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Middle East J Rehabil Health Stud. In Press(In Press):e134171.
Published online 2023 April 2.
https://doi.org/10.5812/mejrh-134171.
Research Article
Effectiveness of TECAR Therapy on Clinical Symptoms and
Neurophysiological Parameters of Patients with Carpal Tunnel
Syndrome: A Randomized Clinical Trial
Babak Vahdatpour 1, Hamid Reza Ghasemi 1and Parisa Taheri1, *
1Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
*Corresponding author: Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Email:
prs_taheri@yahoo.com
Received 2022 December 17; Revised 2023 February 14; Accepted 2023 February 28.
Abstract
Background: Carpal tunnel syndrome (CTS) is the most typical peripheral entrapment neuropathy. To date, various non-invasive
methods have been used to manage CTS. This study investigates the effectiveness of Transfer Energy Capacitive and Resistive (TECAR),
a new physical agent modality, on symptoms and neurophysiological parameters in patients with CTS.
Methods: In this single-blind randomized clinical trial, 29 patients with mild or moderate CTS were randomly assigned to two
groups. Group 1 received TECAR therapy with a frequency of 500 Hz and an intensity of 30 to 50%, 2 sessions/week, in addition to
wrist splints and vitamin B supplements for 4 weeks. Group 2 also received a wrist splint and vitamin B for 4 weeks without TECAR
therapy. The Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ-SSS and FSS), as well as clinical and neurophysi-
ological findings, were assessed before and 8 weeks after treatment. Within and between-group comparisons were made after the
intervention period.
Results: VAS and the Boston Carpal Tunnel Questionnaire (FSS and SSS) showed significant changes. Clinical CTS tests and electro-
physiological parameters did not show significant differences before and after the study. From a clinical perspective (pain relief and
functional improvement), the TECAR therapy group showed more definite changes.
Conclusions: TECAR can be considered an effective non-invasive treatment for patients with mild to moderate CTS.
Keywords: Carpal Tunnel Syndrome, Physical Therapy Modalities, Nerve Conduction Study
1. Background
Carpal tunnel syndrome is a common cause of upper
extremity disability (1). It is a peripheral entrapment neu-
ropathy because of the involvement of the median nerve
in the wrist region.
The symptoms include pain, tingling, paresthesia, and
discomfort, and as the disease progresses, hand movement
will become impaired (2), paresthesia becomes more se-
vere while driving, and symptoms are relieved by shaking
the hand (3).
With a prevalence of 4% in the population, carpal tun-
nel syndrome is one of the most common entrapment neu-
ropathy (4). The causes of CTS include medical conditions
(thyroid disease, kidney failure, acromegaly, etc.), inflam-
matory disease (lupus, rheumatoid arthritis, etc.), tumors
and pseudo-tumors (ganglions, etc.), anatomical anoma-
lies, and in most cases, it is idiopathic (5).
The disease occurs with increased pressure in the
carpal tunnel, especially at the level of the carpal ligament,
which results in pressure on the median nerve, decreased
epineural blood supply to the nerve, and progression of
nerve damage due to local ischemia (6).
Neurophysiologic studies (such as nerve conduction
studies) are highly sensitive diagnostic tests that investi-
gate median nerve involvement (7). The degree of a pa-
tient’s symptoms and level of disability can be assessed us-
ing reliable patient-centered tools like the Boston Carpal
Tunnel Syndrome Questionnaire (BCTQ). The correlation
between clinical findings and nerve conduction study find-
ings allows for assessing the patient’s level of disability (8).
Both surgical and non-surgical alternatives are avail-
able for treating carpal tunnel syndrome. Physical agent
modalities are one of the various non-surgical treatments
for carpal tunnel syndrome (7,9).
Diathermy is one of these modes. Physical therapy uses
diathermy, a deep heat current source that generates a
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Vahdatpour B et al.
high current in the body. Several persistent musculoskele-
tal issues are treated with diathermy (10).
Recently, a new system has been created to trans-
fer resistive and capacitive energy called TECAR thera-
py®. This type of diathermy increases the tissue’s intrin-
sic metabolism through inter-tissue energy transfer with-
out releasing energy to the outside. The TECAR device
works based on the physical principles of the condenser
and consists of two pads separated from the device, placed
on the surface, and made of insulating material. One of
the two electrodes, which is active, is in charge of trans-
ferring energy to the tissue. These two electrodes are con-
nected to the energy-generating device, and a flow be-
tween them is established (10,11). Effects of resistance-
capacitance diathermy, also known as TECAR therapy, have
increased microcirculation flow, vasodilation (increased
oxygenation), and tissue heat (11,12).
