Extracorporeal shock wave as adjuvant therapy for wrist and hand spasticity in post-stroke patients: a randomized controlled trial

Background: Stroke patients often present with upper limb spasticity which impairs the functional status of patients. Recently, extracorporeal shock wave therapy (ESWT) is reported to be a safe, non-invasive, alternative treatment for spasticity. Many articles have been published on the effect of ESWT on lower limb spasticity, but only few of them had focused on upper limb spasticity, so the aim of this study is to evaluate the clinical and electrophysiological effect of ESWT on wrist and hand spasticity of chronic stroke patients and its impact on functional performance. In this monocentric study, forty chronic stroke patients with upper limb spasticity were recruited and randomly allocated into two groups. Both groups continued to receive conventional stroke rehabilitative program, while group I received three sessions of radial extracorporeal shock wave therapy (rESWT) 1 week apart. Results: There was a significant decrease in wrist and hand spasticity after treatment and at follow-up in group I compared to group II (Modified Ashworth Scale after rESWT 1.45 +/- 0.16, 2.90 +/- 0.18 and follow-up 1.55 +/- 0.13, 3.00 +/- .0.15 in groups I and II, respectively). Also, there was a significant improvement of wrist control and hand function after treatment and at follow-up in group I compared to group II (p < 0.001). The improvement of pinch grip was noticed at follow-up with a significant difference relative to baseline in group I (p < 0.05). Hmax/Mmax ratio was significantly decreased at follow-up in group I compared to group II (p < 0.001). Conclusion: ESWT is a valuable adjuvant treatment for spasticity of the hand and wrist in stroke patients which is reflected as improvement of functional activity.