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To evaluate the antitetanic effects of extracorporeal shock wave therapy (ESWT) combined with isokinetic strength training (IST) on calf triceps spasm in patients after a stroke. Forty-five patients with hemiplegia after a stroke and lower extremity spasms were randomly assigned into three groups: a control group (n = 15), an ESWT group (n = 15) and an ESWT+IST group (n = 15). All patients agreed to conventional rehabilitation therapy, while the ESWT and ESWT+IST groups received ESWT of 2.0–3.0 bar once a week for four weeks. In addition, the ESWT+IST group underwent four weeks of ankle IST. All groups were assessed using the modified Ashworth scale (MAS) and surface electromyography before and after four weeks of treatment. The ankle passive movement of all groups was measured using the BIODEX isokinetic system at angular velocities of 60°/s, 120°/s, 180°/s and 240°/s. After four weeks of treatment, compared with the control group, the ESWT+IST groups showed a significant reduction in MASscores (P = 0.030). The ESWT+IST group had significantly lower MAS scores than the baseline (P = 0.002), while the ESWT group did not show a significant difference (P = 0.072). The average electromyography (AEMG) analysis demonstrated a significant difference among the groups after four weeks (P = 0.001), with the ESWT+IST group having lower AEMG values compared with the control group (P < 0.001) and the ESWT group (P = 0.042). Peak resistive torque significantly decreased in both the ESWT and ESWT+IST groups at all velocities (60°/s: P = 0.030, 120°/s: P = 0.039, 180°/s: P = 0.030 and 240°/s: P = 0.042). Extracorporeal shock wave therapy combined with IST can significantly improve calf triceps spasm in patients after a stroke. [ABSTRACT FROM AUTHOR]

Controlling drug release from the bone cavity through physical stimulation remains a challenge because the unique shielding properties of the bone structure make it difficult for many physical stimuli to be effective in skeletal disorders. Herein, we designed a type of high-loading nanocomposites self-assembled from Icariin (ICA), Ca2+, and Zoledronic acid (ZOL), which could respond to extracorporeal shock wave (ESW) to control drug release in the bone cavity and govern osteoblast-adipocyte lineage commitment to prevent osteoporotic fracture. The nanocomposites contain more than 70 % of the payloads and exhibit excellent function in bone marrow targeting. When shocked with ESW, the payloads including ICA, Ca2+, and ZOL, can be released in the bone marrow. ICA can inhibit the formation of adipocyte lineages and promote the formation of osteoblast lineages by inhibiting the transcription of peroxisome proliferators-activated receptor γ (PPARγ) and fatty acid-binding protein 4 (FABP4), ESW, and Ca2+ further increase osteoblast activity meanwhile, and ZOL acts as an inhibitor of osteoclasts, leading to an overall anabolism. In vivo, the treatment contributed to a significant increase in bone anabolism, including bone-related parameters, bone strength, and bone resilience, ultimately greatly reducing the risk of osteoporotic fracture. This study demonstrated the high feasibility of combining the bone-penetrating ESW-responsive drug-controlled release system with the regulation of osteoblast-adipocyte lineage commitment for osteoporotic fracture prevention. [Display omitted] • The Bone marrow-targeted ZCI nanoparticles deliver ICA to the bone cavity. • Extracorporeal shock wave controls the ICA release in the bone cavity. • The bone-penetrating controlled-release system can enhance osteoblast activity by governing the osteoblast-adipocyte lineage commitment of bone marrow mesenchymal stem cells, finally preventing osteoporotic fractures. [ABSTRACT FROM AUTHOR]

