Co esponding au ho : M. Yazidi
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Pseuda h osis o he scaphoid: wha place o conse a i e ea men using
ex aco po eal shock wa e he apy?
Mouad. Yazidi *, Abdelhakim. Kabil, Rime. Dades, Ryme. El beloui, Hasnaa. Bou alja, Nada. Kyal, Fa ima.
Lmidmani, and Abdella i . El a imi
Depa men o Physical and Rehabili a ion Medicine Casablanca.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 038-042
Publica ion his o y: Recei ed on 21 Ma ch 2025; e ised on 28 Ap il 2025; accep ed on 01 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1540
Abs ac
Pseuda h osis o he scaphoid is a ela i ely equen complica ion (5-10%), he pa hophysiology o which is linked in
pa icula o poo ascula iza ion, especially o he p oximal pole. The op imal ea men o pseuda h osis o he
scaphoid has no ye been es ablished and emains con o e sial. Among he non-su gical op ions, ex aco po eal shock
wa e he apy (ESWT) has p o ed o be a eliable and e ec i e non-in asi e modali y o pa ien s wi h delayed o non-
healing ac u es. We epo a e ospec i e s udy conduc ed in he Depa men o Physical and Rehabili a ion Medicine
a CHU Ibn Rochd, including 8 pa ien s wi h scaphoid pseuda h osis. Conse a i e adial shock wa e he apy (ESWT)
was pe o med o e 4 sessions a 1-week in e als (3000 pulses pe session, mean ene gy lux densi y 0.6 mJ/mm2).
Clinical and adiological assessmen was pe o med be o e ea men and wo mon hs a e i s comple ion. A signi ican
imp o emen in algo- unc ional sco es and comple e consolida ion o he pseuda h osis si e was achie ed in 87.5% o
pa ien s. Ex aco po eal shockwa e he apy appea s o be a eliable and e ec i e non-in asi e modali y o he
ea men o scaphoid pseuda h osis.
Keywo ds: Pseuda h osis; Scaphoid; ESWT; QuickDash
1. In oduc ion
Scaphoid ac u e is he mos common ca pal bone ac u e. I mainly a ec s young people. Due o i s pa icula loca ion
and ascula iza ion, i can de elop in o pseuda h osis in 5 o 10% o cases, leading o ea ly os eoa h i is o he w is ,
which can be e y debili a ing o he pa ien [1,2].
The op imal ea men o scaphoid pseuda h osis has no ye been es ablished and emains con o e sial. Among he
non-su gical op ions, ex aco po eal shock wa e he apy (ESWT) has p o en o be a eliable and e ec i e non-in asi e
modali y o pa ien s wi h delayed o non-healing ac u es. [4-6].
Ex aco po eal shockwa e he apy is a he apeu ic modali y o iginally in oduced in o he clinic unde he name o
li ho ipsy, which has also been used success ully o e he las wo decades in he non-in asi e ea men o delayed o
non-healing ac u es. I in e ac s a se e al cellula and molecula le els, inducing egene a ion a he han epai
[7,8,9].
2. Ma e ials and me hods
We conduc ed a e ospec i e s udy be ween Janua y 2023 and Decembe 2024 in he Depa men o Physical and
Rehabili a ion Medicine a CHU Ibn Rochd, including 8 pa ien s wi h pseuda h osis o he scaphoid. Conse a i e adial
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 038-042
39
shock wa e he apy (ESWT) was pe o med o e 4 sessions 1 week apa (3000 pulses pe session, mean ene gy lux
densi y 0.6 mJ/mm2, adjus ed acco ding o he pa ien 's pain ole ance).
A clinical and adiological assessmen was ca ied ou be o e ea men and wo mon hs a e i s comple ion. This
included a clinical examina ion and pain assessmen using a isual analogue scale. Func ional ou come was assessed
subjec i ely using he QuickDash ou come measu e and he Mayo W is Sco e. An ini ial adiog aphic e alua ion (Figu e
1) was pe o med (Schnek 1 incidence), showing he loca ion o he pseuda h osis acco ding o Sche nbe g's
adiological classi ica ion (Figu e 2). A ollow-up adiog aph was aken 2 mon hs a e he end o ea men o assess
consolida ion.
