Carpal Tunnel Syndrome (CTS)
Conditions
Keywords
carpal tunnel syndrome, extracorporeal shock wave therapy, kinesio taping
Brief summary
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.
Detailed description
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.
Interventions
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.
OTHERKinesio taping (KT)
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.
OTHERExercise
Median nerve gliding exercises were given to the 4th group during the follow-up period. The same exercises were given to the other groups.
Sponsors
Sisli Hamidiye Etfal Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Mild to moderate unilateral carpal tunnel syndrome confirmed by electroneuromyography (ENMG) * Patients over 18 years of age * Symptom duration of at least 3 months * Those who have not received any medical treatment other than analgesics in the last 3 months
Exclusion criteria
* Bilateral Carpal Tunnel Syndrome (CTS) * Severe CTS detected by ENMG * Operated CTS * Corticosteroid injection within the last 3 months * History of peripheral nerve damage * Secondary CTS causes (thyroid dysfunction, connective tissue diseases) * Cervical disc herniation * DeQuervain tenosynovitis, trigger finger, Dupuytren contracture * Inflammatory disorder * Bleeding disorder * Pregnancy * Malignancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain level before treatment, 3rd week and 6th week after treatment | From enrollment to the end of treatment at 3rd week and 6th week | Pain level will be evaluated with the Visual Analog Scale. (minimum: 0, maximum: 100 mm) |
| Assessment of symptom severity and functionality | From enrollment to the end of treatment at 3rd week and 6th week | 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. |
| Assessment of median nerve cross sectional area by ultrasonography | From enrollment to the end of treatment at 3rd week and 6th week | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of quality of life | From enrollment to the end of treatment at 3rd week and 6th week | 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. |
| Assessment of grip strength and lateral pinch strength | From enrollment to the end of treatment at 3rd week and 6th week | 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. |
| Assessment of depression | From enrollment to the end of treatment at 3rd week and 6th week | 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. |
| Assessment of functionality | From enrollment to the end of treatment at 3rd week and 6th week | 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. |
| Assessment of neuropathic pain | From enrollment to the end of treatment at 3rd week and 6th week | 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. |
Countries
Turkey (Türkiye)
Outcome results
None listed