Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome


Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran


Background: The carpal tunnel syndrome (CTS) is the most common neuropathy. The aim of this study was to evaluate the effect of a new and noninvasive treatment including extracorporeal shock wave therapy (ESWT) in the treatment of CTS.
Materials and Methods: This study is a clinical trial conducted on 60 patients with moderate CTS in selected health centers of Isfahan Medical University from November 2014 to April 2015. Patients with CTS were randomly divided into two groups. Conservative treatment including wrist splint at night for 3 months, consumption of nonsteroidal anti-inflammatory drugs for 2 weeks, and oral consumption of Vitamin B1 for a month was recommended for both groups. The first group was treated with ESWT, one session per week for 4 weeks. Focus probe with 0.05, 0.07, 0.1, and 0.15 energy and shock numbers 800, 900, 1000, and 1100 were used from the first session to the fourth, respectively. The evaluated parameters were assessed before treatment and after 3 and 6 months. Data were analyzed using SPSS version 19, Student's t-test, and Chi-square test.

Results: All parameters were significantly decreased in the ESWT group after 3 months. These results remained almost constant after 6 months compared with 3 months after treatment. However, only two parameters considerably improved after 3 months of treatment in the control group. The entire indexes in the control group implicated the regression of results in long-term period.

Conclusion: It is recommended to use ESWT as a conservative treatment in patients with CTS.


LeBlanc KE, Cestia W. Carpal tunnel syndrome. Am Fam Physician 2011;83:952-8.  Back to cited text no. 1
Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001. J Neurol Neurosurg Psychiatry 2003;74:1674-9.  Back to cited text no. 2
Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002;58:289-94.  Back to cited text no. 3
da Costa BR, Vieira ER. Risk factors for work-related musculoskeletal disorders: A systematic review of recent longitudinal studies. Am J Ind Med 2010;53:285-323.  Back to cited text no. 4
O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003;1:CD003219.  Back to cited text no. 5
Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008;77:6-17.  Back to cited text no. 6
Payne JM, Brault JS. Digital ischemia after carpal tunnel injection: A case report. Arch Phys Med Rehabil 2008;89:1607-10.  Back to cited text no. 7
Tucci M, Freeland A, Mohamed A, Benghuzzi H. The role of proteoglycans in idiopathic carpal tunnel syndrome. Biomed Sci Instrum 2005;41:141-6.  Back to cited text no. 8
Hammer DS, Adam F, Kreutz A, Kohn D, Seil R. Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: A 2-year follow-up. Foot Ankle Int. 2003;24:823-8.  Back to cited text no. 9
Vulpiani MC, Trischitta D, Trovato P, Vetrano M, Ferretti A. Extracorporeal shockwave therapy (ESWT) in Achilles tendinopathy. A long-term follow-up observational study. J Sports Med Phys Fitness 2009;49:171-6.  Back to cited text no. 10
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 2009;16:2366-72.  Back to cited text no. 11
Ciampa AR, de Prati AC, Amelio E, Cavalieri E, Persichini T, Colasanti M, et al. Nitric oxide mediates anti-inflammatory action of extracorporeal shock waves. FEBS Lett 2005;579:6839-45.  Back to cited text no. 12
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.  Back to cited text no. 13
Dumitru D, Amato AA, Zwarts MJ. Electrodiagnostic medicine. San Antonio, Texas: Hanley and Belfu; 2002.  Back to cited text no. 14
Mariotto S, Cavalieri E, Amelio E, Ciampa AR, de Prati AC, Marlinghaus E, et al. Extracorporeal shock waves: From lithotripsy to anti-inflammatory action by NO production. Nitric Oxide 2005;12:89-96.  Back to cited text no. 15
Hancock CM, Riegger-Krugh C. Modulation of pain in osteoarthritis: The role of nitric oxide. Clin J Pain 2008;24:353-65.  Back to cited text no. 16
Ferreira SH, Duarte ID, Lorenzetti BB. The molecular mechanism of action of peripheral morphine analgesia: Stimulation of the cGMP system via nitric oxide release. Eur J Pharmacol 1991;201:121-2.  Back to cited text no. 17
Kosterlitz HW, Wallis DI. The action of morphine-like drugs on impulse transmission in mammalian nerve fibres. Br J Pharmacol Chemother 1964;22:499-510.  Back to cited text no. 18
Page MJ, O'Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;1:CD009601.  Back to cited text no. 19