This study aims to determine whether ESWT (extracorporeal shock wave therapy) affects ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes. Two authors independently search the papers on the treatment of femoral head necrosis with extracorporeal shock wave in CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), CSPD (China Science Periodical Database), Pubmed, Embase, and Springer databases. Search period from the inception dates to 2 June 2020 and have no limitations in language; two authors independently conducted a quality evaluation and data extraction for included studies and performed a meta-analysis with data extracted and calculate by using RevMan5. Registration number: CRD42020213580. Nine articles with 409 patients are included in this meta-analysis. The pooled results of HHS (Harris hip score) in eight studies with 337 hips show that ESWT achieves higher Harris scores compared to before treatment (MD = −19.95; 95% CI: −26.27, −13.64) and the difference is statistically significant (p < 0.01). The pooled results of VAS (visual analogue score) in seven studies with 253 hips show that ESWT achieves lower VAS compared to baseline (MD = 2.77; 95% CI: 1.88, 3.65) and the difference is statistically significant (p < 0.01). The pooled results of lesion of MRI with 164 hips show that ESWT decreases the lesion area of MRI (SMD = 1.03; CI: 0.75,1.30) and the difference is statistically significant (p < 0.01). ESWT has an effect on pain relief and has a limited effect on motion function. Its effect may be better than surgical groups (core decompression and core decompression with bone grafting). But it cannot decrease the lesion area of the femoral head on MRI and stop disease progression. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work is to compare the clinical, functional, and ultrasonographic outcomes of focused, radial, and combined extracorporeal shock-wave therapy (ESWT) in the treatment of calcific shoulder tendinopathy. Methods: we enrolled 45 patients with calcific shoulder tendinopathy, their ages ranged from 30 to 68 (50.93 ± 9.44) years, classified according to the line of treatment into three groups, all received four sessions of ESWT 1 week apart. Group I: 15 patients received focused shock waves (F-SW) 1500 shocks. Group II: 15 patients received radial shock waves (R-SW) 2000 shocks. Group III: 15 patients received combined focused and radial shock waves (C-SW). All patients were evaluated by musculoskeletal ultrasound (MSK US) before treatment, at 1 week and at 3 months after the last session. Results: In the three studied groups, there was a significant improvement in shoulder pain, active range of motion (ROM), and shoulder function by shoulder disability questionnaire (SDQ) at 1 week after the end of treatment and after 3 months follow up. Moreover, there was a significant sonographic reduction in calcification size in the three groups. At the end of the study, the best improvement as regards a decrease of calcification size was obtained in group III when compared with group I and group II. Conclusion: These results demonstrated clinical, functional, and sonographic improvement in all groups. The best therapy in calcific shoulder tendinopathy appears to be combined focused and radial ESWT compared to interventions alone. Level 1 Evidence Randomized control study. [ABSTRACT FROM AUTHOR]

Objective: Extracorporeal shockwave therapy (ESWT) has been shown to have chondroprotective effects on arthritic diseases. We investigated the effects of ESWT on temporomandibular joint osteoarthritis (TMJOA) using rat chondrocytes and TMJOA rat models.Design: Cell viability and expression of pro-inflammatory cytokines, cartilage degradation, and apoptosis markers were measured in control, monosodium iodoacetate (MIA)-treated and ESWT plus MIA-treated chondrocytes in vitro, and intra-articular MIA injection (TMJOA) and ESWT on TMJOA rats in vivo. In vivo99mTc-hydroxymethylene diphosphonate (HDP) single-photon emission computerized tomography/computerized tomography (SPECT/CT) and ex-vivo micro-CT and histologic examinations were performed in rat models.Results: ESWT plus MIA-treated chondrocytes showed increased cell viability significantly (P = 0.007), while decreased genetic expression of pro-inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6); P < 0.001 for each] and cartilage degradation markers [matrix metalloproteinase-3 (MMP3), matrix metalloproteinase-13 (MMP13), and bone morphogenetic protein 7 (BMP7); P < 0.001 for each], and number of apoptotic cells (P < 0.001) compared to MIA-treated chondrocytes. Changes in cytochrome c and cleaved caspase-3 levels relative to procaspase-3 were decreased over MIA-treated chondrocytes. ESWT on TMJOA rat models was associated with a significant decrease in pro-inflammatory and cartilage degradation markers, as demonstrated by real-time PCR and immunohistochemistry stains (P < 0.001 for each). On 99mTc-HDP SPECT/CT, the ESWT group showed a significantly lower uptake ratio compared to the TMJOA group (P = 0.008). Micro-CT analysis revealed that the ESWT group showed improved structure and bone quality compared to the TMJOA control group.Conclusions: ESWT was associated with a protective effect on cartilage and subchondral bone structures of TMJOA by reducing inflammation, cartilage degradation, and chondrocyte apoptosis. [ABSTRACT FROM AUTHOR]

