From the Guidelines
Shockwave therapy is not a recommended treatment for hand arthritis based on current evidence. The 2019 update of the EULAR recommendations for the management of hand osteoarthritis does not mention shockwave therapy as a treatment option 1. Instead, the guidelines recommend education and training in ergonomic principles, exercises to improve function and muscle strength, orthoses, topical treatments, oral analgesics, and surgery as treatment options for hand arthritis. Some key recommendations from the guidelines include:
- Education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient 1.
- Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient 1.
- Topical NSAIDs are the first pharmacological topical treatment of choice 1. The primary treatments for hand arthritis typically include oral anti-inflammatory medications, topical NSAIDs, splinting to rest the affected joints, physical therapy exercises to maintain range of motion, and in more severe cases, corticosteroid injections or surgery. Patients with hand arthritis should consult with a rheumatologist or hand specialist to develop an appropriate treatment plan based on their specific condition and symptoms.
From the Research
Shockwave Therapy for Hand Arthritis
- Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), has been studied as a treatment for hand arthritis, specifically for first carpometacarpal joint osteoarthritis 2.
- A study published in 2018 found that ESWT led to a reduction in pain, improvement in pinch test performance, and a decrease in hand disability in patients with first CMC joint osteoarthritis, with benefits lasting for at least 6 months 2.
- The treatment involved 2,400 consecutive pulses of focused ESWT, performed at a frequency of 4 Hz and an energy flux density of 0.09 mJ/mm2, once a week for 3 consecutive weeks 2.
Comparison with Other Treatments
- ESWT has been compared to other treatments, such as intra-articular hyaluronic acid injections, and found to have similar or better efficacy in reducing pain and improving hand function 2, 3.
- A systematic review of shockwave therapies in soft tissue conditions found evidence for the benefit of ESWT in treating various musculoskeletal conditions, including plantar fasciitis and calcific tendinitis 4.
- Another study found that ESWT was an effective and alternative therapy to non-steroidal anti-inflammatory drugs and intra-articular hyaluronic acid injection for early osteoarthritis of the knees, with better pain relief and functional scores 3.
Safety and Efficacy
- ESWT has been found to be safe and effective in treating musculoskeletal conditions, with minimal side effects and no significant differences in adverse events compared to other treatments 4, 3, 5.
- The optimal use of ESWT is still to be determined, and further research is needed to establish the best protocols for different indications 4, 5.