A patient asked, “Can focused shockwave (FSW) help the arthritis in my hands”. This is what the research says about osteoarthritis (OA) of the hand, a chronic degenerative disease, and FSW.
If you have pain, swelling, stiffness, and deformity in your hands you probably have arthritis and/or tendinitis in and around some of the hand joints. OA and tendinopathy can involve a high degree of pain and functional disability, making it difficult to perform pinching and gripping tasks. Being able to open a jar, seize a full bottle and raise it, pour liquid from a bottle into a glass, peel a piece of fruit, cut a piece of meat with a knife, button your shirt, turn a key in a lock, turn a door knob, and pick up coins from a tabletop are examples of gripping and pinching tasks evaluated in the Duruoz Hand Index. Having weakness or pain with pinching and gripping tasks is an indication for making an appointment for assessment and treatment of the hands.
A strong grip is an important indicator of overall strength and longevity. If hand pain is left untreated the patient may develop bone-on-bone arthritis and the joints can partially dislocate which can lead to impairments in function with a gradual loss of dexterity and a deterioration of intrinsic muscle strength. poor grip strength generally means you can’t apply yourself to other health measures like lifting and carrying activities.
Some common treatments in the early stages of the disease may include:
- Taking anti-inflammatory medications, such as aspirin or ibuprofen, to help reduce inflammation and swelling. Taking anti-inflammatory drugs is never a good long-term strategy. Anti-inflammatory drugs help to control pain but increase the rate of joint degeneration. They also have side effects on the kidneys, liver and gut.
- Icing the joint for 5 to 15 minutes several times a day for pain control.
- Wearing a supportive splint or compression glove during the day or overnight to limit the joint movement and allow the joint to rest and heal.
Less common treatments include:
- Intra-articular injections: Corticosteroid and Hyaluronic acid
- Focused acoustic shockwave therapy (FSW)
- Surgery, if injections and FSW do not provide enough relief.
An intra-articular corticosteroid injection is relatively safe. However, side effects may occur after repeated injections, such as local infection due to immunological suppression, local tissue atrophy, tendon and ligament weakening, and peri-articular soft tissue calcification so you don’t want to get more than one cortisone injection.
Intra-articular injections with hyaluronic acid (HA), a humectant which attracts moisture into the joint, on the other hand, result in visco supplementation, re-establishing the hand’s elastic properties, such as cushioning, lubrication, and elasticity, and stimulate anti-inflammatory effects. An article, by Spaans et al. published in J Hand Surg Am. 2015;40:16–2 titled, Conservative treatment of thumb base osteoarthritis: a systematic review, observed the effectiveness of both treatments in terms of pain relief. They found a much more long-lasting effect with HA injections. So, if you are considering an injection, go for the HA injection and reject getting a cortisone injection. But wait, there is a better option.
Focused acoustic shockwave therapy (FSW) has proven effective in treating many musculoskeletal disorders owing to its angiogenic (new blood vessel growing ability), analgesic and anti-inflammatory effects. A systematic review recommended three treatments at 1-week intervals, with a dose of 2,000 acoustic shocks at a frequency of 4-8 Hz at the highest dose of energy the patient can tolerate per session. FSW works by increasing nitric oxide levels which can increase blood flow and improve the endothelial cell lining of vessels. It promotes a reduction in the inflammatory process and increases lubricin levels (lubrication) in the joints and tendons allowing them to move freer. Stem cells are drawn to the treated area to heal and strengthen the damaged tissues including the joint cartilage. FSW is regenerative medicine without the need for platelet or stem cell injections.
During a treatment the painful or arthritic part of the hand contacts the FSW applicator. The dose of the FSW is turned up until it feels like a dull ache, 5/10 in intensity. You move your hand over the applicator, finding and treating all of the pockets of damaged tissue in the joint and tendons. During the treatment, the intensity of the sensation diminishes. During your appointment we also mobilize/adjust the joints in your hands and wrists. Improving mobility helps to reduce pain and swelling.
