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E icacy o Ex aco po eal Shockwa e The apy in he
T ea men o Pa ien s wi h T igge Finge
Gle isha Ann Mendonca, In e n
Fa he Mulle Medical College
Mangalo e, India
Cyanna Joseph Dsouza, Lec u e
Lec u e , Fa he Mulle Medical College Mangalo e,
India; and Resea ch Schola , Ins i u e o Physio he apy,
S ini as Uni e si y, Mangalo e, India.
Co esponding Au ho :- Gle isha Ann Mendonca, In e n, Fa he Mulle Medical College, Mangalo e, India
Abs ac :-
Backg ound and Need:- T igge inge being one o
he common causes o pain and disabili y in he
hand, is hough o be caused by in lamma ion and
na owing o he A1 pulley. Ex aco po eal
Shockwa e The apy (ESWT) which is commonly
used o ea a ied o hopaedic condi ions, wo ks
by co ec ing he mechanical insu iciency ela ed o
igge inge . This a icle aims o gi e an o e iew
o ESWT in educing pain, s i ness and imp o ing
ange o mo ion in pa ien s wi h igge inge .
Me hods:- 570 a icles we e e ie ed om da abases
iz. PubMed, Science Di ec and Google Schola .
Conside ing he inclusion and exclusion c i e ia, i e
s udies we e ound eligible o his e iew ha
consis ed o in e en ional and coho s udies.
Resul s:- Two andomised con olled ials ound
signi ican educ ion in pain in ensi y and se e i y o
igge ing, bu did no show any signi ican
di e ences in unc ional impac o igge ing.
Al e na ely, wo non- andomised ials and one
e ospec i e coho s udy showed educed pain
le els and inc eased gene al unc ional capaci y,
g ip s eng h, pinch s eng h and ange o mo ion.
Conclusion:- ESWT can be conside as a sa e and
e ec i e ea men in alle ia ing pain and gene al
unc ion in pa ien s wi h igge inge . Howe e ,
hese indings need o be con i med by u u e ials
and es ablish he sho - and long- e m e ec s o
ESWT on pain, ange o mo ion, s eng h and
unc ion in he managemen o igge inge .
Keywo ds:- ESWT, Ex aco po eal Shockwa e The apy,
T igge Finge , T igge Finge Diso de .
I. INTRODUCTION
A igge inge is a common inge ailmen , hough o
be caused by in lamma ion and na owing o he A1 pulley
and is associa ed wi h clinical signs like pain, clicking,
ca ching, and loss o mo ion o he a ec ed digi .1 The
igge ing occu s a he le el o he me aca pophalangeal
join s and is one o he mos equen causes o pain and
disabili y in he hand.2,3 The gliding o he lexo endons
causes changes ha lead o s enosis o he A1 pulley and he
ic ion caused in he lexo endons when passing h ough
he s eno ic pulley can change he ibe s, o ming an
in a endinous lump.3 The lexo endons which a e
su ounded by he lexo shea h om he me aca pal neck o
he ola pla e o he dis al in e phalangeal join , a e
a ached longi udinally o he unde lying bony s uc u es.
