Professor Hallym University Seoul, Seoul-t'ukpyolsi, Republic of Korea
Case Diagnosis: A 38-year-old male with deep dermal to full-thickness flame burns involving 32% total body surface area over the right shoulder, upper arm, and anterior chest developed painful hypertrophic scarring and shoulder flexion contracture despite standard rehabilitation. At 8 months post-injury, he showed marked scar thickening and stiffness (Vancouver Scar Scale [VSS] 12), active shoulder flexion limited to 80°, and neuropathic scar pain with a numeric rating scale (NRS) of 7/10.
Case Description: Conventional rehabilitation included range-of-motion exercises, stretching, pressure garments, silicone gel, and intermittent steroid injections, with minimal improvement. Extracorporeal shockwave therapy (ESWT) was initiated as an adjunct, using a radial device once weekly for 6 sessions (2,000 shocks, 0.10–0.15 mJ/mm², 8–10 Hz) to the hypertrophic scar over the shoulder and anterior chest. ESWT was combined with immediate post-treatment stretching and strengthening. Outcomes (VSS, ultrasonographic scar stiffness, range of motion, pain NRS) were assessed at baseline, after the 6th session, and 3 months later.
Discussions: After treatment, VSS decreased from 12 to 7, with improved pliability and reduced scar height. Shear-wave elastography showed reduced stiffness and about 25% lower mean elastic modulus. Active shoulder flexion increased from 80° to 135°, and NRS pain decreased from 7/10 to 3/10, with further modest gains at 3 months (flexion 145°, VSS 6, NRS 2/10). No adverse events occurred. These findings support the mechanical and biological effects of ESWT on burn scars.
Conclusions: This case suggests that ESWT is a safe and useful adjunct for post-burn hypertrophic scarring, joint contracture, and neuropathic pain when conventional rehabilitation is insufficient. Incorporating ESWT into multidisciplinary burn rehabilitation may enhance scar pliability, joint mobility, and patient-reported outcomes, although larger controlled studies are needed to standardize protocols and confirm long-term efficacy.