A study, published in Ann Rehabil Med. 2018 Feb; 42(1): 92–100 did a comparison between treating osteoarthritis in the carpometacarpal (CMC) joint at the base of the thumb with FSW therapy and intra-articular HA injections. In the study fifty-eight patients received either FSW or HA injection once a week for 3 consecutive weeks. The main outcome measures were pain and hand function using the visual analogue pain scale (VAS) and the Duruoz Hand Index (DHI), respectively. The secondary outcomes were grip and pinch strength. Each assessment was performed at baseline, at the end of treatment, at 3 and 6-month follow-up visits.
The study observed a higher average improvement in painful symptomatology at the 6-month follow-up visit in the FSW group compared to the HA injection group. According to the results of the pinch and grip tests, they found a significant improvement in strength in both groups. However, the FSW group showed superior improvement on the pinch test beginning immediately at the end of treatment while in the HA group, the improvement started at the 6-month follow-up.
The conclusion, the use of FSW in patients with osteoarthritis at the base of the thumb leads to a reduction in pain, an improvement in pinch and grip performance that persists for at least 6 months, and a decrease in hand disability up to the 6-month follow-up visit.
Surgery is always an option if the results from HA and FSW are not satisfactory. If you go with a surgical option, expect to wear a cast for 4 to 8 weeks after thumb arthritis surgery. Your doctor may also recommend a rehabilitation program that involves physical therapy (hand therapy) to help you regain movement and strength. Depending on the surgery you have, it may take several months to return to normal activities.
FSW is a promising option for the treatment of tendinopathy and OA of the hand because it is non-invasive, requires no downtime, has no complications, is not addictive and it seems to be an equivalent to and possibly a better alternative to HA injection in the treatment of hand OA. FSW is particularly useful for patients with moderate-to-severe pain who are considering injections or surgery. In clinical practice it is advised to treat tendinopathy, including Dupuytren’s Contracture, of the hand with FSW before OA develops. The sooner you start treatment the better. You don’t have to wait until you have moderate to severe OA before starting FSW. The longer you wait the more treatments required. If you have had your problem for 30+ years 6-8 treatments may be needed.
If you choose to undergo a series of FSW treatments for your hands it is advised that you stop taking anti-inflammatory drugs 2 weeks before your first FSW treatment. If you have had a cortisone injection in the hand you are advised to wait for 6 weeks before starting FSW treatments of the hand. While anti-inflammatory drugs make you feel better they interfere with the healing process lessening the benefits from FSW treatments.
For Hand Pain and Osteoarthritis: focused shockwave is better than cortisone
June 10, 2024 by manager • Uncategorized Tags: focused, osteoarthritis, Shockwave •
A patient asked, “Can focused shockwave (FSW) help the arthritis in my hands”. This is what the research says about osteoarthritis (OA) of the hand, a chronic degenerative disease, and FSW.
If you have pain, swelling, stiffness, and deformity in your hands you probably have arthritis and/or tendinitis in and around some of the hand joints. OA and tendinopathy can involve a high degree of pain and functional disability, making it difficult to perform pinching and gripping tasks. Being able to open a jar, seize a full bottle and raise it, pour liquid from a bottle into a glass, peel a piece of fruit, cut a piece of meat with a knife, button your shirt, turn a key in a lock, turn a door knob, and pick up coins from a tabletop are examples of gripping and pinching tasks evaluated in the Duruoz Hand Index. Having weakness or pain with pinching and gripping tasks is an indication for making an appointment for assessment and treatment of the hands.
A strong grip is an important indicator of overall strength and longevity. If hand pain is left untreated the patient may develop bone-on-bone arthritis and the joints can partially dislocate which can lead to impairments in function with a gradual loss of dexterity and a deterioration of intrinsic muscle strength. poor grip strength generally means you can’t apply yourself to other health measures like lifting and carrying activities.