This shea h is hick o e he bones and hin in a eas
o e lying he join s which pe mi s digi al lexion.4
The dominan hand is mo e commonly a ec ed and
occu s in he middle i h o six h decades o li e whe e
women a e a ec ed mo e han men and he li e ime isk o
igge inge de elopmen is be ween 2 o 3 pe cen bu
inc eases o up o 10 pe cen in pe sons wi h diabe es.1,5 The
ing inge is mos commonly a ec ed, ollowed by he
humb, long, index, and small inge s in pa ien s wi h
mul iple igge digi s. Pa ien s wi h diabe es melli us, ca pal
unnel synd ome, Dupuy en’s disease, heuma oid a h i is,
amyloidosis, hypo hy oidism, mucopolysaccha ide s o age
diso de s, and conges i e hea ailu e a e o en a ec ed
wi h igge inge .6 The pa ien p esen s wi h pain in he
palm du ing mo emen o he in ol ed digi s and he lexo
endon causes a pain ul click when he pa ien lexes and
ex ends he digi . The pa ien may p esen wi h a digi
locked in a lexion posi ion.4 Signs and symp oms o
pa ien s wi h igge inge s include pain, ca ching o
snapping as he pa ien lexes and ex ends, lump in he digi ,
and swelling.3
T igge ing o he lexo mechanism o a digi can be
cu ed by su ge y, bu i is no always success ul in elie ing
he pa ien ’s symp oms and a wo s , he phenomenon o
igge ing may be eplaced by discom o om a pain ul
sca .2 O he conse a i e me hods such as splin ing
p e en s he ic ion caused by lexo endon mo emen
h ough he a ec ed A1 pulley un il he in lamma ion
esol es. Besides, co icos e oid injec ions educe he isk o
endon damage. Ex aco po eal Shockwa e he apy (ESWT)
o he ea men o musculoskele al diseases is a ield ha is
de eloping apidly and a ac ing inc easing a en ion.7
Ex aco po eal shockwa es a e de ined as p essu e wa es,
ha p opaga e in h ee dimensions and ypically induce a
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clea inc ease in p essu e wi hin a ew nanoseconds.8 The e
a e h ee main echniques h ough which shockwa es a e
gene a ed, hese a e elec ohyd aulic, elec omagne ic, and
piezoelec ic p inciples, each o which ep esen s a di e en
echnique o gene a ing shockwa es.9
Resea che s ha e ound ha ESWT in he
managemen o igge inge leads o a educ ion in se e i y
o pain and igge ing, and unc ional impac o igge ing,
and his educ ion pe sis ed un il he 18 h week a e
in e en ion. I is ecommended o use ESWT in e ms o a
non-in asi e in e en ion wi h no signi ican complica ions
o pa ien s wi h igge inge .10 This a icle aims o gi e
an o e iew o ESWT and i s uses in igge inge pa ien s
o educe pain and s i ness and inc ease he ange o mo ion
o he a ec ed digi . As he e is a dea h o e idence
conce ning ESWT in igge inge his s udy will help
summa ise i s e ec s.
II. METHODOLOGY
Sea ch S a egy
Da abases used o his e iew we e PubMed, Science
Di ec and Google Schola . The ollowing keywo ds we e
used: ‘ESWT’, ‘ex aco po eal shock wa e he apy’,
‘ ocused ex aco po eal shock wa e he apy’, ‘ adial
ex aco po eal shock wa e he apy’, ‘ igge inge ’ and
‘ igge inge diso de ’.
S udy Selec ion
S udies we e conside ed o inclusion i hey me he
ollowing c i e ia: (a) a icles in English language (b)
a icles ha include adial ex aco po eal shock wa e
he apy and/o ocused ex aco po eal shock wa e he apy
(c) a icles published om 2010 o 2022 and (d) s udies
done on human subjec s. S udies we e conside ed o
exclusion i hey me he ollowing c i e ia: (a) a icles
whose ull ex was no a ailable (b) a icles published
be o e 2010 (c) a icles ha used ESWT o condi ions o he
han igge inge .
Examined Va iables
The a iables examined in he s udy we e: (a)
equency o igge ing, (b) se e i y o igge ing, (c) pain,
(d) gene al unc ional capaci y, (e) ROM, ( ) g ip s eng h
and (g) pinch s eng h.
Sea ch o Li e a u e
The li e a u e sea ch h ough he da abase showed
1865 a icles, ou o which 1295 duplica es we e uled ou .
A e ini ial sc eening, 540 we e excluded and 30 pape s
emained o abs ac e iew. A o al o 25 a icles ha did
no mee he emaining inclusion c i e ia we e excluded,
a e which only 5 s udies ha me all he inclusion c i e ia
we e conside ed o u he e iew. (Figu e 1)
Fig 1 The P isma Flow Diag am, Illus a ing Each S ep in he P ocess o Iden i y he Final Selec ion o S udies o be Re iewed.
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III. RESULTS
Sample
The s udy samples consis ed o adul s su e ing om igge inge . Mos s udies included indi iduals wi h G ade II igge
inge ha was classi ied acco ding o he Quinnel classi ica ion.
