Systematic Mapping Review of Applications of Extracorporeal Shockwave Therapy (ESWT) in Hand Surgical Conditions

Aim:
This systematic mapping review aims to systematically identify, elucidate, and categorise existing evidence regarding the utilisation of shockwave therapy in hand surgical conditions.
Methods:
Adhering to the PRISMA guideline, we conducted a thorough search to identify studies investigating the application of shockwave therapy in hand surgery conditions. Data extraction followed predetermined eligibility criteria, and evaluated outcomes were systematically classified into four dimensions: clinical assessment, Patient-Reported Outcome Measures (PROMs), neurophysiological tests, and a miscellaneous category.
Results:
A total of 43 studies were incorporated, comprising 9 case series, 1 cohort study, and 33 randomised controlled trials (RCTs). Most investigations focused on Carpal Tunnel Syndrome, with other conditions, including Trigger Finger, Dupuytren's disease, post-CTRS pillar pain, Hypertrophic hand scar, Kienbock's Disease, de Quervain tenosynovitis, Osteoarthritis, and Scaphoid wrist nonunions, also examined. Spanning from 2011 to 2023, a discernible upward trend in studies was noted, with Iran and Turkey collectively contributing to nearly half of the included studies. Most investigations reported short-term benefits in clinical and PROMs outcomes, with complications being infrequent and of mild nature. The delivery protocol for shockwaves exhibited heterogeneity in terms of intensity and frequency. Observations on shockwave intensity and frequency's dose dependency for clinical efficacy, reported in some studies, remain inconclusive. A majority of RCTs exhibit a high/moderate risk of bias. Limited evidence supports the beneficial impact of shockwave therapy in the other hand surgical conditions.
Conclusion:
Standardisation of shockwave therapy frequency and intensity is imperative. The administration of shockwave therapy reveals a dose-dependent effect devoid of major complications, with noteworthy short-term efficacy, primarily serving as an adjunct. While the literature is robust for CTS, meticulously designed RCTs are indispensable for comprehending the efficacy in other hand surgical conditions.

Hand and Upper Extremity

PSTM 2024