Figu e 1 Pseuda h osis o he igh scaphoid localised a he p oximal pole 1 yea a e he ini ial auma
(Iconog aphy om he physical medicine and ehabili a ion depa men a CHU Ibn Rochd)
Figu e 2 Sche nbe g dis inguished six ac u e ypes (I–VI) anging om he p oximal pole o he dis al ube cle using
he la e al ube osi y and he adial and medial a icula su aces as e e ences. Dis al ube cle ac u es we e u he
di ided in o small (a), in e media e (b), o la ge (c) agmen s, and we e conside ed likely o heal success ully,
con a y o p oximal ac u es [21]
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 038-042
40
3. Resul s
The sample consis ed o 8 men wi h an a e age age o 26.8 yea s. Six pa ien s had hea y manual wo k. The dominan
hand was a ec ed in 62.5% o cases. 87.5% o pa ien s we e ac i e smoke s a he ime o ea men . The his o y o
auma was p esen in all cases. Ini ial o hopaedic ea men was adminis e ed a e diagnosis o he ac u e, wi h
a ying deg ees and du a ion o immobilisa ion. F ac u es we e classi ied acco ding o he Sche nbe g classi ica ion
(Figu e 3) as ollows: 4 in zone III, 3 in zone IV and 1 in zone V. The mean ime om ini ial auma o ea men was
14.8 mon hs [SD 7.9]. Mean es pain was 4.3/10 a baseline, wi h signi ican imp o emen a e he end o ea men
(p>0.05). The mean QuickDASH sco e was 13.8 a baseline compa ed wi h 27.3 in 2 mon hs.
The Mayo W is sco e showed a signi ican imp o emen (ini ial mean sco e 62% s 79%). No side e ec s we e epo ed
by ou pa ien s. Comple e consolida ion o he pseuda h osis si e was achie ed in se en pa ien s (87.5%). 1 pa ien
had pe sis en pseuda h osis, bu ollow-up adiog aphs showed a educ ion in dias asis.
4. Discussion
Pseuda h osis o he scaphoid is a ela i ely equen complica ion (5-10%), he pa hophysiology o which is linked in
pa icula o poo ascula isa ion, especially o he p oximal pole, bu also o he absence o a pe ios eal en elope on
he scaphoid, 80% o he su ace o which is a icula and he e o e ca ilaginous [2]. Examina ion o he w is will
e eal he diagnosis, based on ex e nal w is pain and loss o mobili y and s eng h. I may go unno iced and only be
disco e ed unexpec edly du ing a second auma [3]. Radiological analysis o good-quali y plain ilms o he w is is
o en su icien o dis inguish a pseuda h osis om a ecen ac u e. Pseuda h osis is usually cha ac e ized by he
p esence o a clea ac u e image, geodic bone eso p ion o he edges and/o os eocondensa ion o he edges. A CT
scan p o ides a be e unde s anding o he local ana omical ea u es (bone eso p ion, ex en o dias asis, exis ence o
luna e il ) and may he e o e be use ul i he e is any doub abou he age o he ac u e, whe eas he iabili y o he
p oximal agmen is bes explo ed using MRI [10,11].
The cha ac e is ics o he popula ion we e compa able o o he se ies in he li e a u e. The sample was composed
en i ely o men, o young a e age age (26.8 yea s), he majo i y o whom we e manual wo ke s. An iden i ied auma
was ound in all ou pa ien s, which co obo a es he esul s o he li e a u e [12,13,14].
Se e al s udies ha e compa ed he e icacy o shock wa e ea men wi h su gical ea men . No a nicola e al. included
in hei e ospec i e s udy mainly conse a i ely ea ed scaphoid ac u es ha did no show adiological healing
a e 6 mon hs. These non-union scaphoid ac u es we e ei he ea ed wi h ESWT (n=58) o su gically e ised (n=60).
