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Background Extracorporeal shock wave therapy (ESWT) has been widely used in musculoskeletal disorders. This meta-analysis was designed to assess the effectiveness and safety of ESWT for patients with low back pain (LBP). Methods Multiple electronic databases including Pubmed, Embase, Cochrane’s library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December, 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences were calculated for continuous outcomes, while odd ratios were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Results Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P

Background: Shock wave therapy is one of the modern methods of treatment used to treat diseases of muscles, tendons, and entheses in orthopedics, as well as in sports medicine. The therapy is increasingly used in the treatment of plantar fasciitis—a disease that is very difficult and burdensome to treat. Where basic conservative treatment for heel spurs fails, the only alternative consists of excision of the bone outgrowth, and shock wave therapy: a modern, minimally invasive, and relatively safe method. The aim of the study was to determine the long-term effectiveness of extracorporeal shock wave therapy in the treatment of painful ailments occurring in the course of plantar fasciitis in amateur runners. Materials and methods: The study includes a group of 39 men and women, aged 34–64 (mean age 54.05 ± 8.16), suffering from chronic pain in one or both feet, occurring in the course of plantar fasciitis. The patients had to meet five criteria to qualify for the study. The group was divided into two subgroups: those who had not undergone other physiotherapeutic procedures prior to the extracorporeal shock wave therapy (ESWT-alone; 23 people), and those who had received other procedures (ESWT-plus; 16 people). The therapy was performed using extracorporeal shock wave (ESWT). No local anesthesia was used. The effectiveness of the extracorporeal shock wave therapy was evaluated using the visual analogue scale of pain (VAS), Modified Laitinen Pain Index Questionnaire, the AOFAS scale (American Orthopedic Foot and Ankle Society), and a survey questionnaire consisting of 10 questions concerning metrics and subjective assessment of the effects of therapy. The interview was conducted before ESWT, and again five years later. Results: The use of extracorporeal shock wave therapy reduced the intensity and frequency of pain, and improved daily and recreational activity. Moreover, a reduction in the level of pain sensation on the VAS scale and pain symptoms during walking was demonstrated. More favorable results were obtained in the ESWT-plus group; however, the first effects were observed later than in the ESWT-alone group. Conclusions: Extracorporeal shock wave therapy is an effective form of therapy for amateur runners. It reduces pain associated with plantar fasciitis that amateur runners may experience at rest, while walking, and during daily and recreational activity.

Objective—To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) on pain in calcaneal spur. Methods— A single-blind randomized study was performed in which 15 patients underwent a regular treatment Pre and post-experimental design. their ages ranged from 25 to 45 years old. They were examined before and after treatment with shock waves because of pain post calcaneal spur. They were treated by shock wave therapy with 2000 strokes, 10 Hz frequency and 2.5 bar capacity. Two sessions/ week for 6 weeks. Variations in symptoms were evaluated by visual analogue scale (VAS) and Serum cortisone level. Results—A significant decrease in VAS was seen. There is a statistically significant increase in the mean cortisol level after in comparison to before Conclusion—ESWT is safe and improves the symptoms of most patients with a painful heel, and reduce pain.

Purpose: This study assessed the effects of long periods of radial extracorporeal shockwave therapy (ESWT) applied to the thoracolumbar fascia on fascia thickness, fat, and mechanical properties. Methods: Among the 15 patients with low back pain, 10 received twice-weekly ESWT of the thoracolumbar fascia for 5 weeks. The thickness of the thoracolumbar fascia was evaluated by ultrasonography before and after ESWT, and the mechanical properties (frequency, decrement, and stiffness) were assessed using a MyotonPRO device. Data were analyzed using IBM SPSS Statistics for Windows, version 21.0, and paired t-tests were used to determine statistical differences between the pre- and post-intervention groups. The statistical significance was defined as α=0.05. Results: Ultrasonography showed a greater decrease in thoracolumbar fascia thickness in the ESWT group at 5 weeks (p=0.309). The patients who received ESWT to the thoracolumbar fascia showed significant changes in the mechanical properties of fascia stiffness and decrement values between pre- and post-intervention (p＜0.05). However, no significant differences were observed in fascia tone. Conclusion: Clinically, there was no change in thoracolumbar fascia thickness, while the reduction in muscle tone and stiffness of the thoracolumbar fascia increased the mobility following ESWT.

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 c...