2. Objectives
Studies evaluating the efficacy of TECAR therapy in the
treatment of peripheral neuropathies, particularly entrap-
ments of peripheral nerves, are rarely available, although
numerous studies have been conducted to date to investi-
gate the effectiveness of TECAR therapy in various diseases.
One of the pioneering studies on using TECAR therapy as
an innovative physical therapy modality to treat median
nerve entrapment at the wrist (carpal tunnel syndrome)
was conducted in this study.
3. Methods
3.1. Trial Design
The present study is a single-blind randomized clini-
cal trial performed in neuromuscular clinics affiliated with
the Department of Physical Medicine and Rehabilitation
of Isfahan University of Medical Sciences in 2022. Patients
presenting with complaints in their hands, such as pain,
paresthesia, numbness, or weakness, were approached
with a detailed history and a complete physical examina-
tion, including special tests for CTS such as Compression,
Tinel, Phalen, and Reverse Phalen tests. The patients were
then chosen to receive an EMG-NCV neurophysiological
evaluation to confirm the diagnosis of CTS and rule out any
other potential diagnoses. Mild and moderate cases of CTS
that met the criteria of the American Association of Electro-
diagnostic Medicine’s guidelines (13) were included in the
study. A peak latency greater than 3.5 milliseconds and NCV
across wrist < 40 m/s was considered mild, and an average
motor onset latency greater than 4 milliseconds was con-
sidered moderate. The EMG-NCV was taken by the physi-
cal medicine specialist of Isfahan University of Medical Sci-
ences with a Natus device (UltraPro S100, Natus Neurology
Incorporated 3150 pleaseant view road Middleton, WI USA).
Other inclusion criteria were age over 18 and under 60
years old and unilateral or bilateral idiopathic carpal tun-
nel syndrome lasting more than a month. The following
criteria for exclusion were used: the presence of both sys-
temic and local diseases (such as diabetes, RA, wrist arthri-
tis, hypothyroidism), current or past cancer, use of a splint
within the previous three months, pregnancy, burns to the
hand or forearm, use of a pacemaker, prosthesis, or IUD, pe-
ripheral vascular diseases, fractures in the wrist and hand
region, and corticosteroid injection in the carpal tunnel
within the prior three months (14).
3.2. Interventions
Both groups (1 and 2) were treated for four weeks with
a wrist splint of thermoplastic type in 0 to 5 degrees of the
extension during the nights and during activity in the day-
time plus 300 mg of vitamin B1(Vitamin B1-SHAFA 300 MG)
tablets. In the intervention group (group 1), TECAR ther-
apy was also performed with the WINBACK 3 device made
in France, with a frequency of 500 Hz and intensity of 30
to 50% and medium Capacitive Energy Transfer electrode
(60 mm), from the proximal carpal tunnel to the palm Me-
dian nerve path, while the active capacitive electrode was
moved by an operator in a circular pattern and the passive
electrode fixed on the dorsum of the hand, in two sessions
per week for four weeks (Figure 1).
3.3. Outcomes
At baseline, the VAS and Boston questionnaires were
completed for both groups. After 2 months of the treat-
ment, the questionnaires were filled out again. VAS scale
(15) is a 10 cm graduated line whose numbers are graded
from 0 (absence of pain) to 10 (the most severe pain pos-
sible). In this scale, the patient circles a number to deter-
mine its score. This scale has been widely and comprehen-
sively used in research related to pain, and its validity and
reliability have been confirmed (16).
Levine designed for the first time in 1993 the Boston
Questionnaire to determine the severity and quality of
carpal tunnel syndrome, which includes 2 sections on
symptom severity and functional status in people with
carpal tunnel syndrome (17). Each question has a maxi-
mum of five and a minimum of one point, and the aver-
age score is obtained by dividing the total points by the
number of questions. A. Rezazadeh et al. (18) corroborated
the validity and reliability of the Boston questionnaires
among the Iranian population.
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Vahdatpour B et al.
Assessed for eligibility
N = 34
Excluded = 5
Randomized
N = 29 (50 wrist)
Grp 2: wrist splint + Vit
B1
Grp1 : TECAR (long
wave diathermy)
+ splint + B1
Follow up 2 months
after treatment
Follow up 2 months
after last session
Figure 1. Flowchart of the study
Clinical tests and NCV parameters (Median antidromic
sensory peak latency, sensory nerve conduction velocity
(NCV) across the wrist, Median motor distal onset latency)
were also examined and compared before and after treat-
ment.
