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

  • 1Department of Physical Medicine and Rehabilitation, Sapienza University of Rome, Rome, Italy.
  • 2Emergency Department of Plastic Surgery and Hand Surgery, Sapienza University of Rome, Rome, Italy.
  • 3Department of Life, Health and Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy.


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.
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.
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.
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.


Extracorporeal shock wave therapy; Hyaluronic acid; Thumb; Osteoarthritis

MeSH Terms

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