The aim of the study is to examine the effects of ESWT applications at different pulse rates
on pain, function, grip strength and median nerve conduction velocity in patients with Carpal
Tunnel Syndrome. The sample of the study will consist of patients with carpal tunnel syndrome
who were diagnosed in Gaziosmapaşa Training and Research Hospital between April 2022 and
December 2022 and whose symptoms have persisted for at least 3 months. The patients will be
randomly divided into 3 groups: the low dose ESWT group (28), the high dose ESWT group (28),
and the control group (28). The first two groups will receive ESWT treatment at different
doses, while the control group will be treated with sound only (1 time/week-3 weeks). The
evaluation of the patients participating in the study will be made by the physician who is
not aware of the groups. Evaluations will be made 3 times before the treatment, at the 1st
month and at the 3rd month. In the evaluation, Boston Carpal Tunnel Syndrome Questionnaire to
evaluate symptoms and functionality, visual analog scale (VAS) to evaluate pain, SF-36 to
evaluate quality of life, hand dynamometer to evaluate grip strength and electrodiagnostic
examination to evaluate median nerve conduction velocity will be performed. After the initial
evaluations, the patients participating in the study will be randomly divided into 3 groups.
Tendon shifting and nerve shifting exercises will be performed in all groups. ESWT will be
applied to 2 groups at different beat numbers. One session of ESWT will be applied to both
groups each week for 3 consecutive weeks. In addition to the exercises in the low dose ESWT
group, 1000 beats at a pressure of 4 bar and a frequency of 5 Hz will be applied on the ESWT
carpal tunnel. In addition to the exercises in the high-dose ESWT group, 2000 beats at a
pressure of 4 bar and a frequency of 5 Hz will be applied on the ESWT carpal tunnel. In the
control group, in addition to the exercises, sham ESWT will be applied. No energy will be
used in Sham ESWT application, only sound will be given. Each group will be given a 15-minute
cold-pack application after the ESWT application. The exercises will be taught to the patient
before the first ESWT application and the exercises will be given to the patients in brochure
form. These exercises will be given to the patient as home exercises. You will be asked to do
these exercises at home in 2 sets of 5 repetitions 2 times a day. Tendon gliding exercises
are performed with the fingers in 5 different positions as regular grip, hook grip, fist,
desktop and normal fist. In the distal median nerve gliding exercise, firstly, in the neutral
position of the wrist, the fingers and thumb are flexed, in the second position, all the
fingers are in the neutral position, in the third position, when the thumb is in the neutral
position, the wrist and other fingers are in extension, in the fourth position, the wrist,
thumb and other fingers are in extension, In the fifth position, when the wrist and fingers
are in the same position, the forearm is in supination, in the sixth position, in the fifth
position, the thumb stretching is applied.
