Constant Versus Ascending Radial Pressure Wave Therapy for Pain Management in Carpal Tunnel Syndrome: A Pilot Exploratory Study

Background/Objectives: This exploratory report compares two radial pressure wave therapy (RPWT) regimens for carpal tunnel syndrome and describes clinical trajectories and observations relevant to future trial design. The statistical plan and the selection of the 2-month comparison followed inspection of the study data. Methods: Fifty-one participants were randomized (25 constant, 26 ascending; NCT07070661). Seven left the study (six ascending, one constant); forty-three contributed clinical scores. Both arms received three weekly sessions and the same home exercise program; pressure, frequency, and theoretical emission duration differed jointly. The main exploratory comparison was between-regimen pain change at 2 months. Results: The pain difference (ascending minus constant) was −0.54 points on the numeric pain rating scale (NPRS, 0–10; 95% CI −2.14 to 1.06), and observed mean NPRS decreased from baseline to 2 months in both arms: from 6.50 to 4.04 in the constant arm and from 6.37 to 3.37 in the ascending arm. Descriptive observations included asymmetric attrition (six of seven departures in the ascending arm) and observed baseline imbalance (grip strength SMD 0.624; symptom duration 28.7 versus 39.2 months). Three participants had early indications for carpal tunnel release. Conclusions: Although mean pain improved in both groups, these non-conclusive pilot data establish neither superiority nor equivalence. The observed improvement cannot be attributed to the RPWT device because both groups received exercises and no sham or exercise-only control was included. These findings inform a definitive trial with stratified randomization and an appropriate comparator.