3.4. Sample Size
According to the formula for comparing means in clin-
ical studies, considering type 1 error of .05, study power of
80%, d = 1.52, and S = 1.7 (for VAS variable in previous stud-
ies (19)) for the interpretation of the result for the superior-
ity of TECAR therapy combined to conventional treatment
over conventional treatment, the final sample size was de-
termined 25 hands in each group.
3.5. Randomization
The participants were enrolled using a consecutive
sampling method. Random assignment was done via an
online random sequence generator.
3.6. Blinding
In this single-blind research, the clinician and the pa-
tients were aware of the intervention groups. However, the
outcome assessor and the statistical consultant were kept
blind to each patient’s intervention group.
3.7. Statistical Methods
The collected data were analyzed using SPSS version 26.
Appropriate parametric and nonparametric tests, includ-
ing the paired-sample t-test (Boston-SSS and FSS variables
and electrodiagnostic parameters in within-group com-
parison), independent t-test (Boston-SSS and FSS variables
and electrodiagnostic parameters in between groups com-
parison), chi-square test (Demographic table variables),
McNemar and Fisher exact test (Compression, Tinel, Phalen
and Reverse Phalen variables within and between groups),
Wilcoxon, and Mann-Whitney U test (VAS variable within
and between groups), were used for statistical analyses. P-
value < 0.05 was considered as the significance level.
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Vahdatpour B et al.
4. Results
Table 1 shows the demographics of the study partici-
pants. Before treatment, there was no significant differ-
ence in pain levels between the two groups. Two months af-
ter treatment, in both groups, patient pain levels were sig-
nificantly reduced (P < 0.001) (Figure 2). If the reduction
of 25% of pain level (20) is considered significant, group 2
(wrist splint) didn’t reach MCID (a minimal clinically im-
portant difference). There was a significant difference in
pain reduction between the two groups, with a higher re-
covery rate in the TECAR treatment group (P = 0.008) (Fig-
ure 3). After two months of treatment within groups, the
difference became significant in all special clinical tests
(Tinel (0.002), Compression (0.004), Phalen (0.031), and re-
verse Phalen (0.031)) in the TECAR group and Compression
(0.031) and Reverse Phalen (0.016) tests in the wrist splint
group. But between the groups, clinical tests did not show
a significant difference. Before the study, there was no sig-
nificant difference in BCTQ (FSS and SSS) variables between
groups (P = 0.740). Two months after the treatment, a sig-
nificant difference was seen within (P = 0.018, P = 0.01) and
between groups (P = 0.003, P = 0.014) (Table2 and Figures 4 -
7). In our study, the wrist splint group didn’t reach for both
SSS and FSS to cut off level, but in the TECAR group, SSS was
significant in MCID level (21), but FSS not significant.
Table1. Characteristics of the Study of Participants
Group 1 (TECAR +
Splint) (n = 14, 25
Wrist)
Group 2 (Splint)
(n = 15, 25 Wrist)
P-Value
Age 47.08 ±8.81 44.92 ±10.20 0.678
Gender(f/m) 19/6 18/7 0.530
Affected wrist 0.321
Right 2 4
Left 1 1
Both 11 10
Neurophysiological
class
0.620
Mild 14 12
Moderate 11 13
Before the intervention, there was no discernible dif-
ference between the two groups according to neurophys-
iological tests (median sensory peak latency, median mo-
tor distal onset latency, and sensory NCV across the wrist).
Also, there was no significant clinical difference between
and within the groups two months after the treatment, ac-
cording to the tests (Table 3).
5. Discussion
In this study, we assessed the impact of TECAR therapy
on electrodiagnostic parameters and clinical symptoms in
patients with mild to moderate CTS.
In our study, VAS and Boston Questionnaire variables
showed a good response, but NCV parameters did not show
any specific changes from a clinical point of view. Perhaps
the reason for the lack of clear changes in the NCS changes
is that there is not enough time for changes to show. How-
ever, we can justify the VAS and Boston Questionnaire vari-
ables by examining the research and article review mecha-
nism.
Few studies have been done on TECAR therapy, a novel
deep heat physical modality, as a possible treatment for pe-
ripheral entrapment neuropathies or neuropathic pain.
The mechanism of action of TECAR has not been eluci-
dated. The articles confirmed reduced muscle spasms, in-
creased oxygenation, improved metabolic status, and re-
duced pain. By increasing radiofrequency energy to tis-
sues, this treatment relaxes muscles and ligaments and im-
proves nervous system repair (22). The main complaint of
CTS patients is usually pain, which was measured by the
VAS scale in this study. According to the Gate theory pro-
cesses and mechanisms described above, reductions in VAS
scales and patient pain levels are justifiable.