To observe the short- and long-term clinical efficacy differences of body acupuncture and scalp acupuncture combined with extracorporeal shock wave and simple extracorporeal shock wave. Sixty patients with scapulohumeral periarthritis were randomly divided into two groups: the treatment group and control group, 30 cases in each one. Both groups underwent basic rehabilitation training. Patients in the treatment group were treated with body acupuncture and scalp acupuncture combined with extracorporeal shock wave.Yújì (鱼际 LU10), Hégŭ (合谷LI4), Zhōngzhŭ (中渚TE3), Hòuxī (后溪SI3). There were three needles for the scalp acupuncture with the first between Shéntíng (神庭 GV 24) and Yìntáng (印堂 EX-HN3), and the other two straightly through the inner canthus and parallel to the first needle. Shock wave treatment was intensively applied in some pressure points around shoulder joint. The control group used the same shock wave therapy as the treatment group. Both groups were all treated once a day, 6 times a week. Patients were treated for one course which lasted for 4 weeks. VAS score, the Constant-Murley score and the HAMA (the Hamilton Anxiety Scale) are as therapeutic effect index. 30 days telephone investigation followed-up after the treatment course was evaluated. Totally 28 cases completed the clinical observation in the treatment group, and 29 cases in the control group. The total effective rate of the treatment group was 85.7% (24/28), which was higher than 69.0% (20/29) of the control group (P < 0.05). VAS score: There were significant statistical differences before and after the treatment in the two groups (the treatment group: 6.67 ± 1.43 vs 3.47 ± 1.35, the control group: 7.57 ± 1.31 vs 5.36 ± 1.45, both P < 0.05). There were significant statistical differences before the treatment and at the follow-up in the two groups (the treatment group: 6.67 ± 1.43 vs 2.68 ± 0.81, the control group: 7.57 ± 1.31 vs 4.56 ± 1.35, both P < 0.05). The VAS scores of the treatment group after treatment and at the follow-up were respectively lower than those of the control group (both P < 0.05). Shoulder joints activity score: There were significant statistical differences before and after the treatment in the two groups (the treatment group: 54.65 ± 1.65 vs 65.54 ± 2.19, the control group: 54.32 ± 2.31 vs 61.01 ± 0.95, both P < 0.05). There were significant statistical differences before treatment and at follow-up in the two groups (the treatment group: 54.65 ± 1.65 vs 66.18 ± 1.35, the control group: 54.32 ± 2.31 vs 62.11 ± 1.49, both P < 0.05). The shoulder activity scores of the treatment group after treatment and at follow-up were respectively higher than those of the control group (both P < 0.05). HAMA scores: There were singificant statistical differences before and after treatment in the two groups (the treatment group: 16.83 ± 1.56 vs 13.26 ± 2.36, the control group: 17.04 ± 1.84 vs 15.23 ± 3.17, both P < 0.05). There were significant statistical differences before treatment and at follow-up in the two groups (the treatment group: 16.83 ± 1.56 vs 11.01 ± 3.20, the control group: 17.04 ± 1.84 vs 13.68 ± 2.49, both P < 0.05). The HAMA scores of the treatment group after treatment and at follow-up were lower than those of the control group (both P < 0.05). Body acupuncture and scalp acupuncture combined with extracorporeal shock wave can relieve the clinical symptoms of patients with scapulohumeral periarthritis, ease anxiety and improve daily life activities. [ABSTRACT FROM AUTHOR]

