Combined Effect of Shock Wave to Conventional Physical Therapy Program on Wrist Joint Pain Intensity in Treatment of Triangular Fibrocartilage Complex

Background: Triangular fibrocartilage complex (TFCC) is considered an important supportive structure of the wrist joint to stabilize the ulnar aspect of the wrist joint. Degenerative TFCC injury usually occurs due to overuse and accumulation of micro stresses.  TFCC injuries are usually treated conservatively via rest or immobilization, activity modification to eliminate stress, ice application, and splint immobilization.
Objective: This study aimed to investigate the combined effect of shock wave to conventional physical therapy programs on wrist joint pain in the treatment of patients with degenerative TFCC, compared to conventional physical therapy rehabilitation alone.
Subjects & methods: Thirty male and female patients were diagnosed with degenerative TFCC & referred to Hand Clinic and Rehabilitation Center. Their ages ranged from 18 and 30 years. They all met the inclusion criteria and then signed a consent. They were randomly assigned into two equal groups: Control group (A) (n=15) that was treated by the conventional physical therapy program for TFCC injuries only that involved immobilization and activity reduction by an ulnar-based orthosis, proprioceptive training, and strengthening exercises, and study group (B) (n=15) that received the shock wave in addition to the conventional physical therapy program for TFCC injuries. Both groups’ patients had evaluations before and after the course of therapy (6 weeks) for their pain via VAS.
Results: Through comparing the statistical findings post-treatment within and between both groups, group (B) showed significant improvements regarding the measured outcomes compared to baseline and group (A). Statistically, group (B) experienced a 74.35%decrease in VAS score compared to 40.82%, improvements in group (A). The net results gave the privilege of the intervention applied to the study group. 
Conclusion: Adding shock wave to conventional physical therapy program seems to be more beneficial in relieving the wrist joint pain intensity than isolated conventional physical therapy program.