Lindblad et al. (23) investigated the efficacy of TECAR
therapy for chemotherapy-induced neuropathic pain. Al-
though TECAR therapy reduced patients’ pain perception,
the mean pain Numeric Rating Scale (NRS) did not reveal
a discernible difference between groups. In the Lindblad
study, using the interferential therapy with high-power
TECAR didn’t result in significant pain relief in the in-
tervention group; however, from the gate control theory,
we expected some more pain reduction; this may be be-
cause the disease is chronic, and resistant to treatment,
and different from a focal entrapment neuropathy. M.
Niajalili et al. (24) evaluated the effectiveness of TECAR
therapy in diabetic patients with peripheral neuropathy.
Both groups (Group 1=TECAR + Infrared and Group 2=In-
frared + Sham TECAR) experienced an improvement in
pain management, with the intervention group experienc-
ing greater recovery. It suggests that the cause of the neu-
ropathy may influence the TECAR therapy’s effectiveness.
In the field, however, more research is necessary.
Also, TECAR’s action can be compared to other deep
heat modalities. Ebenbichler et al. (25) studied the efficacy
of therapeutic ultrasound in patients with mild to mod-
erate CTS. They showed improved clinical symptoms, and
NCS parameters were also observed at the 6-month follow-
up. Also, Huisstede et al. (26) reported no short-term im-
provements in their systematic review of ultrasound ef-
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Vahdatpour B et al.
8
7
6
5
4
3
2
1
0Group 1 Group 2
Pre treatment
Post treatment
Figure 2. VAS within groups
Table2. Comparison of the Pre-treatment and Post-treatment Clinical Tests, Pain, Function, and Severity of Disease Within and Between Groups
Group 1 (TECAR +
Splint) Group 2 (Splint) 95% Confidence Interval of the Difference FP-Value
(Mann-Whitney)
Lower Upper
VAS
Pre 6.96 ±1.01 6.36 ±1.15 -0.01820 1.21820 0.0565 0.057
Post 4.52 ±.96 5.28 ±.97 -1.31235 -0.20765 0.019 0.008
P-value (Wilcoxon) < 0.001 < 0.001
P-value (Independent
t-test)
Levine-Boston/SSS
Pre 2.30 ±.0.44 1.70 ±0.48 3.628 9.492 0.111 0.740
Post 1.14 ±0.15 1.45±0.46 -5.571 -1.228 18.818 0.003
P-value (Paired-samples t-test) 0.012 0.011
Levine-Boston/FSS
Pre 1.95±0.48 2.10±0.44 -03.322 0.921 0.658 0.261
Post 1.45 ±0.36 1.72±0.38 -3.871 -0.448 < 0.001 0.014
P-value (Paired-samples t-test) 0.018 0.01
P-value (Fisher’s Exact
Test)
Tinel test (positive/negative)
Pre 17/8 16/9 1.000
Post 7/18 12/13 0.378
P-value (McNemar test) 0.002 0.063
Compression test (positive/negative)
Pre 16/9 16/9 0.010
Post 8/17 10/15
P-value (McNemar test) 0.004 0.031 0.194
Phalen test (positive/negative)
Pre 13/12 15/10 0.015
Post 9/16 12/13
P-value (McNemar test) 0.031 0.063 0.393
Reverse Phalen test (positive/negative)
Pre 15/10 17/8 0.081
Post 9/16 10/15 0.667
P-value (McNemar test) 0.031 0.016
fects, but long-term effects were seen. We also found that
TECAR therapy was effective in improving clinical symp-
toms but no NCS parameters at 2 months, during which
long-term follow-up was not performed.
Possibly one of the reasons for reducing patient symp-
toms and improving performance is the reduction of
edema in the carpal tunnel region. One of the pathological
causes of this disease is increased pressure in this area, so
by increasing lymphatic outflow and reducing pressure on
nerves, gradual improvements in patient symptoms can be
observed (27).
Another deep heat modality used for CTS treatment is
shortwave diathermy (SWD). In a study by Incebiyik et al.
(28), SWD has shown pain relief, improved hand function,
Middle East J Rehabil Health Stud. In Press(In Press):e134171. 5
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Vahdatpour B et al.
