Comparative Study of the Effects of Tecar Therapy, Extracorporeal Shock Wave Therapy, and Massage Therapy in the Management of Dorsal Hand Hypertrophic Scars: A Prospective Randomized Controlled Study

Abstract

Background: Hypertrophic scars of the dorsal hand can cause pain, stiffness, impaired elasticity, and functional limitations. Although several treatment modalities are available, an established gold-standard treatment has not been identified. This study aimed to compare the effects of Tecar therapy combined with massage, extracorporeal shock wave therapy (ESWT) combined with massage, and massage therapy alone in the management of dorsal hand hypertrophic scars.

Methods: This prospective, randomized controlled study included 45 adults with clinically stable hypertrophic scars of the dorsal hand. Participants were randomly assigned to three groups (n=15 each): Tecar therapy plus massage, ESWT plus massage, or massage therapy alone. Interventions were administered for 6 weeks, with outcomes assessed at baseline, week 6, and week 8. Pain intensity, scar elasticity, scar characteristics, and hand function were evaluated using the Visual Analogue Scale (VAS), durometer measurements, Vancouver Scar Scale (VSS), and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, respectively. Statistical analyses included one-way ANOVA, paired t-tests, Tukey HSD post-hoc comparisons, and Cohen’s d effect sizes.

Results: All three groups demonstrated significant improvements in pain, elasticity, scar appearance, and hand function at week 8 (p<0.001). ESWT plus massage produced the greatest improvements, with pain reduction of 52.7%, elasticity improvement of 40.9%, VSS reduction of 48.2%, and DASH improvement of 53.6%. Tecar plus massage achieved corresponding changes of 47.0%, 36.8%, 42.9%, and 47.9%, while massage alone achieved 29.2%, 22.4%, 24.5%, and 30.4%, respectively. Between-group differences were statistically significant for all primary outcomes (p<0.001). The overall clinical responder rate was 100% for ESWT plus massage, 73% for Tecar plus massage, and 20% for massage alone. No serious adverse events were reported.

Conclusion: ESWT combined with massage and Tecar therapy combined with massage were effective and well-tolerated non-invasive treatments for dorsal hand hypertrophic scars. ESWT plus massage demonstrated the greatest improvements across pain, elasticity, scar appearance, and functional outcomes. Larger multicenter studies with longer follow-up are warranted to confirm these findings.