Comparison of high- and low-dose radial extracorporeal shock wave therapy in carpal tunnel syndrome

The aim of this study was to compare the efficacy of radial extracorporeal shock wave therapy administered at low vs. high pressures in patients with carpal tunnel syndrome.

Patients with carpal tunnel syndrome were randomized into two groups: low-dose group and high-dose group. Each patient underwent a total of four sessions of radial extracorporeal shock wave therapy, administered once a week. The radial extracorporeal shock wave therapy was delivered at 4.0 bars for the high-dose group and 1.5 bars for the low-dose group. Both groups received conventional physical therapy program consisting of transcutaneous electrical nerve stimulation, paraffin wax, orthoses, and tendon gliding exercises, three times per week over a 4-week duration. Outcome measures included pain levels, hand grip strength, pinch strength, the Boston Carpal Tunnel Syndrome Questionnaire, and nerve conduction studies.

Both groups exhibited improvements across all measures, except for the nerve conduction studies parameters. In the intragroup analysis, statistically significant differences were observed with small-to-moderate effect sizes for median motor distal latency, median sensory nerve conduction velocity, median sensory distal latency, and the Boston functional status subscale, all favoring the high-dose group (p<0.05). In the low-dose group, a statistically significant difference with a moderate effect size was noted solely for hand grip strength (p<0.05).

High-dose radial extracorporeal shock wave therapy was significantly better than low-dose radial extracorporeal shock wave therapy with small-to-moderate effect sizes in the recovery of the function and nerve conduction studies parameters of patients with carpal tunnel syndrome.

The study was registered on the Clinical Trials Registry (registration number: NCT05681663).