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(Stroke. 2005;36:1967.)
© 2005 American Heart Association, Inc.

Original Contributions

Long-Term Effect of Shock Wave Therapy on Upper Limb Hypertonia in Patients Affected by Stroke

From the Hand Surgery Department (P.M.) and Neurological Rehabilitation, Department of Neurological Sciences and Vision (E.A.), Verona Hospital, University of Verona, Italy.

Correspondence to Paolo Manganotti, MD, PhD, Dipartimento di Scienze Neurologiche e della Visione, Sezione di Neurologia Riabilitativa, Univerisity of Verona, Policlinico Borgo Roma, Via delle Menegone, 37134 Verona, Italy. E-mail paolo.manganotti{at}univr.it

Background and Purpose— Spasticity is a disabling complication of stroke and different noninvasive treatments are used to reduce muscle hypertonia. Shock waves are defined as a sequence of single sonic pulses largely used in the treatment of diseases involving bone and tendon as well as muscular contractures. The effect and duration of extracorporeal shock wave therapy (ESWT) was investigated on muscle hypertonia of the hand and wrist.

Methods— A total of 20 patients affected by stroke associated with severe hypertonia in upper limbs were evaluated. Placebo stimulation was performed 1 week before active stimulation in each patient. Evaluation was performed using the National Institutes of Health and Ashworth scales and video monitoring with a digital goniometer before and immediately after placebo or active stimulation. Motor nerve conduction velocity from abductor digiti minimi were recorded. Patients were monitored at 1, 4, and 12 weeks after active treatment.

Results— After active ESWT, patients showed greater improvement in flexor tone of wrist and fingers compared with placebo stimulation. At the 1- and 4-week follow-up visits, a significant decrease of passive muscle tonicity was noted on muscles in all patients receiving active treatment. At 12 weeks after therapy, 10 of the 20 patients showed persistent reduction in muscle tone. There were no adverse events associated with ESWT.

Conclusions— ESWT reduces hypertonia of the wrist and finger muscles for 12 weeks after treatment. The possible mechanisms of action of ESWT are discussed.

Key Words: extracorporeal shock wave therapy • muscle spasticity • rehabilitation • shock waves • stroke

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