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Carpal Tunnel Syndrome (CTS) is a common upper extremity nerve compression syndrome that causes significant economic and social burden to affected individuals. Although the severity may vary among patients, symptoms such as night pain, transient numbness, tingling, constant pain, muscle weakness, and sleep disturbance may be observed. The treatment of CTS can be grouped as nonsurgical and surgical treatments. The aim of this study is to investigate the effects of treatment with sound waves and a healing method called extracorporeal shock wave therapy and a therapeutic flexible tape called kinesiology taping on pain, grip strength, quality of life, depression symptoms, hand functions, and ultrasonographic median nerve cross-sectional area in patients with CTS.
Carpal tunnel syndrome is the most common nerve entrapment syndrome, typically affecting the dominant extremity. Symptoms often become more pronounced at night, and may include numbness, tingling, electric shock sensations, pain, and other related symptoms. Diagnosis can be made based on patient history, physical examination, electrodiagnostic tests, and ultrasonography. Treatment options include splinting, exercise therapy, physical therapy modalities, various injections, and surgical methods.
In our study, we compared the effects of extracorporeal shock wave therapy (ESWT) and kinesiology taping (KT) on carpal tunnel syndrome. The study involved four randomized groups: Group 1 received both ESWT and KT, Group 2 received only ESWT, Group 3 received only KT, and Group 4 received exercise therapy alone. Evaluations were conducted using the Visual Analog Scale, Boston Carpal Tunnel Questionnaire, Douleur Neuropathique 4 Questions, Nottingham Health Profile, grip strength measurements, and median nerve cross-sectional area via ultrasonography. Evaluations were performed three times: before treatment, at week 3, and at week 6.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | Active Comparator | Those who received both extracorporeal shock wave therapy (ESWT) and kinesio taping (KB) |
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| Group 2 | Active Comparator | Those who received ESWT |
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| Group 3 | Active Comparator | Those who received KT |
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| Group 4 | Other | Those who received only exercise |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Extracorporeal shock wave therapy (ESWT) | Other | Radial ESWT (Vibrolith OrthoⓇ) was applied to the wrist as 1000 pulses with a frequency of 5 Hz and a power of 1.5 bar. The treatment was applied once a week for a total of 3 sessions. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain level before treatment, 3rd week and 6th week after treatment | Pain level will be evaluated with the Visual Analog Scale. (minimum: 0, maximum: 100 mm) | From enrollment to the end of treatment at 3rd week and 6th week |
| Assessment of symptom severity and functionality | The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) questionnaire was used to assess symptom severity and functionality. It includes 2 subgroups: Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Symptom severity is assessed with 11 questions, and functional status is assessed with 8 questions. Each question is scored from low to high, 1 to 5. As the total score increases, deterioration increases. | From enrollment to the end of treatment at 3rd week and 6th week |
| Assessment of median nerve cross sectional area by ultrasonography | The median nerve cross-sectional area was measured by tracing just proximal to the carpal tunnel entrance with the wrist resting on a table in a neutral position. The carpal tunnel entrance was identified by detecting the proximal side of the transverse carpal ligament. The distal radioulnar joint was also observed at this level. | From enrollment to the end of treatment at 3rd week and 6th week |
| Measure | Description | Time Frame |
|---|---|---|
| Assessment of grip strength and lateral pinch strength | A hydraulic hand dynamometer was used to assess grip strength, and a hydraulic pinchmeter was used to assess lateral pinch strength. Measurements were made using the 2nd level resistance (3.75 cm) with the elbow at 90 degrees of flexion and the forearm and wrist in a neutral position. Patients were asked to squeeze with maximum force, measurements were made three times, and the average result was recorded in kilograms. For lateral pinch (LP), the pinchmeter was pressed with the distal middle of the thumb, and the lateral part of the second phalanx of the index finger was used to support the lower part. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Banu Kuran, Professor, MD | ĹžiĹźli Hamidiye Etfal Training and Research Hospital, Deparment of Physical Medicine and Rehabilitation | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| ĹžiĹźli Hamidiye Etfal Training and Research Hospital | Istanbul | Turkey (TĂĽrkiye) |
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| Kinesio taping (KT) | Other | KT was prepared as 2 pieces of 2.5 cm I band and 1 piece of 5 cm I band. It was applied with a maximum of 50% tension (without tension on the ends) while the wrist was in 30 degrees of extension, forearm supination and elbow extension. The treatment was applied once a week for a total of 3 sessions. |
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| Exercise | Other | Median nerve gliding exercises were given to the 4th group during the follow-up period. The same exercises were given to the other groups. |
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| From enrollment to the end of treatment at 3rd week and 6th week |
| Assessment of functionality | Duruöz Hand Index was used for functional assessment. This questionnaire contains 18 questions on hand activities. It consists of five areas. There are eight questions on kitchen activities, two questions on dressing, two questions on personal hygiene, two questions on office work and four questions on other activities. The patient selects one of the answers for each question on a scale of one to five. The scores given for each question are added to obtain a total score ranging from 0 to 90. Higher scores indicate more severe hand disability. | From enrollment to the end of treatment at 3rd week and 6th week |
| Assessment of neuropathic pain | Douleur Neuropathique 4 Questions was used to assessment of neuropathic pain. The DN4 questionnaire consists of 10 items. The first 7 items are related to pain characteristics and sensation, while the remaining 3 items are related to examination. For each item, a score of "1" is given if the answer is "yes" and a score of "0" if the answer is "no". If the total number of yes answers from the 10 items is calculated as 4 or more, the patient is defined as having neuropathic pain. | From enrollment to the end of treatment at 3rd week and 6th week |
| Assessment of quality of life | The Nottingham Health Profile was used.As a general health status questionnaire, it provides a brief indication of a patient's perceived emotional, social and physical health and is designed for use in the general population. It is concerned with the individual's health status and includes energy levels, pain, emotional responses, sleep, social isolation and physical abilities. The energy levels domain consists of 3 items, pain 8 items, emotional responses 9 items, sleep and social isolation domains 5 items each and physical abilities domain 8 items. Each item requires a yes or no response. The patient's score is calculated out of a total of 600 points. The higher the score, the lower the quality of life. | From enrollment to the end of treatment at 3rd week and 6th week |
| Assessment of depression | Beck Depression Inventory was used for depression assessment. It consists of 21 items with four precursors scored between 0 and 3. Patients are asked to mark the item that best suits their mood in the past week. As the score increases, it is thought that the depressive state is more severe. The total score is scored as 0-9 = Minimal, 10-16 = mild, 17-29 = moderate, 30-63 = severe. | From enrollment to the end of treatment at 3rd week and 6th week |
| ID | Term |
|---|---|
| D002349 | Carpal Tunnel Syndrome |
| ID | Term |
|---|---|
| D020423 | Median Neuropathy |
| D020422 | Mononeuropathies |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
| D009408 | Nerve Compression Syndromes |
| D012090 | Cumulative Trauma Disorders |
| D013180 | Sprains and Strains |
| D014947 | Wounds and Injuries |
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| ID | Term |
|---|---|
| D000074059 | Extracorporeal Shockwave Therapy |
| D015444 | Exercise |
| ID | Term |
|---|---|
| D014464 | Ultrasonic Therapy |
| D003972 | Diathermy |
| D006979 | Hyperthermia, Induced |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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