If you suffer from Carpal tunnel syndrome you know that it causes numbness, tingling, and pain in the wrist, hand and arm. You were probably told that you have a compression of the median nerve somewhere among the sea and ligaments of the wrist. For you, like many people, your condition may have worsened overtime.
Over the course of time you have tried:
- Ergonomic modification of office.
- Varying over the counter anti-inflammatories and pain medications.
- Wearing different wrist splints and braces.
- Exercise and physical therapy.
- Steroid injections.
Through your medical journey you may have been given Electrophysiological tests to the degree of median nerve impairment in carpal tunnel syndrome. This would include:
- Nerve conduction studies (NCS).
- Electromyogram (EMG).
A July 2022 study (1) compared the effects of radial extracorporeal shock wave therapy and local corticosteroid injection in patients with carpal tunnel syndrome
- A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study.
- One group received radial extracorporeal shock wave therapy,
- One group received the local corticosteroid injection
- The control group only used a resting hand splint.
Results:
- Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients.
- Pain, numbness and function scores improved in the first week after the treatment. At the 12th week after the treatment, these scores were significantly lower in the local corticosteroid injection group compared with the other two groups.
A June 2022 paper (2) compared the effects of low level laser therapy and corticosteroid injection in patients with moderate carpal tunnel syndrome (CTS).
- Eighty-seven patients (143 wrists) with moderate CTS were randomized to the corticosteroid or low level laser therapy groups. 40 mg of triamcinolone acetate solution was applied to carpal tunnel of 44 patients (74 wrist). Low level laser therapy was applied to 43 patients (70 wrist) five times a week, for a total of 15 sessions
- In both groups, median nerve intensity rate and palm function and pain improved significantly after the treatment. Based on this study, corticosteroid injection and low level laser therapy groups showed statistically significant difference at the 1st month (short-term), whereas there was no significant difference at the 6th month (intermediate-term).
A June 2022 study (3) tested the effects of hydrodissection in carpal tunnel syndrome. The researchers wrote: “Hydrodissection is an ultrasound-guided technique that has received more attention recently for its role in nerve entrapment syndromes. The purposes of this systematic review were to evaluate the safety and effectiveness of hydrodissection in carpal tunnel syndrome . . . (The researchers) concluded that nerve hydrodissection for carpal tunnel syndrome can be safely performed under ultrasound guidance. However, it is unclear whether the hydrodissection mechanism truly causes improvements in clinical outcomes. We were also unable to draw conclusions regarding the ideal procedure-related parameters.
A February 2022 study (4) assessed the effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients. In this study the researchers examined six previously published outcome studies involving 401 patients. Reviewing these findings the research team concluded that their study: “highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with carpal tunnel syndrome.
1 Durmaz, H.Ö., Tuncay, F., Durmaz, H. and Erdem, H.R., 2022. Comparison of Radial Extracorporeal Shock Wave Therapy and Local Corticosteroid Injection Effectiveness in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Study. American Journal of Physical Medicine & Rehabilitation, 101(7), pp.685-692.
2 Güloğlu SB, Filiz MB, Kılıç KK, Doğan ŞK, Toslak İE, Toraman NF. Treatment of carpal tunnel syndrome by low-level laser therapy versus corticosteroid injection: a randomized, prospective clinical study. Lasers in medical science.
3 Neo EJ, Shan NT, San Tay S. Hydrodissection for carpal tunnel syndrome: A systematic review. American journal of physical medicine & rehabilitation.
4 Jiménez-del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E, Pérez-Bellmunt A. The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis. International orthopaedics. 2021 Dec 3:1-2.
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