Me hodological Quali y o T ials
In acco dance wi h he selec ion and ejec ion c i e ia, only 4 s udies we e inally accep ed o he p esen s udy (Figu e 1).
Since he s udy done by Chen e al.11 and Yildi im e al.14 adop ed he design o a andomised con olled ial (Le el 2), he PED o
scale was used o assess he quali y o hese ials, which was 9/10 and 8/10 espec i ely. The s udies conduc ed by Vahda pou e
al. 10 and Dog u e al.12 we e a non- andomised clinical ials whe eas he s udy by Mallia opoulos e al.13 adop ed he design o a
e ospec i e coho s udy (Le el 3).
In e en ions
The in ensi y and ype o ESWT di e ed in he s udies. Chen e al. compa ed he e ec s o a high and low ene gy ESWT,
whe ein he pa ien s in he high ene gy ESWT g oup and low ene gy ESWT g oup ecei ed 1500 impulses o ocused shockwa es
a a densi y o 0.01 mJ/mm2 and 0.006 mJ/mm2 espec i ely. Yildi im e al. compa ed he e ec o he ESWT o a equency o 15
Hz wi h a local co icos e oid injec ion. O he ypes o ESWT such as Radial ex aco po eal shockwa e he apy ( ESWT) and
Focussed ex aco po eal shockwa e he apy ( ESWT) we e also es ed. ESWT, a ype o ESWT adop s a ocke mechanism o
s imula e p essu e wa es on he pe iphe al issues o he nodule whe eas ESWT was adminis e ed di ec ly on he nodule and si e
o maximum ende ness. All in e en ions we e gi en o an a e age o 12-18 weeks (Table 1).
Table 1 B ie Desc ip ion o Included S udies
No
Au ho &
Yea
Sample
size
In e en ion/De ice
Du a ion,
F equency,
In ensi y o
In e en ion
Dependen
a iables
E alua ion/
e-
assessmen
Resul s
1
Chen YP e
al.11 (2021)
N=60
HS
g oup=20
LS
g oup=20
Sham
g oup=20
Wide- ocused ESWT
de ice (LM-IASO)
Once pe
week o
4weeks
HS g oup
(ene gy lux
densi y o
0.01mJ/mm2,
5.8 ba , 1500
impulses)
LS g oup
(ene gy lux
densi y o
0.006mJ/mm2,
3 ba , 1500
impulses)
Sham g oup
(1500
impulses o
ene gy ee
ib a ion)
Pain sco e,
equency o
igge ing,
se e i y o
igge ing,
unc ional
impac o
igge ing,
gene al
unc ional
capaci y
Baseline,
one, h ee
and six
mon hs a e
in e en ion
All g oups
showed
signi ican
imp o emen ;
HS g oup
demons a ed
highe
magni ude o
imp o emen ;
no e ec on
unc ional
impac o
igge ing
2
Yildi im P e
al.14 (2016)
N=40
ESWT
g oup=20
Injec ion
g oup=20
Vib oli h O ho ESWT
Th ee sessions
(one week
in e al
be ween each
session)
ESWT g oup
(ene gy lux
densi y o
15Hz, 2.1 ba ,
1000
impulses)
Injec ion
g oup (local
co icos e oid)
Cu e a e,
pain sco e,
equency o
igge ing,
se e i y o
igge ing,
unc ional
impac o
igge ing,
gene al
unc ional
capaci y
Baseline,
one, h ee
and six
mon hs a e
in e en ion
Bo h g oups
demons a ed
s a is ically
signi ican
imp o emen s
in all ou come
measu es; no
be ween g oup
di e ences o
cu e a es, pain
and unc ional
s a us a ollow
up
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3
Vahda pou B
e al.10 (2020)
N=19
DUOLITH SD1 Towe
( ESWT + ESWT)
Th ee sessions
(one week
in e al
be ween each
session)
eESWT
(ene gy lux
densi y o
15Hz, 2.1 ba ,
1000
impulses)
Pain sco e,
se e i y o
igge ing,
igge inge
sco e,
gene al
unc ional
capaci y
Baseline,
immedia ely
a e , six and
eigh een
weeks a e
in e en ion
