Ann Rehabil Med.  2018 Feb;42(1):92-100. 10.5535/arm.2018.42.1.92.

Comparison Between Extracorporeal Shock Wave Therapy and Intra-articular Hyaluronic Acid Injections in the Treatment of First Carpometacarpal Joint Osteoarthritis

• Ioppolo F
• Saracino F
• Rizzo RS
• Monacelli
• Lanni D
• Di Sante L
• Cacchio A
• Santilli V
• Venditto T

• KMID: 2440974
• DOI: http://doi.org/10.5535/arm.2018.42.1.92

Abstract

OBJECTIVE
To compare extracorporeal shockwave therapy (ESWT) with hyaluronic acid (HA) intra-articular injections in terms of pain relief, improvement in hand function, and strength in subjects with first carpometacarpal (CMC) joint osteoarthritis.
METHODS
Fifty-eight patients received either focused ESWT or HA injection once a week for 3 consecutive weeks. In the ESWT group, 2,400 consecutive pulses were performed during each treatment session using a frequency of 4 Hz and an energy flux density of 0.09 mJ/mm2. The HA group underwent one cycle of three injections of 0.5 cm3 HA. The main outcome measures were pain and hand function as measured by the visual analogue scale (VAS) and Duruoz Hand Index (DHI), respectively. The secondary outcomes were grip and pinch strength. Each assessment was performed at baseline, at the end of treatment, and at 3- and 6-month follow-up visits.
RESULTS
According to VAS and DHI scores, a significant change in test performance was observed over time in both groups (p < 0.001), with a greater average improvement in painful symptomatology at the 6-month follow-up in the ESWT group. A significant improvement in strength was observed in both groups, but the ESWT group showed better results on the pinch test starting immediately at the end of treatment.
CONCLUSION
The use of ESWT in patients with first CMC joint osteoarthritis leads to a reduction in pain, an improvement in pinch test performance that persists for at least 6 months, and a decrease in hand disability up to the 6-month follow-up visit.

Keyword

Extracorporeal shock wave therapy; Hyaluronic acid; Thumb; Osteoarthritis

MeSH Terms

Carpometacarpal Joints*
Follow-Up Studies
Hand
Hand Strength
Humans
Hyaluronic Acid*
Injections, Intra-Articular
Joints
Osteoarthritis*
Outcome Assessment (Health Care)
Pinch Strength
Shock*
Thumb
Hyaluronic Acid

Figure

• 

  Fig. 1 A flow diagram showing the treatment process and assessment methods. ESWT, extracorporeal shock wave therapy; HA, hyaluronic acid; EFD, energy flux density.

• 

  Fig. 2 Extracorporeal shock wave therapy device.

• 

  Fig. 3 Changes over time of visual analogue scale score in both groups. ESWT, extracorporeal shock wave therapy; HA, hyaluronic acid.

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