Shock Waves

 

Extracorporeal Shock Wave Therapy

 

Extracorporeal shock wave therapy (ESWT) has proven to be a new and very effective treatment modality based on the shock wave technology established since 20 years in urological stone therapy. In addition to its fragmentation power shock waves turned out to provide significant therapeutic effects in various musculoskeletal diseases.

The more established form of medical ESWT involves Focused Shock Waves (F-ESWT). These are concentrated into small focal areas of 2–8 mm diameter in order to optimise therapeutic effects and minimise effects on other tissues.

Focused Shock Wave systems differ in their design and in particular whether the Shock Waves are generated by electrohydraulic, electromagnetic or piezoelectric mechanisms. The proposed mechanisms for the benefit of F-ESWT on musculoskeletal tissue include direct effects on tissue calcification, alteration of cell activity through cavitation, acoustic microstreaming, alteration of cell membrane permeability and effects on nociceptors through hyperstimulation, blocking the gate control mechanism.

Another form of treatment, often described as ‘radial shock wave therapy’, is better termed ‘radial pulse therapy’ (RPT). Some studies of ‘low energy ESWT’ are in fact referring to the use of RPT. Their description as SWs is inappropriate and has caused much confusion in interpreting the literature. Radial ‘shock’ waves are generated by a ballistic source and do not have the characteristics of real medical SWs. They are not focused and it has been demonstrated that they do not have a penetrating effect on tissue, but rather act superficially.

Approved standard indications in Orthopaedics and Traumatology

(Consensus statement in International Society for Medical Shock Wave Treatment)

Chronic tendinopathies:

▪  Plantar fasciitis with or without heel spur

▪  Achilles tendon

▪  Radial epicondylopathy (tennis elbow)

▪  Rotator cuff with or without calcification

▪  Patella tendon

▪  Greater trochanteric pain syndrome

 

Impaired bone healing function:

▪  Delayed bone healing

▪  Stress fractures

▪  Early stage of avascular bone necrosis (native X-ray without pathology)

▪  Early stage osteochondritis dissecans (OD) post-skeletal maturity

 

Common empirically-tested clinical uses

Tendinopathy:

▪  Ulnar epicondylopathy

▪  Adductor syndrome

▪  Pes anserinus syndrome

▪  Peroneal tendon syndrome

 

Muscular pathologies:

▪  Myofascial syndrome (fibromyalgia excluded)

▪  Injury without discontinuity

 

It has also been demonstrated over the past few decades that SW is a safe treatment with adverse effects occurring rarely and there is no doubt about final acceptance of this technology by the medical community. 

 

 

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