Efficacy of extracorporeal shock wave therapy for grade Ⅲ-Ⅳ (Quinnell classification) stenosing flexor tenosynovitis

Objective：To observe the clinical efficacy of extracorporeal shock wave therapy (ESWT) for stenosing flexor tenosynovitis of Quinnell grade Ⅲ-Ⅳ. Methods：A total of 90 patients with stenosing flexor tenosynovitis of Quinnell graded Ⅲ-Ⅳ were randomly assigned to the ESWT group, local steroid injection group, and combined treatment group, with 30 cases in each group. The visual analogue scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and pinch strength were assessed before and 4 weeks after the treatment. The overall response rate was also evaluated at same time. Results：After treatment, there were significant improvements in VAS score, DASH score, and pinch strength in all the groups. The VAS score of patients was significantly lower in local steroid injection group and combined treatment group than that in ESWT group (P<0.05). There was no significant difference in VAS score between combined treatment group and local steroid injection group. The DASH score was lower in combined treatment group than that in local steroid injection group and ESWT group (P<0.05); The DASH score was lower in local steroid injection group than that in the ESWT group (P<0.05). There was significantly greater improvement in pinch strength in combined treatment group than that in the other two groups (P<0.05). There was no significant difference in pinch strength between ESWT group and local steroid injection group. The overall response rate was significantly higher in combined treatment group (96.67%) than that in steroid injection group (83.33%) and ESWT group (76.67%), and the differences were statistically significant (P<0.05). Conclusions：ESWT alone might not produce satisfactory therapeutic effect on grade Ⅲ-Ⅳ stenosing flexor tenosynovitis, but it could improve the clinical efficacy for the disease in combination with the local steroid injection.