This paper aims to review the pathophysiology, diagnosis, and treatment of insertional Achilles tendinopathy (IAT). There is no current consensus regarding conservative or surgical treatments for IAT. There has recently been an increase of trials demonstrating utility for extracorporeal shock wave in treating IAT. Additionally, a retrospective study of percutaneous ultrasonic tenotomy shows promise. IAT has historically been recalcitrant to treatment. There are multiple available treatment options, and many that may confer some benefit. Knowing the available conservative treatment options and discussing the risks and benefits with the patient can help the patient and clinician determine what treatment options to employ for each individual.

Object To observe the clinical efficacy of combined application of extracorporeal shock wave and exercise therapy in the treatment of refractory stress injury Method patients with pressure ulcer were randomized into three groups conventional treatment group shock wave group combined shock wave and exercise therapy group Judgment was based on evaluating the scores of pressure ulcer healing PUSH and the ability of daily living activities ADL Results The score of the combined shock wave and exercise therapy group was better than that of the other two groups P and the score of the shock wave group was better than that of the conventional group with statistical significance P Conclusion Combined extracorporeal shock wave and exercise therapies can improve the wound healing rate the overall functional status of patients and the ability of daily living activities ADL

Objectives To evaluate the combination effect of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) for moderate carpal tunnel syndrome (CTS), compared with PRP alone. Design A randomized, double-blinded, placebo-controlled trial. Setting A single medical center in Taiwan. Patients Patients diagnosed with moderate CTS. Interventions All subjects were administered one dose of ultrasound-guided PRP injection at baseline. After two weeks, one session of rESWT was completed in the intervention group, whereas the control group received one session of sham rESWT. Evaluations were performed at baseline and one, three, and six months post–PRP injection. Outcome Measures The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was measured as the primary outcome. Electrophysiological study and cross-sectional area (CSA) of the median nerve were used as secondary outcomes. Results All 40 enrolled subjects (male/female: 4/36) completed the study, resulting in an analysis of 32 wrists per group (total: N = 64 wrists). Compared with the control group, the intervention group did not show statistically significantly superior outcomes, except in BCTQs at one month (mean change ± SE = –11.47 ± 1.18 vs –7.06 ± 1.26, P = 0.013) and distal motor latency at three months (mean change ± SE = –0.59 ± 0.09 vs –0.30 ± 0.09, P = 0.031). Conclusions Combined PRP and one-session rESWT was not superior to PRP alone in treating moderate CTS. Further studies with multiple sessions of ESWT and longer follow-up periods are needed to verify the clinical efficacy of ESWT.

Background and Objective:Spasticity (most common disability in upper motor neuron syndrome or UMNS) caused an inability of patients’ to perform daily activities and a decrease inquality of life. One of the promising methods nowadays, but still not widely used in everyday practice, for spasticity reduction is extracorporeal shock wave. The aim of this study was to evaluate the objective clinical effects of combined treatment botulinum toxin type A and radial Extracorporeal Shock Wave Therapy in spasticity post stroke.Methods:We considered 30 subjects (14 female and 16 male) with post stroke spasticity of Biceps Brachii, Superficial Flexor Digitorum, Gastrocnemius Medialis and Lateralis and we divided patients into two groups (group A received botulinum toxin injection and physiotherapy while group B received botulinum toxin injection, rESWT and physiotherapy). Assessments were performed before treatment (t0), after 1 (t1), 2 (t2) e 3 (t3) months using Modified Ahworth Scale, Visual Analogical Scale for pain and MyotonPro® device (to assessed myometric evaluation of muscles tone and stiffness).Results:Visual Analogical Scale, Modified Ahworth Scale, muscles tone and stiffness statistically decreased until t3 in the group A and in the group B, but the differences between the two groups were significant at the t1 only.Conclusion:Radial Extracorporeal Shock Wave Therapy could be an effective physical treatment aimed at the reduction of upper and lower limbs spasticity and could lead to the improvement of trophic conditions of the spastic muscles in post-stroke.

