Clinical utility of extracorporeal shock wave therapy in restoring hand function of patients with nerve injury and hypertrophic scars due to burns: a prospective, randomized, double-blinded study
TL;DR
This study provides high-quality evidence from a double-blind RCT that ESWT can significantly improve hand function in burn patients with nerve injuries and hypertrophic scars. The improvements in pain, joint mobility, fine motor skills, and scar characteristics suggest ESWT addresses multiple aspects of post-burn hand dysfunction simultaneously. For patients struggling with burn rehabilitation, ESWT offers a safe, non-invasive treatment option that can accelerate functional recovery.
Key Numbers
ESWT group showed significantly better VAS pain scores than sham (P=0.004)
Hand extension range of motion improved significantly more with ESWT (P=0.02)
Writing, small object handling, and light object tasks all improved significantly with ESWT (P<0.001, P<0.001, P=0.002)
Skin distensibility and biological elasticity both significantly better with ESWT (P<0.001)
103 patients completed the 12-week double-blind randomized controlled trial
Key Findings
ESWT significantly reduces pain compared to sham treatment
Patients who received shockwave therapy experienced significantly less scar pain than those who received fake treatment.
VAS score improvement significantly greater in ESWT group vs sham (P=0.004)
ESWT improves hand joint extension range of motion
Shockwave therapy helped burn patients extend their fingers more than the control treatment.
Extension ROM improvement significantly greater in ESWT group vs sham (P=0.02)
ESWT improves hand function for fine motor tasks
Patients receiving shockwave therapy showed better performance in writing, picking up small objects, and handling light objects compared to those who didn't.
JTT scores for writing, small objects, and light objects were significantly better in ESWT group (P<0.001, P<0.001, P=0.002)
ESWT improves skin characteristics of burn scars
Shockwave therapy made burn scars more flexible and elastic, and improved their pigmentation compared to fake treatment.
Significant improvements in melanin (P=0.004), skin distensibility (P<0.001), and biological skin elasticity (P<0.001) in ESWT vs sham
ESWT is safe with no serious complications
While the treatment caused some discomfort, there were no serious side effects that stopped patients from completing their sessions.
Participants complained of pain during ESWT but were able to continue; no ecchymosis, skin abrasion, or scar deterioration requiring treatment discontinuation
Our Take
This is an impressive study that demonstrates shockwave therapy's versatility beyond its traditional musculoskeletal applications. The double-blind, randomized design with a proper sham control gives us confidence in the results. What stands out is that ESWT improved multiple dimensions of hand function - not just pain relief, but actual functional improvements in tasks like writing and handling objects. The improvements in scar elasticity and flexibility likely contribute to better joint mobility. For burn patients dealing with the challenging combination of nerve damage and scarring, this study suggests ESWT could be a valuable addition to their rehabilitation program. The treatment was well-tolerated with no serious side effects, making it a reasonable option to discuss with your care team if you're recovering from hand burns.
Treatment Protocol
- Device
- Duolith SD-1 (StorzMedical)
- Frequency
- 1x/week
Study Limitations
- • Small sample size
- • Short follow-up period (only immediately after 12 weeks of treatment)
- • Diversity of wound healing phases among participants
- • No electromyography testing after treatment to objectively confirm nerve regeneration
- • Study limited to dominant right hand burns only