Some common treatments in the early stages of the disease may include:
Less common treatments include:
An intra-articular corticosteroid injection is relatively safe. However, side effects may occur after repeated injections, such as local infection due to immunological suppression, local tissue atrophy, tendon and ligament weakening, and peri-articular soft tissue calcification so you don’t want to get more than one cortisone injection.
Intra-articular injections with hyaluronic acid (HA), a humectant which attracts moisture into the joint, on the other hand, result in visco supplementation, re-establishing the hand’s elastic properties, such as cushioning, lubrication, and elasticity, and stimulate anti-inflammatory effects. An article, by Spaans et al. published in J Hand Surg Am. 2015;40:16–2 titled, Conservative treatment of thumb base osteoarthritis: a systematic review, observed the effectiveness of both treatments in terms of pain relief. They found a much more long-lasting effect with HA injections. So, if you are considering an injection, go for the HA injection and reject getting a cortisone injection. But wait, there is a better option.
Focused acoustic shockwave therapy (FSW) has proven effective in treating many musculoskeletal disorders owing to its angiogenic (new blood vessel growing ability), analgesic and anti-inflammatory effects. A systematic review recommended three treatments at 1-week intervals, with a dose of 2,000 acoustic shocks at a frequency of 4-8 Hz at the highest dose of energy the patient can tolerate per session. FSW works by increasing nitric oxide levels which can increase blood flow and improve the endothelial cell lining of vessels. It promotes a reduction in the inflammatory process and increases lubricin levels (lubrication) in the joints and tendons allowing them to move freer. Stem cells are drawn to the treated area to heal and strengthen the damaged tissues including the joint cartilage. FSW is regenerative medicine without the need for platelet or stem cell injections.
During a treatment the painful or arthritic part of the hand contacts the FSW applicator. The dose of the FSW is turned up until it feels like a dull ache, 5/10 in intensity. You move your hand over the applicator, finding and treating all of the pockets of damaged tissue in the joint and tendons. During the treatment, the intensity of the sensation diminishes. During your appointment we also mobilize/adjust the joints in your hands and wrists. Improving mobility helps to reduce pain and swelling.
The study observed a higher average improvement in painful symptomatology at the 6-month follow-up visit in the FSW group compared to the HA injection group. According to the results of the pinch and grip tests, they found a significant improvement in strength in both groups. However, the FSW group showed superior improvement on the pinch test beginning immediately at the end of treatment while in the HA group, the improvement started at the 6-month follow-up.
The conclusion, the use of FSW in patients with osteoarthritis at the base of the thumb leads to a reduction in pain, an improvement in pinch and grip performance that persists for at least 6 months, and a decrease in hand disability up to the 6-month follow-up visit.
Surgery is always an option if the results from HA and FSW are not satisfactory. If you go with a surgical option, expect to wear a cast for 4 to 8 weeks after thumb arthritis surgery. Your doctor may also recommend a rehabilitation program that involves physical therapy (hand therapy) to help you regain movement and strength. Depending on the surgery you have, it may take several months to return to normal activities.
FSW is a promising option for the treatment of tendinopathy and OA of the hand because it is non-invasive, requires no downtime, has no complications, is not addictive and it seems to be an equivalent to and possibly a better alternative to HA injection in the treatment of hand OA. FSW is particularly useful for patients with moderate-to-severe pain who are considering injections or surgery. In clinical practice it is advised to treat tendinopathy, including Dupuytren’s Contracture, of the hand with FSW before OA develops. The sooner you start treatment the better. You don’t have to wait until you have moderate to severe OA before starting FSW. The longer you wait the more treatments required. If you have had your problem for 30+ years 6-8 treatments may be needed.
If you choose to undergo a series of FSW treatments for your hands it is advised that you stop taking anti-inflammatory drugs 2 weeks before your first FSW treatment. If you have had a cortisone injection in the hand you are advised to wait for 6 weeks before starting FSW treatments of the hand. While anti-inflammatory drugs make you feel better they interfere with the healing process lessening the benefits from FSW treatments.