Shockwave therapy and carpal tunnel syndrome - What does the evidence suggest?

Focused shockwave therapy (fESWT) shows effectiveness as a non-invasive treatment for carpal tunnel syndrome (CTS), particularly for mild to moderate cases, and to a lesser extent for moderate to severe cases.

Key Findings from Recent Studies

• Short-term Symptom and Function Improvement:

  Multiple randomised controlled trials indicate that fESWT, when combined with conservative treatments (such as night splints and gliding exercises), provides significant short-term improvements in symptoms, hand function, and nerve conduction compared to conservative treatment alone. These benefits are observed in both mild-to-moderate and moderate-to-severe CTS.

• Pain and Nerve Conduction:

  Patients treated with fESWT report reduced pain scores (as measured by the visual analogue scale) and improved sensory and motor nerve conduction parameters at follow-ups ranging from 3 to 12 weeks after treatment. Improvements are also seen in hand grip strength and patient-reported outcomes.

• Treatment Protocol:

  Most studies use a protocol of three weekly sessions of fESWT, with energy flux densities ranging from 0.01 to 0.15 mJ/mm² and 1500 pulses per session. 

• Effectiveness Compared to Other Treatments:

  While fESWT is effective, a recent systematic review and meta-analysis found that its effects may not be significantly different from night wrist splinting in some cases, suggesting that its superiority over standard conservative treatments remains debatable.

• Safety and Non-invasiveness:

  fESWT is considered safe and non-invasive, with no significant adverse effects reported in the reviewed studies.

Focused shockwave therapy is an effective and non-invasive option for short-term management of carpal tunnel syndrome, especially when combined with conservative measures. Its benefits include pain relief, improved function, and better nerve conduction, but its long-term efficacy and superiority over standard conservative treatments remain uncertain.