Excep o
se e i y o
igge ing, he e
we e
s a is ically
signi ican
ou comes in all
a iables pos
in e en ion
4
Dog u e al.12
(2020)
N=18
Swiss Dolo clas
ESWT
Ten sessions,
wice a week
o 5 weeks
ESWT
(ene gy lux
densi y o
10Hz, 2 ba ,
2000
impulses)
Pain sco e,
gene al
unc ional
capaci y,
ange o
mo ion, g ip
s eng h,
pinch
s eng h
Baseline,
immedia ely
a e and
h ee mon hs
a e
in e en ion
S a is ically
signi ican
ou comes in all
a iables pos
in e en ion
5
Mallia opoulos
N e al.13
(2016)
N=44
S o z Medical
Mas e plus MP200
ESWT de ice
Weekly un il
symp oms
subsided
(based on
indi idual
esponse)
ESWT
(ene gy lux
densi y o 5-
6Hz, 1-3 ba s,
2000
impulses)
Pain sco e,
unc ional
ou come
Baseline,
one, h ee
and wel e
mon hs a e
in e en ion
Signi ican
educ ions in
pain sco es and
unc ional
imp o emen
we e ound
be ween
baseline and all
ollow-up
assessmen s
N: Sample Size; ESWT: Ex aco po eal Shockwa e The apy; HS:High-ene gy ESWT; LS:Low-ene gy ESWT; ESWT: adial
Ex aco po eal Shockwa e The apy; ESWT: ocused Ex aco po eal Shockwa e The apy
IV. DISCUSSION
Pa ien s wi h igge inge diso de p esen wi h pain,
educed ROM, ca pal unnel synd ome, une en inge
mo emen s and locked digi . I has been sugges ed ha
ESWT helps in co ec ing he igge inge diso de by
educing pain, se e i y o igge ing and unc ional impac
o igge ing. The in e en ional s udies and coho s udies
which we e selec ed o he e iew showed ha ESWT
educes pain se e i y, inc eases gene al unc ional capaci y,
g ip s eng h, pinch s eng h and ROM. Some o he s udies
demons a ed posi i e e ec s o ESWT in igge inge
pa ien s whe eas some o he a icles showed no di e ence
ollowing ESWT in some pa ame e s which we e e lec ed
in he esul s.
Chen YP e al.11 who used he wide- ocused ESWT
de ice ound ha pa icipan s expe ienced a signi ican
imp o emen in all clinical pa ame e s such as pain,
equency and se e i y o igge ing. Howe e , he
unc ional impac o igge ing did no imp o e. I was
no ewo hy ha e en he sham g oup demons a ed hese
imp o emen s wi h ime, implying ha he pa ien s’s
expec a ions and use o NSAIDs may lead o he
de elopmen o his placebo e ec . Also, his ial only
included pa ien s wi h G ade II igge inge , whe e
symp oms a e caused due o in lamma ion and no due o
mechanical locking. Hence, his could be he eason behind
all g oups displaying simila esul s as all pa icipan s we e
allowed o consume NSAIDs and ake adequa e es .
Compa ing o a ixed ene gy densi y, his s udy no ed ha
ESWT wi h a maximum ole able ene gy could be mo e
e ec i e in elie ing pain and unc ion. This s udy also did
no exclude pa icipan s wi h associa ed como bidi ies such
as diabe es melli us and ca pal unnel synd ome. The e ec
o ESWT was compa ed wi h ha o a co icos e oid
injec ion by Yildi im e al.14 whe e bo h g oups
demons a ed s a is ically signi ican imp o emen s in cu e
a es, pain and unc ional s a us a e 6 mon hs o ea men .
These indings emphasise ha ESWT can be a
ecommended al e na i e o pa ien s who a e alle gic o
local anaes hesia, ha e needle phobia o hose who ea he
complica ions o co icos e oid injec ions in gene al.
