Extracorporeal shock wave therapy versus local corticosteroid injection for the treatment of carpal tunnel syndrome: a meta-analysis

J Orthop Surg Res. 2020 Nov 23;15(1):556. doi: 10.1186/s13018-020-02082-x.


Background: Many studies have demonstrated the effectiveness of extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) for the treatment of carpal tunnel syndrome (CTS), and some studies showed that the effect of ESWT was superior to LCI. We performed this meta-analysis to compare the clinical effects across the two therapies.

Methods: Relevant randomized controlled trials (RCTs) comparing ESWT and LCI for the treatment of CTS were searched in electronic database. The Cochrane risk bias tool was used for quality assessment. After data extraction and quality assessment of the included studies, a meta-analysis was performed using RevMan 5.3 software. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were analyzed. The protocol for this systematic review was registered on INPLASY (202080025) and is available in full on the inplasy.com ( https://doi.org/10.37766/inplasy2020.8.0025 ) RESULTS: A total of 5 RCT studies with 204 patients were included from the electronic database. The meta-analysis results showed that two therapies were not significantly different in terms of visual analog scale (VAS) score (P = 0.65), Boston Carpal Tunnel Questionnaire (BQ) score (P = 0.14), sensory distal latency (P = 0.66), and nerve conduction velocity (NCV) of the sensory nerve (P = 0.06). There were significant differences between the results of motor distal latency (P < 0.0001), compound muscle action potential (CMAP) amplitude (P < 0.00001), and sensory nerve action potential (SNAP) amplitude (P = 0.004).

Conclusions: In terms of pain relief and function improvement, the effects of ESWT and LCI are not significantly different. In terms of electrophysiological parameters, LCI has a stronger effect on shortening motor distal latency; ESWT is superior to LCI in improving action potential amplitude. ESWT is a noninvasive treatment with fewer complications and greater patient safety. In light of the heterogeneity and limitations, these conclusions require further research for definitive conclusions to be drawn.

Keywords: Carpal tunnel syndrome; Extracorporeal shock wave; Local corticosteroid injection; Meta-analysis.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review

MeSH terms

  • Action Potentials
  • Adrenal Cortex Hormones / administration & dosage*
  • Carpal Tunnel Syndrome / diagnosis
  • Carpal Tunnel Syndrome / physiopathology
  • Carpal Tunnel Syndrome / therapy*
  • Extracorporeal Shockwave Therapy / methods*
  • Female
  • Humans
  • Injections, Intralesional
  • Male
  • Neural Conduction
  • Pain Management / methods
  • Randomized Controlled Trials as Topic
  • Reaction Time
  • Recovery of Function
  • Sensory Receptor Cells / physiology
  • Treatment Outcome


  • Adrenal Cortex Hormones