Background: Effective treatment strategies for post-stroke muscle spasticity are still a significant interdisciplinary issue and challenge for neurologists, neurosurgeons, physiatrists nurses and physiotherapists. Extracorporeal shock wave (ESW) treatment is a well-supported physical modality used in a wide range of musculoskeletal disorders. The list of justified indications for ESW treatment and scientific areas of investigations is continuously evolving and adapting to different pathologies, including spasticity after stroke. Objectives: To analyze the relevant available research and clinical studies demonstrated that the treatment potentials and effectiveness of ESW procedure including mechanisms of the anti-spastic action within hypertonic muscles after stroke. Literature Search: A computer research was performed using MEDLINE, PubMed, PEDro, CINAHL, and EMBASE databases. Assessment of eligibility of papers was determined by two independent reviewers. The inclusion criteria comprised: publication in peer-reviewed journals, studies published in the last 10 years, involving clinical trials, full-version available and written in English only. Discussion: A total of 91 articles were collected, 83 of which were non relevant. Ultimately, 8 clinical studies within a total of 195 patients met inclusion criteria for this review. Only one randomized controlled trial was found and then scored using the Cochrane-based assessment. The other studies involving were analyzed separately according to their methodological quality in a descriptive manner. Conclusions: ESW was found to be safe and effective. The mechanism of ESW action is still under investigation. [ABSTRACT FROM AUTHOR]

Background: The aim of this metaanalysis was to investigate the effectiveness of extracorporeal shock wave therapy (ESWT) in cellulite.Methods: Electronic databases (such as Ovid MEDLINE, Scopus and Ovid) as well as reference lists of the available studies were evaluated in June 2015 by two expert examiners. Assessment of each study's methodological quality was performed with the help of the published quality index tool by Downs and Black.Results: This metanalysis included a total of eleven clinical trials on the effects of ESWT on cellulite with a total of 297 included females. Among the eleven clinical trials five randomized controlled trials on ESWT in cellulite with a total number of 123 females have been published so far. Both, focused as well as radial ESWT devices have been found effective in treating cellulite so far. Typically, one or two sessions per week and six to eight sessions overall were studied in the published clinical trials. Overall, outcome parameters mainly focused on digital standardized photographs, circumference measurements and specific ultrasound examinations. Reporting quality showed substantial heterogenity from 22 to 82 points with a mean of 57 points.Discussion: This metanalysis identified eleven published clinical studies on ESWT in cellulite with five randomized-controlled trials among them. There is growing evidence that both, radial as well as focused ESWT and the combination of both are able to improve the degree of cellulite. Typically, six to eight treatments once or twice a week have been studied. Long-term follow-up data beyond one year are lacking as well as details on potential combination therapies in cellulite such as with low level laser therapy (LLLT), cryolipolysis and others. [ABSTRACT FROM AUTHOR]

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Impaired wound healing in surgical patients with diabetes increases the incidence of infection, prolongs hospitalization, and even increases the rate of mortality. Low-energy extracorporeal shock wave treatment (ESWT) was reported to accelerate chronic wound healing by promoting revascularization and tissue regeneration; however, it is not known if ESWT could also improve healing of acute surgical incisional wounds in diabetes. In this study, using a rat model of diabetes, we investigated the effect of low-energy ESWT on collagen content in wound tissues and its efficacy in incisional wound healing. A single dorsal incisional wound was inflicted in streptozotocin-induced diabetic rats, and they received ESWT at different time post-wounding. Rats were sacrificed on days 7 and 14 post-wounding. Wound breaking strength, hydroxyproline content, histological characteristics and the expression of transforming growth factor beta 1 (TGF-β1) were analyzed. As a result, the wound breaking strength was significantly enhanced and the hydroxyproline content in wound tissues was increased at each time point examined. The number of fibroblasts was significantly increased, and the new collagen fibers were more abundant at the wound site after ESWT. Furthermore, the expression of TGF-β1 was up-regulated after ESWT on day 7 post-wounding. These results suggest that low-energy ESWT can increase collagen content, enhance wound breaking strength and improve the healing of incisional wound in diabetic rats. The increased collagen content may be attributed, at least in part, to the up-regulation of TGF-β1 expression in wound tissues. [ABSTRACT FROM AUTHOR]