Effect of Shockwave Versus Low Level Laser Therapy on Recurrent post Operative Dupuytren’s Contracture

Abstract

Background: Dupuytren’s disorder is a disease which develops gradually in stages as a result of thickening of palmar facia that provides cords and nodules and it reveals loss or decrease in ROM of the involved fingers and pain with tenosynovitis. Dupuytren’s disorder is diagnosed by fibrotic stage that generate from fibrocellular proliferation. The most affected finger normally is the ring finger then the little and center fingers. This can make certain tasks more difficult of day living as face washing, brushing hair and placing hand in a glove and shaking hands1. Purpose: This study was conducted to investigate the efficacy of shock wave and low-level laser therapy on recurrent post-operative Dupuytren’s contracture. Subjects and Methods: Sixty patients who had been diagnosed with recurrent post-operative Dupuytren’s contracture with age ranged from 50 to 70 years old suffering from flexion deformities of the ring and little digits and loss of range of motion. They were divided into two equal groups in number, each group had 30 patients: Group (A): Thirty patients received extracorporeal shock wave therapy (one session per week for six weeks) in addition to the traditional physical therapy protocol (U.S, massage, stretching ex, range of motion (ROM) ex and splinting). Group (B): Thirty patients received low-level laser therapy (two sessions per week for six weeks) in addition to the traditional physical therapy protocol (U.S, massage, stretching ex, range of motion (ROM) ex and splinting). Evaluations of both groups (A and B) were done two times pre and post six weeks treatment using JAMAR hand grip dynamometer and universal goniometer. Results: There was no significant difference between groups pre-treatment. There was a significant decrease in flexion contracture and a significant increase in hand grip strength post treatment in both groups compared with that pretreatment. Comparison between groups post treatment revealed a significant decrease in flexion contracture and a significant increase in hand grip strength of group (A) compared with that of group (B). The percent of change in flexion contracture and hand grip strength of group A was 52.90 and 28.29% respectively, and that in group B was 23.83 and 12.77% respectively. Conclusion: Shock wave therapy and low laser therapy has a significant effect on improving the grip strength and decreasing the flexion contracture in patients with recurrent post-operative Dupuytren’s contracture. Yet, the shock wave therapy had significantly higher effect on both outcomes than low laser therapy