Short-term effect of shockwave therapy, temperature controlled high energy adjustable multi-mode emission laser or stretching in Dupuytren’s disease: a prospective randomized clinical trial

Abstract

Dupuytren’s disease is a debilitating disease of the hand characterized by nodules on the surface of the palm with progressive loss of finger extension. The chosen forms of treatment are infiltrative and surgical. Conservative treatment could be useful but few studies have been carried out and these regarded mainly stretching exercises and thermo-therapy. To date, no study has analyzed the effects of biostimulation with shock-waves (SW) and high energy laser therapy [Temperature controlled High Energy Adjustable multi-mode emission Laser (THEAL)]. We recruited 45 patients, 32 males and 13 females (average age 63.4 years) affected by early or late stage Dupuytren’s disease [33 metacarpophalangeal (MCP) joints, 12 proximal interphalangeal (PIP) joints]. We randomized the patients into three treatment groups: extracorporeal shockwave therapy (ESWT), THEAL and stretching exercises. Follow-ups were at the end of treatment (T1), after 1 month (T2), and after 3 months (T3). The three forms of treatment determined a progressive clinical-functional improvement. The pain relief was statistically significant for SW and THEAL at all follow-ups (FUs) (p>/=0.01). The functional recovery was statistically significant in the SW group at all FUs and in the THEAL and Stretching groups at T1 and T2 (p>0.01). Patient satisfaction level was higher for SW at T2 and T3 and for THEAL at T2 (p>/=0.01). The extension deficit recovery as regards the MCP and PIP joints was statistically significant in the SW group at T1 and T2 (p>/= 0.01) and in the stretching group at T1 (p>0.01). The SW and THEAL treatments appear safe, have good efficacy and are associated with good patient satisfaction in the short and medium terms. Further studies may verify the possibility of repeated cycles and/or combined therapies to improve results.