Besides ec ui ing indi iduals only wi h G ade II igge
inge , his s udy lacked a con ol g oup and he pain
expe ienced du ing ei he ea men was no documen ed.
Simila ly, Vahda pou B e al.10 who adminis e ed
ESWT ound ha i lead o educ ion in pain and se e i y
o igge ing immedia ely a e in e en ion bu did no yield
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a s a is ically signi ican di e ence compa ed o be o e
in e en ion. On he o he hand, he e ec o he ea men
on educing pain se e i y, se e i y o igge ing, and
unc ional impac o igge ing in he 6 weeks a e
in e en ion did no yield a s a is ically signi ican
di e ence compa ed o he 18 weeks a e in e en ion.
Dog u M e al12 and Mallia opoulos N e al13 showed ESWT
is an e ec i e me hod in pa ien s wi h igge inge diso de
by dec easing pain le els and inc easing gene al unc ional
capaci y, g ip s eng h, pinch g ip and ange o mo ion o
he a ec ed digi . All ou come measu es showed s a is ically
signi ican imp o emen s immedia ely a e and h ee
mon hs pos ea men bu , hese s udies did no include a
con ol g oup. The numbe o ESWT sessions signi ican ly
co ela ed wi h p e ea men symp om du a ion.
O e all, all he abo e indings indica e ha ESWT can
be a sa e al e na i e o medica ions and also play a majo
ole in he conse a i e managemen o pa ien s wi h igge
inge . I is pos ula ed ha he ac ion o ESWT is o
s imula e biological ac i i y in cells leading o he
de elopmen o mechanosensi i e bio eedback be ween he
sound wa es and he cells. Resea che s show ha an
inc ease in he angio ensin ac o by ESWT esul s in
neo ascula iza ion and app op ia e ascula suppo o he
inju ed endon leading o i s epai . Mo eo e , ESWT
s imula es he syn hesis o ni ic oxide which supp esses
in lamma ion.15-18 Ne e heless, he e ec i eness o ESWT
depends on se e al ac o s including he loca ion o p essu e
applica ion, he ene gy lux densi y, o e all ene gy,
adhe ence o he p inciples o shockwa e p oduc ion, and
he de ice i sel .19
The cu en e iew obse ed ce ain limi a ions. Only
limi ed a icles could be included since many o he s used
ESWT along wi h o he p ocedu es. The e iew could no
main ain homogenei y in he ype o s udy, such ha only
ew andomized con olled ials we e included. I was also
di icul o compa e he quali y among he chosen s udies as
some had no con ol g oups. The s udies had smalle sample
sizes which could po en ially a ec he eliabili y o he
esul s, leading o highe a iabili y and bias. Though he
de ices used o in e en ion we e no o he same make, he
s udies we e compa able in e ms o ea men in ensi y and
du a ion.
V. CONCLUSION
The indings o his e iew sugges ha physical
he apis s can sa ely conside he use o ESWT as an adjunc
o he con en ional p o ocol o ea ing igge inge
e ec i ely. The use o ESWT no only wa an s educ ion in
pain le els, bu also can accele a e unc ional pe o mance
and eco e y in pa ien s wi h igge inge . Fu u e esea ch
is needed o include s udies wi h imp o ed esea ch
p o ocols, wi h la ge s udy popula ions and ha a e speci ic
o he ype and dosage o ESWT o be used. These will
u he s eng hen he e idence owa ds he use o ESWT in
clinical p ac ice. The e o e, aking in o accoun he
limi a ions o his li e a u e e iew, he esea che s wa an a
u u e scope wi h new expe imen al p o ocols wi h be e
me hodological quali y o con i m he e icacy o ESWT in
he managemen o igge inge .
Decla a ion o Con lic ing In e es s
The au ho s decla e no con lic s o in e es wi h
espec o he au ho ship and/o publica ion o his a icle.
Funding
The au ho s ecei ed no inancial suppo o he
esea ch and/o au ho ship o his a icle.
Acknowledgemen
We would like o exp ess ou g a i ude o he s a o
he ins i u ional depa men o hei suppo and guidance.
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ISSN No:-2456-2165
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