# State of shock – a systematic review of extracorporeal shockwave therapy in hand surgery

## TL;DR

This review examines how well shockwave therapy works for various hand conditions, finding it effective for pain and function improvement in several cases.

## Contribution

The paper systematically evaluates extracorporeal shockwave therapy effectiveness for specific hand surgeries and conditions.

## Key findings

- ESWT significantly improves functional status and pain in Dupuytren’s disease and trigger finger.
- ESWT is as effective as corticosteroid injections for trigger finger with fewer side effects.
- Shockwave therapy shows short- and mid-term benefits for carpal tunnel syndrome with ≥4 sessions.

## Abstract

As the number of elective hand surgeries has increased across the board, this systematic review aims to elucidate the effectiveness of extracorporeal shockwave therapy (ESWT) in hand surgery. Of interest are Dupuytren’s disease (DD), trigger finger (TF), De Quervain’s tenosynovitis, osteonecrosis of the lunate (ONL), and carpal tunnel syndrome (CTS).

Qualitative analysis of the current evidence according to the Cochrane Handbook for systematic reviews of interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using electronic databases, and quality assessment of the included studies using the Cochrane risk of bias in non-randomized Studies – of Interventions assessment tool, the Cochrane risk-of-bias tool for randomized trials and the measurement tool to assess systematic reviews 2 were performed.

ESWT with ≥5 sessions in DD improved functional status and symptom severity significantly and consistently, especially pain, in the short- and mid-term. In TF ESWT alleviated pain in the short-, mid- and long-term. Also, functional status and severity of triggering improved consistently in the mid- and long-term. Three sessions of ESWT are the optimal number in TF patients. In DQT ESWT improved pain and functional status in the short- and mid-term. One study showed LCI and ESWT to be equally effective in DQT patients. Another study showed ESWT as an effective treatment of the pain and progression of ONL. ESWT improved pain and functional status in CTS in the short- and mid-term, especially if ≥4 sessions of ESWT are performed. The long-term effectiveness of ESWT has been suggested but not sufficiently proven.

ESWT is an effective and recommended treatment in DD, TF, and CTS to improve pain and functional status, especially, rESWT regarding CTS and likely also TF. It represents an equally effective option as local corticosteroid injections in TF, DD and CTS with fewer and less severe adverse effects. In the treatment of DQT, ESWT should be considered an option in the clinical setting. Further research is necessary to develop normed protocols and expand its scope of application.

The review and search protocol were registered at PROSPERO (National Institute for Health and Care Research) – CRD42024598627.