Comparative effectiveness of extracorporeal shock wave therapy and high-intensity laser therapy in trigger finger: a randomized controlled trial.

Abstract

Trigger finger (TF) is stenosing tenosynovitis causing pain and impaired hand function. To compare extracorporeal shock wave therapy (ESWT) and high-intensity laser therapy (HILT) as adjuncts to home exercise in TF. In this three-arm randomized controlled trial, patients were allocated to ESWT, HILT, or home exercise alone. Active modalities were applied for 3 weeks (nine sessions), and all groups followed the same exercise program. Assessments were performed at baseline, week 3, and week 12. The primary outcome was week 12 QuickDASH; secondary outcomes were VAS, Quinnell grade, grip strength, tip-pinch strength, Assessment of Pain Pressure Threshold (PPT), and Nine-Hole Peg Test (9HPT). Analyses included 116 completers (ESWT n = 39, HILT n = 45, home exercise n = 32). Week 12 QuickDASH scores differed significantly among groups (ESWT: 42.6 ± 18.3; HILT: 26.6 ± 16.5; home exercise: 51.2 ± 14.5; p < 0.001); effect sizes favored HILT versus home exercise (d = 1.60) and ESWT (d = 0.92). VAS scores were lowest in the HILT group at both follow-ups (p < 0.001). Quinnell grading favored HILT at week 3 (p = 0.009) and week 12 (p = 0.001). Grip strength was higher in both active-treatment groups than in home exercise at week 3 and week 12 (p = 0.007 and p < 0.001), whereas tip-pinch strength did not differ. PPT differed only at week 3 (p = 0.009), and baseline 9HPT imbalance was absent during follow-up. HILT may provide greater short-term improvements in pain and patient-reported function, while ESWT remains a useful non-invasive adjunct to home exercise.