine and Rehabilitation, Health Science University Antalya Training and Research Hospital, Antalya, Turkey.
| | - Meral Bilgilisoy Filiz
- Physical Medicine and Rehabilitation, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Koray Kaya Kılıç
- Radiology, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Şebnem Koldaş Doğan
- Physical Medicine and Rehabilitation, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - İclal Erdem Toslak
- Radiology, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Naciye Füsun Toraman
- Physical Medicine and Rehabilitation, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
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Xie Y, Zhang C, Liang B, Wang J, Wang L, Wan T, Xu F, Lei L. Effects of shock wave therapy in patients with carpal tunnel syndrome: a systematic review and meta-analysis. Disabil Rehabil 2022; 44:177-188. [PMID: 32419508 DOI: 10.1080/09638288.2020.1762769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To determine whether shock wave therapy could improve symptoms and hand function in patients with carpal tunnel syndrome. MATERIALS AND METHODS Medline, Embase, Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, OpenGrey, CNKI, VIP, Wang Fang databases, and China Biological Medicine were searched, from inception to December 2019. RESULTS Ten trials involving 433 patients (501 wrists) were included in this systematic review. The shock wave therapy was observed to have a significant effect on pain relief (MD: -0.60, 95% CI: -1.16 to -0.05, p = 0.03), syndrome alleviation (MD: -2.26, 95% CI: -3.24 to -1.27, p < 0.00001) and functional recovery (MD: -1.25 95% CI: -2.08 to -0.43, p = 0.003) among the carpal tunnel syndrome patients. As revealed by the subgroup analysis, radial shock wave therapy made a significant difference in pain relief, syndrome alleviation, and functional recovery (p < 0.05). Focused shock wave had no significant effect on pain relief, syndrome alleviation, and functional recovery (p > 0.05). CONCLUSION Shock wave therapy could be conductive to improve syndrome and hand function for carpal tunnel syndrome patients.Implications for rehabilitationShock wave therapy is beneficial for alleviating syndrome and improving hand function of carpal tunnel syndrome patients.Radial shock wave therapy seems superior to focused shock wave therapy on syndrome alleviation and functional recovery of hand in carpal tunnel syndrome patients.
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Affiliation(s)
- Yujie Xie
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Chi Zhang
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Bin Liang
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Jianxiong Wang
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Li Wang
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Tenggang Wan
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Fangyuan Xu
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Lei Lei
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
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13
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Haghighat S, Khosravi M, Rezaei M. The Effect of Shock Wave and Phonophoresis in the Improvement of the Clinical Symptoms and Function of Patients with Mild to Moderate Carpal Tunnel Syndrome: A Clinical Trial. Med J Islam Repub Iran 2021; 35:179. [PMID: 35706523 PMCID: PMC9167763 DOI: 10.47176/mjiri.35.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Carpal tunnel syndrome is a common condition that causes pain, sensory and motor symptoms in the hands, especially in the thumb, index, and middle fingers due to the compression of the median nerve in the carpal tunnel. The purpose of this research was to investigate the effect of the shock wave and phonophoresis in the improvement of clinical symptoms and function of patients with mild to moderate carpal tunnel syndrome. Methods: The present research has employed a double-blind randomized clinical trial on 60 patients in Isfahan, Iran. Patients were randomly divided into 3 treatment groups of shock, phonophoresis, and control, and all patients received conservative treatments. Wrist thermoplastic splint, vitamin B1, and celecoxib were prescribed for all patients. The shock group received their intervention in four sessions of shock once a week for 4 weeks. Patients in the phonophoresis group received phonophoresis (pulse 1:4) 15 minutes every other day for 2 weeks. Pain scores were assessed based on the visual analog pain scale, and the Boston questionnaire severity scale was completed for each patient before, 1 and 2 months after the intervention. The used analytic tests included Fisher's exact tests, 1-way analysis of variance, and repeated measures analysis. Results: Shock wave and phonophoresis showed a significant decrease in pain, symptom severity index (p<0.001), and functional status (p<0.001). This reduction was more persistent in the phonophoresis group. Conclusion: The use of noninvasive shock wave and phonophoresis methods were good alternatives in the treatment of carpal tunnel syndrome.