Since most cancer nanomedicine relies on the enhanced permeability and retention (EPR) effect to eradicate tumors, strategies that are able to promote nanoparticle (NP) delivery and extravasation are presupposed to elevate the EPR effect for more effective cancer therapeutics. However, nanothermotherapeutics still suffers from limited drug delivery into tumor sites, for even though numerous efforts have been made to enhance the selective tumor targeting of NPs. In this study, we uncovered that radial extracorporeal shock wave therapy (rESWT), an important approach in physical therapy that has been overlooked in cancer treatment in the past, can largely improve the EPR-dependent tumor uptake of NPs. We here defined the optimal low dosage and desirable combinatory manner for rESWT in driving NP accumulation towards tumors. Two underlying biophysical mechanisms responsible for the rESWT-enhanced EPR effect were proposed. On one hand, rESWT-conducted compressive and tensile forces could relieve high intra-tumoral pressure; on the other hand, rESWT-induced cavitation bubbles could directly distend and disrupt tumor blood vessels. All these together synergistically promoted vessel vasodilation, tumor perfusion and NP extravasation. Further experiments revealed that the combinatory therapeutics between rESWT and nanothermotherapeutics greatly improved the tumor-killing efficacy. Thus, our findings open a new path to improve EPR-mediated drug delivery with the assistance of rESWT.

The aim of the study is to investigate effect of high-power pain threshold ultrasound versus extracorporeal shock wave on myofascial trigger points. Methods: this randomized single blinded controlled trial included a sample of 60 subjects (age 20 to 26) years old with upper trapezius myofascial trigger points. Subjects randomly allocated into 3 groups; Extracorporeal shock wave (ESWT) group (n=20) which received low level energy ESWT plus neck stretching, strengthening exercise, High Power Pain threshold Ultrasound (HPPT) group (n=20) received high power-pain threshold ultrasound with intensity range from 0.5 to 2 Watt/cm² plus neck stretching, strengthening exercise and control group (n=20) received neck stretching, strengthening exercise, Arabic Neck Disability Index and Pressure algometer was used to measure neck functional disability (ANDI) and Pressure pain threshold (PPT). Results: within group study showed statistically significant improvement in ANDI and PPT in both ESWT group and HPPT group as p value was (P

Objective: To investigate the clinical effects of electroacupuncture combined with extracorporeal shock wave in the treatment of periarthritis of shoulder. Methods: 136 patients with periarthritis of shoulder admitted to our hospital from September 2018 to September 2019 were randomly divided into two groups by double-blind method. 68 patients in the control group were treated with extracorporeal shock wave; 68 patients in the observation group were treated with electroacupuncture combined with extracorporeal shock wave. The shoulder joint pain, joint function and activities of daily living were compared between the two groups. Results: The VAS score of shoulder joint pain in the observation group after treatment (1.92±0.24) was lower than that in the control group (3.51±0.32), and the UCLA score of shoulder joint function (31.28±1.96) was higher than that of the control group (27.42±2.36), the differences were statistically significant (P

Tennis Elbow (TE) encompasses pain and tenderness due to overuse or injury of the extensor wrist tendons...

OBJECTIVE The purpose of this study was to examine the intervention effect of radial extracorporeal shock wave combined with ultrashort wave diathermy on immobilization-induced fibrosis and contracture of muscle. DESIGN The groups included male rabbits for the group (control group). To cause joint contracture, rabbits underwent plaster fixation of a left knee joint at full extension. After immobilization for 4 wks, all rabbits were randomly divided into five groups: model group, natural recovery group, radial extracorporeal shock wave treatment group, ultrashort wave diathermy group, and radial extracorporeal shock wave combined with ultrashort wave diathermy group. All intervention effects were assessed by evaluating the cross-sectional area and the collagen deposition of muscle, the knee joint range of motion and the protein levels for transforming growth factor β1 and hypoxia-inducible factor 1α. RESULTS The combined treatment group got the best recovery of the knee joint function. The combined treatment was more effective than radial extracorporeal shock wave or ultrashort wave diathermy alone against the fibrosis and contracture of muscle, as well as the overexpression of transforming growth factor β1 and hypoxia-inducible factor 1α. CONCLUSIONS Radial extracorporeal shock wave combined with ultrashort wave diathermy was effective in alleviating immobilization-induced contracture and fibrosis of muscle, as well as reducing the molecular manifestations of muscle fibrosis.

