Tendonitis of the Wrist or Hand

Prior to any Sonocur treatment, care must be taken to be certain that the patient meets the treatment criteria, has no treatment contraindications, has had the necessary pre-treatment imaging studies, and has read and signed the proper informed consent.

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PROCEDURE TECHNIQUE

1. Place patient on treatment table in supine position with a pillow under the head.
   
   
2. Position hand over abdomen or alongside the body depending on the painful site location and support with wedge or pillow.
   
   
3. Identify trigger point (sore area near or over wrist or proximal hand) by palpation and mark with a pen if necessary.
   
   
4. Apply transmission gel over trigger point.
   
   
5. Swing Sonocur shock head into place and position over identified trigger point.
   
   
6. Apply shock waves initially at lowest energy level (level 1) at 4Hz.
   
   
7. Move shock head or hand in small increments until patient reports maximal reproduction of discomfort.
   
   
8. Accomplish fine adjustment of shock wave penetration depth by adjusting amount of fluid in bellows, again with patient feedback to identify maximal trigger point stimulation.
   
   
9. Great care must be taken to precisely identify the exact area of pain. It may require the use of several shocks (eg.100) to identify this site.
   
   

10. Depending upon patient tolerance, gradually increase energy levels to the highest level that can be maximally tolerated. In hand and wrist tendinopathies, this is generally level one (1) or two (2). Some patients may tolerate up to level three (3). Be certain that the patient does not become too uncomfortable. It is more important to deliver all the shock waves to the correct area at a lower energy level than miss the mark with higher levels because the patient is too uncomfortable.
    

11. Readjust the shock head position after every 200-400 shocks to precisely treat the maximal area of tenderness. This is necessary because of the slight positional movement which may occur during treatment.
    

12. Deliver a total of 2000 shocks to the affected site after it has been identified.
    

13. Remove shock head from the treated site and observe the site of application.
    

14. Wipe away the gel.
    

15. Supply patient with post treatment instructions and return appointment for additional treatment or physician visit.
    

HELPFUL HINTS

1. If the patient is exquisitely tender or has significant discomfort, it may be helpful to initiate treatment slightly away from the point of maximal tenderness. After 100-200 shocks, slowly readjust the shock head so that the shock waves are focused more progressively toward area of maximal tenderness. Slowly advance to the maximal trigger point and complete the treatment.
   
   
2. De-Quervain's tenosynovitis is seen most often. This is very superficial and therefore careful attention should be given to make sure the shock wave penetration is very shallow. Often, nearly full inflation of the coupling bellows is desirable to ensure proper focusing. Hand and wrist tendinopathies are usually uncomfortable to treat and therefore lower energy levels are usually required. Rarely is it necessary to exceed energy level two (2).
   
   
3. Some patients may experience shock wave exit sensations opposite the application site at medium or higher energy settings. This is normal and causes no harm.
   
   
4. Inform the patient that it is usual to have soreness after treatment and that often the pain will be worse for a few days until healing begins. Explain that if multiple treatments are necessary, that subsequent treatments can sometimes be more uncomfortable than the initial treatment. In addition, emphasize that healing may take several weeks to occur and that one should not expect maximal improvement until 12 weeks after the last treatment.
   
   

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