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Affiliation(s)
- Shila Haghighat
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Khosravi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Rezaei
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Hernández-Secorún M, Montaña-Cortés R, Hidalgo-García C, Rodríguez-Sanz J, Corral-de-Toro J, Monti-Ballano S, Hamam-Alcober S, Tricás-Moreno JM, Lucha-López MO. Effectiveness of Conservative Treatment According to Severity and Systemic Disease in Carpal Tunnel Syndrome: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2365. [PMID: 33671060 PMCID: PMC7957741 DOI: 10.3390/ijerph18052365] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022]
Abstract
(1) Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and moderate idiopathic CTS. However, severe CTS and systemic conditions were an exclusion criterion from the studies. The aim of this study is to review the effectiveness of conservative treatment in patients with CTS regardless of the level of severity and the presence or not of systemic diseases in the last ten years. (2) Methods: Randomized controlled clinical trials that compared the effect of conservative treatment on the Boston questionnaire and pain were selected. PubMed, PEDro, Scopus, Cochrane, and Web of Science databases were used. PRISMA statement checklist was performed. (3) Results: 876 studies were recorded, 29 were selected. Pharmacology, Electrotherapy and Manual Therapy had benefits for CTS. Electrotherapy and manual therapy could be effective for severe CTS patients with a systemic condition in the short term, but there was a low percentage of these patients included in the studies. (4) Conclusion: Some pharmacological treatments, manual therapy and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown. It would be necessary to include patients with systemic conditions in the selection criteria for future studies.
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Affiliation(s)
- Mar Hernández-Secorún
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - Raquel Montaña-Cortés
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
| | - César Hidalgo-García
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jacobo Rodríguez-Sanz
- Department of Basic Sciences, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain;
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Jaime Corral-de-Toro
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - Sofia Monti-Ballano
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - Sami Hamam-Alcober
- Unit of Reconstructive Surgery of the Locomotor System, Hand-Microsurgery, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - José Miguel Tricás-Moreno
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - María Orosia Lucha-López
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
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15
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Stania M, Król B, Franek A, Błaszczak E, Dolibog P, Polak A, Dolibog P, Durmała J, Król P. A comparative study of the efficacy of radial and focused shock wave therapy for tennis elbow depending on symptom duration. Arch Med Sci 2021; 17:1686-1695. [PMID: 34900050 PMCID: PMC8641526 DOI: 10.5114/aoms.2019.81361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In physical therapy, the duration and severity of pain complaints determine the choice of an appropriate physical agent and parameters needed. The aim of this study was to compare the therapeutic efficacy of focused and radial shock waves for tennis elbow with respect to the dysfunction period. MATERIAL AND METHODS The patients with acute (n = 27) and chronic (n = 31) tennis elbow were randomly assigned to a treatment arm: focused shock wave therapy (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm²) or radial shock wave therapy (3 sessions, 2000 shocks, 8 Hz, 2.5 bar). In order to objectivize therapy effects, the severity of pain complaints (Visual Analog Scale), strength of wrist flexors and extensors and grip strength were assessed. We performed pre-intervention measurements and short-term follow-up at 1, 6 and 12 weeks of therapy completion. RESULTS At 6 and 12 weeks of therapy completion, all groups exhibited significantly reduced pain complaints (p < 0.05). The most noticeable changes in grip strength, wrist extensors and flexors strength were observed in the affected extremities of all experimental groups while changes within the unaffected extremities were slight. Grip strength as well as the strength of flexor and extensor muscles of the affected limb were significantly greater at 12 weeks of therapy completion compared to pre-intervention values (p < 0.05). At the same time point, percent changes of all study parameters were comparable for all groups (p > 0.05). CONCLUSIONS Focused and radial shock wave therapy tend to show a significant and comparable short-term therapeutic effect for acute and chronic tennis elbow.