Aims Proliferation, migration, and differentiation of anterior cruciate ligament (ACL) remnant and surrounding cells are fundamental processes for ACL reconstruction; however, the interaction between ACL remnant and surrounding cells is unclear. We hypothesized that ACL remnant cells preserve the capability to regulate the surrounding cells’ activity, collagen gene expression, and tenogenic differentiation. Moreover, extracorporeal shock wave (ESW) would not only promote activity of ACL remnant cells, but also enhance their paracrine regulation of surrounding cells. Methods Cell viability, proliferation, migration, and expression levels of Collagen-I (COL-I) A1, transforming growth factor beta (TGF-β), and vascular endothelial growth factor (VEGF) were compared between ACL remnant cells untreated and treated with ESW (0.15 mJ/mm2, 1,000 impulses, 4 Hz). To evaluate the subsequent effects on the surrounding cells, bone marrow stromal cells (BMSCs)’ viability, proliferation, migration, and levels of Type I Collagen, Type III Collagen, and tenogenic gene ( Scx, TNC) expression were investigated using coculture system. Results ESW-treated ACL remnant cells presented higher cell viability, proliferation, migration, and increased expression of COL-I A1, TGF-β, and VEGF. BMSC proliferation and migration rate significantly increased after coculture with ACL remnant cells with and without ESW stimulation compared to the BMSCs alone group. Furthermore, ESW significantly enhanced ACL remnant cells’ capability to upregulate the collagen gene expression and tenogenic differentiation of BMSCs, without affecting cell viability, TGF-β, and VEGF expression. Conclusion ACL remnant cells modulated activity and differentiation of surrounding cells. The results indicated that ESW enhanced ACL remnant cells viability, proliferation, migration, and expression of collagen, TGF-β, VEGF, and paracrine regulation of BMSC proliferation, migration, collagen expression, and tenogenesis. Cite this article: Bone Joint Res 2020;9(8):457–467.

Background Many studies have demonstrated the effectiveness of extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) for the treatment of carpal tunnel syndrome (CTS), and some studies showed that the effect of ESWT was superior to LCI. We performed this meta-analysis to compare the clinical effects across the two therapies. Methods Relevant randomized controlled trials (RCTs) comparing ESWT and LCI for the treatment of CTS were searched in electronic database. The Cochrane risk bias tool was used for quality assessment. After data extraction and quality assessment of the included studies, a meta-analysis was performed using RevMan 5.3 software. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were analyzed. The protocol for this systematic review was registered on INPLASY (202080025) and is available in full on the inplasy.com (10.37766/inplasy2020.8.0025) Results A total of 5 RCT studies with 204 patients were included from the electronic database. The meta-analysis results showed that two therapies were not significantly different in terms of visual analog scale (VAS) score (P = 0.65), Boston Carpal Tunnel Questionnaire (BQ) score (P = 0.14), sensory distal latency (P = 0.66), and nerve conduction velocity (NCV) of the sensory nerve (P = 0.06). There were significant differences between the results of motor distal latency (P < 0.0001), compound muscle action potential (CMAP) amplitude (P < 0.00001), and sensory nerve action potential (SNAP) amplitude (P = 0.004). Conclusions In terms of pain relief and function improvement, the effects of ESWT and LCI are not significantly different. In terms of electrophysiological parameters, LCI has a stronger effect on shortening motor distal latency; ESWT is superior to LCI in improving action potential amplitude. ESWT is a noninvasive treatment with fewer complications and greater patient safety. In light of the heterogeneity and limitations, these conclusions require further research for definitive conclusions to be drawn.

BACKGROUND This study was carried out to compare the therapeutic efficacy of extracorporeal shock wave (ESW) and ultrashort wave (UW) for temporomandibular joint disorder (TMD). MATERIAL AND METHODS A total of 80 patients with myofascial pain and TMD were enrolled in this study. The subjects were randomized to receive ESW or UW treatments. Patients in the ESW group received 1 ESW treatment for 4 weeks and patients in the US group were given US treatment once a day for 5 days per week for 4 weeks. The pain was measured using visual analog scale (VAS) and mouth opening was determined as pain-free maximum mouth opening (MMO) before and 4 weeks after the treatments. Other parameters assessed included functional indexes of temporomandibular joint such as mandibular movement (MM), joint noise (JN), joint press (JP), and disability index (DI). RESULTS After therapy, VAS, MMO, MM, JN, JP, and DI in ESW group, and VAS in UW group were significantly improved (P

