The Effect of ESWT in Carpal Tunnel Syndrome
Condition: Carpal Tunnel Syndrome
MeSH terms: Carpal Tunnel Syndrome; Syndrome
Study type: Interventional

Summary: 
      50 patients who meet the inclusion criteria will be included in this prospective, randomized
      and controlled study. Demographic information of the patients will be taken and recorded.
      After the patients are numbered according to the order of application, they will be divided
      into 2 groups as study and control groups according to randomization with the computer
      program. A total of 5 sessions of ESWT (1000 shock, 1.6 bar, 5 Hz) will be applied to the
      study group (1st group) for 2 weeks. Patients will be taught median nerve and tendon shifting
      exercises and will be asked to do it regularly. Patients in the control group (Group 2) will
      be asked to perform median nerve and tendon shifting exercises only for the wrist. Patients
      will be evaluated before treatment, at 4 and 12 weeks after treatment. In the evaluation,
      Boston Carpal Tunnel Inquiry Form, pain severity assessment with VAS (visual analog scale),
      neuropathic pain intensity with LANSS scale and median nerve conduction velocity with EMG
      will be evaluated.
    

Detailed description: 
      Carpal tunnel syndrome is a clinical picture that occurs with a group of symptoms and signs
      as a result of compression and compression in the carpal tunnel where the median nerve passes
      to the wrist. Another name is hand-wrist canal disease, the most common entrapment is
      neuropathy. It is generally observed in individuals between the ages of 40-60, its prevalence
      is 4-5%, and it is 3 times more common in women than men. Clinical signs 1.-2.-3. numbness,
      tingling, abduction and positioning of the thumb, pain in the wrist and inner part of the
      hand, autonomic symptoms (heat or discoloration, dry skin) worsening of symptoms due to
      provocative factors (forcing the wrist to flex). Loss of strength and atrophy of the palm
      muscles occur in the later stages. The diagnosis is made by clinical examination,
      electrophysiological methods (EMG) and imaging methods (such as ultrasound, magnetic
      resonance imaging). Clinical examination consists of sensory motor examination and
      provocative tests. Treatment is divided into conservative and surgical. Among the
      conservative treatment methods, splinting, exercise (sliding movements of the median nerve
      and wrist flexor tendons in the wrist), local corticosteroid injection (corticosteroid
      injection into the carpal tunnel), ultrasound (warming the deep tissues with sound energy),
      TENS (electrodes placed on the skin). pain relief by applying controlled low-voltage electric
      current to the nervous system through the skin), paraffin bath (immersion of the hand in a
      pool of heat-melted paraffin), ergonomic arrangements. ESWT is a widely used treatment method
      in the treatment of carpal tunnel syndrome in recent years. ESWT is called "Extracorporeal
      Shock Wave Therapy", in Turkish "Shock Wave Therapy Applied Outside the Body" or simply
      "Shock Wave Therapy". It is a treatment method based on the principle of focusing the shock
      (pressure) waves created outside the body to the desired area of the body by means of a
      steel-headed applicator. Shock waves are single pulsatile acoustic waves of high amplitude.
      It reaches high pressure (100Mpa) and then negative pressure (5-10 Mpa) in a short time
      expressed in nanoseconds (10 ns). This device was first applied in the destruction of urinary
      stones in the 1980s. In the following years, it has been used in cases such as shoulder
      calcific tendinitis, lateral epicondylitis, plantar fasciitis, and fracture healing.
      Currently indications for ESWT are non-union fractures, revision arthroplasties, lateral
      epicondylitis, plantar fascitis, calcified tendinitis of the shoulder, avascular necrosis of
      the femoral head, Achilles tendinitis, patellar tendinitis, myofascial pain syndrome,
      ischemic heart disease, peyronia disease, chronic diabetic heart disease. It covers a wide
      range of disease groups such as ulcers, knee osteoarthritis, complex regional pain syndrome,
      carpal tunnel syndrome. Studies have shown that ESWT increases angiogenesis,
      neovascularization, anti-inflammatory growth factor release, progenitor and stem cell
      activation. Morphological changes were detected in cutaneous sensory nerve fibers with shock
      wave application on the nerves. It has been observed that there is a relationship between
      reduction of PGP 9.5 (protein gene product) and CGRP (calcitonin gene-related peptide) and
      pain reduction following shock application in sensory nerve fibers in the epidermal region.
      At the same time, integrin molecules are secreted for axonal growth with shock application
      and this continues cumulatively with ESWT application. GAP 43 (growth associated
      phosphoprotein) molecule, which is a marker related to axonal regeneration and which is
      highly expressed especially during neuron development and axonal 3/10 elongation, has been
      found to increase after ESWT application. In this study, it was aimed to investigate the
      effectiveness of ESWT treatment applied to patients diagnosed with mild to moderate carpal
      tunnel syndrome by EMG.
    

Intervention name(s): ESWT
Intervention type(s): Device
Intervention description(s): In the study group, a total of 5 sessions of focused ESWT (1000 shock, 1.6 bar, 5 Hz) will be applied to the affected wrist within 2 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: After the patients are numbered according to the order of application, they will be divided into 2 groups as study and control groups according to randomization made with the computer program (block randomization). A total of 5 sessions of ESWT (1000 shock, 1.6 bar, 5 Hz) will be applied to the study group (1st group) for 2 weeks. Median nerve and tendon shifting exercises will be taught to the patients and they will be asked to do it regularly. Patients in the control group (Group 2) will be asked to perform median nerve and tendon shifting exercises only for the wrist. Patients will be evaluated before treatment and at 4 and 12 weeks after treatment.
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: ESWT