Shock wa e g oup pa ame e s we e selec ed using 4000 pulses om an elec omagne ic sou ce a a mean ene gy lux
densi y o 0.09 mJ/mm2. Fo he p ima y a ge pa ame e o bone healing a 12 mon hs, he au ho s again ound
compa able esul s in he wo in e en ion g oups (bone healing in 79% o he ESWT g oup and 78% o he su gical
g oup). The Mayo w is sco e as a clinical pa ame e showed excellen and good esul s in 57% and 60% espec i ely
(ESWT s. Su ge y). The consolida ion a e in ou se ies was 87.5%, compa able o he success a e ound by
No a nicola e al, Fallnhause e al (71%) and Alkhawashki e al (75% o all si es combined). [12,13,14].
Cacchio e al. conduc ed a p ospec i e, andomized, con olled, mul icen e s udy o examine he e ec s o shock wa e
ea men on unhealed long bones compa ed wi h su ge y. Radiological assessmen , which was he p ima y ou come
pa ame e , was pe o med a se e al di e en poin s up o 24 mon hs a e ea men . Radiological esul s showed no
signi ican di e ence be ween he s udy g oups, and bone healing was e iden in 94% o g oup 1 (0.4 mJ/mm 2 ), 92%
o g oup 2 (0.7 mJ/mm 2) and 95% o he su gical g oup a e 2 yea s. Howe e , he Visual Analogue Scale (VAS), he
Lowe Limb Func ion Scale (LLFS) and he Disabili y o A ms, Shoulde s and Hands Ques ionnai e (DASH) showed a
signi ican ly be e ou come in he ESWT g oups a 3 and 6 mon hs compa ed wi h su ge y. In addi ion, no ad e se
e en s we e obse ed in he ESWT g oups, wi h he excep ion o small pe echial haemo hages and mino hema omas
in 23 pa ien s [15].
Sys emic isk ac o s o bone healing we e conside ed by E e ding e al. In e es ingly, al hough hey ha e been shown
o be nega i e p edic o s in o he s udies, hey we e unable o demons a e a nega i e associa ion be ween smoking
and ESWT ea men success [17].
In esponse o inc eased in eg in exp ession, ocal adhesion kinase (FAK) is signi ican ly ac i a ed by ele a ed
phospho yla ion, leading o inc eased adhesion, dis ibu ion and mig a ion o os eoblas s, ul ima ely p omo ing
ac u e healing. Fu he mo e, a dec eased RANKL/OPG a io was ound in shock wa e-s imula ed os eoblas s,
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 038-042
41
indica ing inhibi ion o os eoclas ogenesis. Inc eased RUNX-2 p o ein le els and educed RANKL/OPG a ios p omo e
bone healing [18].
The applica ion o low-ene gy adial shock wa es p o ides a biological e ascula izing e ec , a he han a mechanical
up u e e ec . This e ec is induced by he local elease o os eogenic ac o s such as NO, TGF-be a 1 and bone
mo phogenic p o ein 2 (BMP-2), as well as neo-angiogenic ac o , a ascula endo helial g ow h ac o . P e ious
esea ch has shown ha shock wa es induce hype pola iza ion o he cell memb ane, s imula ing os eoblas
p oli e a ion and p omo ing NO syn hesis. The p oduc ion o TGF-b1 and BMP-2 is hough o p omo e os eogenic
di e en ia ion o mesenchymal s em cells [18-20].
5. Conclusion
Pseuda h osis is a ai ly equen complica ion o scaphoid ac u es, due o i s pa icula loca ion and ascula iza ion,
which makes i di icul o consolida e. Su gical and non-su gical echniques a e used o ea his complica ion. Among
he non-su gical op ions, ex aco po eal shock wa e he apy has p o ed o be a eliable and e ec i e non-in asi e
modali y. The esul s ob ained a e compa able o hose o su ge y, wi h a clea ly posi i e cos -bene i a io.
Howe e , u he p ospec i e and andomized s udies a e needed o subs an ia e hese esul s and ob ain u he
op imiza ion o he apeu ic pa ame e s and subsequen ea men .
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s decla e no con lic o in e es .
Financing s a emen
The au ho s ecei ed no inancial suppo o he esea ch, w i ing and/o publica ion o his a icle.
S a emen o In o med consen
In o med consen was ob ained om all pa icipan s included in he s udy.
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