Background: Previous studies have reported that extracorporeal shock wave (EPSW) combined spinal core decompression (SCD) has been used for the treatment of patients with femoral head necrosis (FHN) effectively. However, their results are still inconsistent. Therefore, this study will systematically assess the efficacy and safety of EPSW and SCD for the treatment of patients with FHN. Methods: This study will systematically search the following databases from inception through March 1, 2020: MEDLINE, Web of Science, Scopus, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and China National Knowledge Infrastructure. All searches will be performed without language and publication date restrictions. This study will only include randomized controlled trials investigating the efficacy and safety of EPSW and SCD for the treatment of patients with FHN. Two authors will independently assess all literatures, extract data, and appraise risk of bias. Any confusion between 2 authors will be cleared up by a third author through discussion. RevMan 5.3 software will be utilized to analyze the data and to perform a meta-analysis if necessary. Results: This study will summarize up-to-date evidence and provide a detailed summary related to the efficacy and safety of EPSW and SCD for the treatment of patients with FHN. Conclusion: This study may provide helpful evidence to determine whether or not EPSW combined SCD is effective and safety for the treatment of patients with FHN. Systematic review registration: INPLASY202040092.

Background: UROLOGIC pelvic surgery is the integration of surgical activities for the pelvis, the colon, urogenital, and gynecological organs primarily for the treatment of obstructions, dysfunction, malignancies, and inflammatory diseases.Aim of Study: To evaluate the efficacy of extracorporeal shock wave therpy on male coccydenia after urological surgery.Subjects: Thirty male patients who complain from coc-cydenia after urological surgery, their age range from 40-60 years old, choosen from El-Sahel Teaching Hospital and Police Hospital in Agoza, Cairo, Egypt during the period of June-2017 to November-2017.Methods: Patients assigned randomly into two groups of equal numbers, Group (A) control group which include 15 patients received routine medication only (anti-inflammatory drugs or NSAID), and Group (B) study group received shock wave therapy one session per week up to four weeks each session took 10 minutes the patients were received 2000 shots of ESWT in the coccyx, the frequency was 5Hz and the pressure was 3-4 bar in addition to traditional medications routine (anti-inflammatory drugs). Both groups were assessed pre and post-treatment for pain level by Visual Analogue Scale (VAS).Results: There was a significant decrease in the median values of visual analogue scale post-treatment of study group compared with control group (p=0.002) in favor of study group.Conclusion: Shock wave therapy is effective as a physical therapy program on improving coccydenia.

Tiemeier, Henning/0000-0002-4395-1397 WOS: 000434304300098 PubMed: 29461364 Aim: The purpose of this study was to evaluate the effect of the unfocused extracorporeal shock wave therapy (ESWT) on healing of mandible ramus defects in diabetic rats. Material and method: Forty male Wistar albino rats were used in the experiment. All animals were randomly divided into 2 main groups, nondiabetic and diabetic. Critical-sized defects were created on ramus in all rats. ESWT was performed to half of rats in each group at 3 sessions after surgery. Animals were euthanized at either fourth or eighth week. Stereological and radiologic examination was performed. Data were statistically analyzed by one-way variance analysis and Tukey post-hoc test. Results: Hounsfield Unit values were higher in D-E+ group than D-E- group in both 8-week and 4-week groups (P>0.05). In both 4-week and 8-week diabetic groups, higher value was observed when compared with nondiabetic groups (P>0.05). According to stereological results, in 4-week groups, there was a higher new bone, connective tissue, and neovascularization volume in D-E- group than D-E+ group and in D+E- group than D+E+ group. These results are similar for the 8-week groups except NV volume. Conclusion: It was found that ESWT application has no positive effect on the healing of critical-sized bone defects in nondiabetics whereas promising effects in diabetics were observed. Project Management Office Coordinatorship of Ondokuz Mayis UniversityOndokuz Mayis University [PYO.-DIS.1904.12.006] This experimental study was supported by Project Management Office Coordinatorship of Ondokuz Mayis University with PYO.-DIS.1904.12.006 project code.

