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Extracorporeal shock wave lithotripsy (ESWL) has been used increasingly in clinical practice over the last few years. The aim of this study was to investigate the effects of shock waves on cartilage often unintentionally placed inside the focal volume during ESWL. We investigated whether the physical state of the chondrocytes exposed to shock waves has an influence on cell lethality. Chondrocytes of 12 patients were exposed to shock waves generated by a Piezoson 300. We used 200 shock waves of different energy levels (0.08 and 0.26 mJ/mm2) and the cells were prepared in two physical states: a fluid suspension and a viscous alginate. After ESWL the percentage of dead cells was determined by microscopy. DNA electrophoresis was carried out to detect fragmentation of the DNA. A significant increase of dead cells at higher energy levels in suspension ( P = 0.001) in contrast to alginate medium ( P = 0.263) was detected immediately after ESWL. The long-term survival of chondrocytes was not affected in either substance, as shown in an investigation of the cells three weeks after ESWL. At the molecular level a permeabilisation of the cell membrane was detected. DNA was not affected, even at high-energy levels. Alginate is definitely closer to the real state of cartilage in vivo than suspension. Therefore the negative effects of shock waves which are shown in many investigations that used cells in suspension are not necessarily to be expected in vivo. It can be assumed that side effects will not occur in a clinical setting. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the ultrasonographic appearance of chronically painful, proximal plantar fasciitis. Materials and methods Twenty-two patients with a unilateral proximal plantar fasciitis were prospectively enrolled after unsuccessful conservative treatment lasting 6 months. The contralateral plantar fascia was used as the control. ESWT (3·3000 shock waves/session of 0.2 mJ/mm2) was performed at weekly intervals. The thickness of the plantar fascia was measured ultrasonographically about 2 cm distal of the medial calcaneal tuberosity. Pain estimation on a visual analogue scale (VAS) and the comfortable walking time were recorded. No local anaesthesia was applied. Follow-up was done at 6, 12 and 24 weeks. Results Before ESWT, the plantar fasciitis side was ultrasonographically significantly thicker than the control side (p<0.05), whereas 6 months after ESWT, the thickness of the fascia was no longer significantly different. The decrease in thickness of the plantar fasciitis side was significant (p<0.05). Pain during activities of daily living decreased by 79% according to the VAS, and the comfortable walking time increased, both significantly (p<0.01). In patients with little pain (VAS<30), the thickness of the plantar fasciitis side was significantly less (p<0.01) compared with patients who still suffered more pain (VAS>30). Conclusion After ESWT, the thickness of the plantar fascia in patients with plantar fasciitis decreased, pain and walking time improved (all significantly). [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effect of extracorporal shock wave therapy (ESWT) in tennis elbow and painful heel. Nineteen patients with tennis elbow and 44 patients with painful heel in which conservative treatment had failed underwent ESWT. Both groups received 3000 shock waves of 0.12 mJ/mm2 three times at weekly intervals. After a follow-up of 5 and 6 months respectively, pain measured on a visual analogue scale (VAS) decreased significantly in both groups. The success rate (excellent and good results) was 63% in tennis elbows and 70% in painful heels. ESWT seems to be a useful conservative alternative in the treatment of both conditions. [ABSTRACT FROM AUTHOR]