Systematic mapping review of applications of extracorporeal shockwave therapy (ESWT) in hand surgery

This systematic mapping review aims to consolidate and categorize existing evidence regarding the utilization of extracorporeal shockwave therapy (ESWT) in hand surgery.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a comprehensive search was performed to identify studies assessing ESWT in hand conditions. Eligible studies required a minimum of 3 months' follow-up. Data extraction adhered to predetermined criteria, and outcomes were classified into clinical assessment, patient-reported outcome measures (PROMs), neurophysiological tests, and miscellaneous domains.

Thirty studies met inclusion criteria, comprising 18 randomized controlled trials (RCTs), 10 case series, and two cohort studies. Evidence was predominantly centered on carpal tunnel syndrome (CTS), with additional studies addressing trigger finger, Dupuytren's disease, post-carpal tunnel release (post-CTRS) pillar pain and scaphoid wrist nonunions. Most reports demonstrated short-term improvements in clinical and PROM outcomes, with complications infrequent and generally mild. However, treatment protocols varied widely in terms of shockwave type, intensity, and frequency. Observations on dose dependency were inconsistent, and most RCTs carried a moderate to high risk of bias, with all reporting a Fragility Index (FI) of zero.

This review highlights ESWT as a promising adjunct with short-term benefits across select soft tissue conditions of the hand. Nevertheless, its role in long-term management remains uncertain. Standardization of treatment parameters and rigorously designed multicenter RCTs with extended follow-up and functional outcomes are required to establish the durability, safety, and clinical utility of ESWT in hand surgery.