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Affiliation(s)
- Magdalena Stania
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Barbara Król
- Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia in Katowice, Poland
| | - Andrzej Franek
- Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia in Katowice, Poland
| | - Edward Błaszczak
- Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia in Katowice, Poland
| | - Paweł Dolibog
- Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia in Katowice, Poland
| | - Anna Polak
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Patrycja Dolibog
- Department of Medical Biophysics, School of Medicine in Katowice, Medical University of Silesia in Katowice, Poland
| | - Jacek Durmała
- Department of Rehabilitation, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Poland
| | - Piotr Król
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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16
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Ahmed L, Ismaiel A, Taha N. Comparison between the effect of single-dose radial extracorporeal shock wave and local corticosteroid injection in treatment of patients with carpal tunnel syndrome. JOURNAL OF MEDICINE IN SCIENTIFIC RESEARCH 2021. [DOI: 10.4103/jmisr.jmisr_1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Li W, Dong C, Wei H, Xiong Z, Zhang L, Zhou J, Wang Y, Song J, Tan M. Extracorporeal shock wave therapy versus local corticosteroid injection for the treatment of carpal tunnel syndrome: a meta-analysis. J Orthop Surg Res 2020; 15:556. [PMID: 33228746 PMCID: PMC7685634 DOI: 10.1186/s13018-020-02082-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many studies have demonstrated the effectiveness of extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) for the treatment of carpal tunnel syndrome (CTS), and some studies showed that the effect of ESWT was superior to LCI. We performed this meta-analysis to compare the clinical effects across the two therapies. METHODS Relevant randomized controlled trials (RCTs) comparing ESWT and LCI for the treatment of CTS were searched in electronic database. The Cochrane risk bias tool was used for quality assessment. After data extraction and quality assessment of the included studies, a meta-analysis was performed using RevMan 5.3 software. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were analyzed. The protocol for this systematic review was registered on INPLASY (202080025) and is available in full on the inplasy.com ( https://doi.org/10.37766/inplasy2020.8.0025 ) RESULTS: A total of 5 RCT studies with 204 patients were included from the electronic database. The meta-analysis results showed that two therapies were not significantly different in terms of visual analog scale (VAS) score (P = 0.65), Boston Carpal Tunnel Questionnaire (BQ) score (P = 0.14), sensory distal latency (P = 0.66), and nerve conduction velocity (NCV) of the sensory nerve (P = 0.06). There were significant differences between the results of motor distal latency (P < 0.0001), compound muscle action potential (CMAP) amplitude (P < 0.00001), and sensory nerve action potential (SNAP) amplitude (P = 0.004). CONCLUSIONS In terms of pain relief and function improvement, the effects of ESWT and LCI are not significantly different. In terms of electrophysiological parameters, LCI has a stronger effect on shortening motor distal latency; ESWT is superior to LCI in improving action potential amplitude. ESWT is a noninvasive treatment with fewer complications and greater patient safety. In light of the heterogeneity and limitations, these conclusions require further research for definitive conclusions to be drawn.
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Affiliation(s)
- Wenhao Li
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Chunke Dong
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhencheng Xiong
- Institute of Medical Technology, Peking University Health Science Center, Peking University Third Hospital, Beijing, 100089, China
| | - Liubo Zhang
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jun Zhou
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yanlei Wang
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jipeng Song
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Mingsheng Tan
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China.
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18
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Xu D, Ma W, Jiang W, Hu X, Jiang F, Mao C, Wang Y, Fang L, Luo N, Li H, Lou Z, Gan K. A randomized controlled trial: comparing extracorporeal shock wave therapy versus local corticosteroid injection for the treatment of carpal tunnel syndrome. INTERNATIONAL ORTHOPAEDICS 2019; 44:141-146. [PMID: 31655883 DOI: 10.1007/s00264-019-04432-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/04/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Extracorporeal shock wave therapy (ESWT) has been reported as a new therapy for carpal tunnel syndrome (CTS). However, few studies have compared ESWT with the local corticosteroid injection (LCI). METHODS In this study, a randomized controlled trial comparing 30 patients with ESWT and 25 patients treated with LCI was conducted. The clinical outcomes were obtained with tests including the visual analog scale (VAS) for pain and paresthesia, the Boston Carpal Tunnel Questionnaire (BQ), and a nerve conduction study, before the study started and at three, nine, and 12 weeks after the start of the treatment. RESULTS Significantly greater improvement in the VAS and BQ scores was noted for the ESWT group than for the LCI group (P < 0.05). For the nerve conduction study, there was a significant improvement in the median nerve sensory nerve action potential distal latency at the nine and 12-week follow-ups for the ESWT group. CONCLUSIONS ESWT is a useful noninvasive short-term treatment for mild to moderate carpal tunnel syndrome and elicits a better recovery than LCI does, but more research is needed to test the clinical outcomes of ESWT.
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Affiliation(s)
- Dingli Xu
- Ningbo University Medical School, Ningbo, 315000, China.,Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, 315000, China
| | - Weihu Ma
- Ningbo No.6 Hospital, Ningbo, 31500, China
| | | | - Xundong Hu
- Ningbo No.6 Hospital, Ningbo, 31500, China
| | | | | | - Yang Wang
- Ningbo No.6 Hospital, Ningbo, 31500, China
| | | | - Ni Luo
- Ningbo No.6 Hospital, Ningbo, 31500, China
| | - Haojie Li
- Ningbo No.6 Hospital, Ningbo, 31500, China
| | - Zhenqi Lou
- Ningbo No.6 Hospital, Ningbo, 31500, China
| | - Kaifeng Gan
- Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, 315000, China.
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19
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Kim JC, Jung SH, Lee SU, Lee SY. Effect of extracorporeal shockwave therapy on carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e16870. [PMID: 31415424 PMCID: PMC6831378 DOI: 10.1097/md.0000000000016870] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- Ju Chan Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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