Post tratment
Pre-treatment
0 1 2 3 4 5 6 7 8
Group 2
Group 1
Figure 3. VAS- between groups
2/5
2
1/5
1
0/5
0
Group 1 Group 2
Pre treatment
Post treatment
Figure 4. BCTQ- FSS- within groups
Post-tratment
Pre-treatment
0 0/5 1 1/5 2 2/5
Group 2
Group 1
Figure 5. BCTQ- FSS- between groups
and CTS clinical testing, but electrodiagnostic parameters
have not been studied. In our study, the pain decreased,
and hand function improved in the treatment group, but
we observed no important changes in clinical tests com-
pared to the control group.
Frasca et al. (6) conducted a study in 2011 to evaluate
the efficacy of microwave diathermy (MWD) in sham and
treatment groups. They found a reduction in VAS for pain
and an improvement in the Boston Carpal Tunnel Ques-
tionnaire but no electrodiagnostic changes. In our study,
an electrodiagnostic improvement was observed in addi-
tion to the improvements observed in the previous study.
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Vahdatpour B et al.
2/5
2
1/5
1
0/5
0Group 1 Group 2
Pre treatment
Post treatment
Figure 6. BCTQ-SSS-whin groups
Post-tratment
Pre-treatment
0 0/5 1 1/5 2 2/5
Group 2
Group 1
Figure 7. BCTQ-SSS-between groups
Table3. Comparison of Neurophysiologic Parameters Within and Between Groups
Group 1 (TECAR +
Splint) Group 2 (Splint) 95% Confidence Interval of the Difference FP-Value(Paired Sample
t-Test)
Lower Upper
Median sensory PL (millisecond)
Pre 4.195±0.322 4.170 ±0.450 -0.197 0.248 2.179 0.818
Post 4.089 ±0.284 4.130±0.449 -0.256 -0173 4.843 0.700
P-value (Independent t-test) < 0.001 < 0.001
Median motor OL (millisecond)
Pre 4.209 ±0.552 4.194±0.448 -0.270 0.301 1.627 0.913
Post 4.147 ±0.510 4.098±0.400 -0.212 0.309 2.087 0.709
P-value (Independent t-test) 0.113 0.136
NCV across wrist (meter/second)
Pre 33.48 ±5.94 34.72±5.20 -4.414 1.942 0.221 0.438
Post 33.92±5.99 35.12 ±5.23 -4.825 1.545 0.237 0.306
P-value (Independent t-test) 0.048 < 0.001
Among other interventions in managing CTS, corticos-
teroid injections into the carpal tunnel revealed primary
evidence of efficacy in a systematic review by Piazzini et
al. (29). Also, Visser et al. (30) showed that corticosteroid
injection therapy is more effective in patients with mild
CTS. In our study, sensory nerve conduction showed more
changes than motor studies, but no significant differences
were found between the two groups and clinically within
the groups. This fact may indicate that patients with mild
CTS respond better to treatment, but our study did not ex-
amine patients with mild and moderate CTS separately.
5.1. Study Limitations
Because of COVID-19, the study was conducted with a
small sample size, and no follow-up was performed due to
time constraints. However, this study points to the need
Middle East J Rehabil Health Stud. In Press(In Press):e134171. 7
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Vahdatpour B et al.
for longer follow-ups.
5.2. Conclusions
Our results indicated that TECAR could effectively treat
mild to moderate CTS patients. To investigate this, future
interventional studies are required. It is better to conduct
a study with a larger sample size and a longer follow-up to
examine the changes in NCS from a clinical point of view.
Footnotes
Authors’ Contribution: Study concept and design:
Babak vahdatpour and Parisa Taheri.; analysis and inter-
pretation of data: H.R.Ghasemi, and B.Vahdatpour.; draft-
ing of the manuscript: F. M.; critical revision of the
manuscript for important intellectual content: P.Taheri.,
and B.Vahdatpour.; statistical analysis: H.R.Ghasemi.
Clinical Trial Registration Code: This study was
registered in the Iranian Registry of Clinical Trials
(IRCT) by the code: IRCT20220405054422N1. (Link:
https://www.irct.ir/trial/62775)
Conflict of Interests: The authors are not the editorial
board management of this journal. Dr. Babak Vahdatpour
is an interesting worker in the field of neuromuscular re-
search and is a professor at Isfahan Medical University. The
authors’ other field is rehabilitation in the musculoskele-
tal system.
Ethical Approval: The Ethics Committee of Isfahan
University of Medical Sciences approved the protocol
of this study (code: IR.MUI.MED.REC.1400.340; Link:
https://ethics.research.ac.ir/IR.MUI.MED.REC.1400.340)
Funding/Support: There was no grant in this study.
Informed Consent: The participants were aware of the
study goals and protocol. Written consent was obtained
from patients before assignment to each treatment group.
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