(1) This study tests hypothesis whether extracorporeal shock wave (ECSW) therapy effectively salvages mouse critical limb ischemia (CLI). In vitro result demonstrated that the angiogenesis parameters (i.e., tubular length/cluster/network formation) and protein expressions of EGFR/VEGFR2/RAS/c-Raf/MEK/ERK/VEGF/p-PI3K/p-Akt/p-m-TOR were significantly and progressively increased with stepwise augmentation of ECSW energy (0.1/0.14/0.20 mJ/mm2/140 impulses). On the other hand, they were suppressed by administration of Avastin (20 μM). Adult male B6 mice (n = 24) were equally categorized into group 1 (sham-operated control), group 2 (CLI), group 3 [CLI + ECSW (0.12 mJ/mm2/120 impulses/at days 1/3/7 after CLI induction)] and group 4 [CLI + ECSW (0.12 mJ/mm2/120 impulses) + Avastin (1 mg/intramuscular-injection)] at days 1/3/7 after CLI induction] and quadriceps were harvested by day 14. The laser Doppler result showed that the ratio of left (ischemia) to right (normal) limb blood flow was highest in group 1, lowest in group 2, and significantly higher in group 3 than in group 4 by days 7/14 after the CLI procedure (p < 0.0001). The protein expressions of cell proliferation/migration/angiogenesis receptors (EGFR/VEGFR2), angiogenesis biomarkers (VEGF/CXCR4/SDF-1) and cell proliferation/growth/survival (Ras/c-Raf/MEK/ERK)/(PI3K/Akt/m-TOR) and cell motility/proliferation (p-FAK/p-Scr) signaling biomarkers were significantly higher in group 3 than in groups 1/2/4, and significantly lower in group 1 than in groups 2/4, but they did not show a difference between groups 2 and 4 (all p < 0.001). The small vessel density and cellular levels of endothelial cell surface marker (CD31+) exhibited an identical pattern of blood flow, whereas the angiogenesis (CXCR4+/VEGF+) displayed an identical pattern of VEGFR2 among the groups (all p < 0.0001). The in vitro and in vivo studies found ECSW salvaged the CLI mainly through upregulating Ras-Raf-MEK/ERK/cell motility, cell proliferation/growth pathways and angiogenesis.

Osteoporosis (OP), which is associated with an imbalance between osteoblasts (OBs) and osteoclasts (OCs), is sequentially treated with anabolic and anti-resorption agents in the clinic to improve outcome. However, the long duration of treatment and the accuracy of dosing are still major limiting factors affecting outcome. In the present study, a radial extracorporeal shock wave (rESW) responsive precise sequential release nanoplatform with zoledronic acid (ZOL) adsorbed onto the surface of hollow hydroxyapatite nanoparticles (hNPs) is reported. The ZOL on the surface of hNPs was rapidly released and inhibited hyperactivation of OCs in the OP region. The remaining hNPs with a wall thickness of approximately 10 nm were crushed into fragments by rESW to control Ca2+ release and proton neutralization, promoting anabolic metabolism. In addition, mechanical stimulation by rESW helped bone formation. In vivo, maximum anti-resorption and pro-anabolic effects, marked improvements in bone-associated parameters and mechanical properties in ovariectomy-induced OP rats were achieved following co-treatment with rESW and ZOL-hNPs. These findings suggest that this precise sequential release nanoplatform based on rESW can be used for effective anti-OP treatment.

Background: We tested the hypothesis that extracorporeal shock wave (ECSW)-assisted 5-FU therapy effectively suppressed human tongue squamous carcinoma cell line SAS (i.e., SAS cells) proliferation and tumor growth. Methods and results: In vitro study showed that as compared with lower ECSW energy (≤0.12 mJ/mm2), higher ECSW energy (≥0.25–035 mJ/mm2) significantly suppressed the SAS cell proliferation and upregulated tumor cell apoptosis/DNA-damage/oxidative-stress, whereas combined higher ECSW energy (0.35 mJ/mm2) and 5-FU (20uM) further significantly altered the expressions of these parameters (all p

IntroducciónLos efectos de las ondas de choque extracorpóreas (OCEC) han sido investigados en: osteoblastos humanos, focos fracturarios, pseudoartosisy células periósticas. Los mejores resultados del tratamiento de pseudoartrosis con Ondas de choque extracorpórea (OCEC) se han documentado para pseudoartrosis hipertróficas. El objetivo del presente estudio consistió en investigar el efecto de la terapia con OCEC sobre un foco de pseudoartrosis "atrófica" generado en tibia de conejo.Material y MétodosSe establecieron tres grupos dispuestos de la siguiente manera: a) Grupo A: fracturados sometidos a ondas de choque extracorpóreas. b) Grupo B (“control”): fracturados no sometidosa OCEC. c) Grupo C: no fracturados (pierna derecha). Se trataron 37 conejos (cuniculus NV) blancos y esqueléticamente maduros de Nueva Zelanda. Se procedió a practicar la cauterización del periostio con electrobisturí bipolar en una extensión de 20mm en ambos muñones óseos (proximal y distal). Luego se aplicaron OCEC en una sola sesión. Se realizaron tinciones con Hematoxicilina-Eosina. Se realizó el análisis biomecánico con un método de carga a “3 puntos”. Se estudiaron la carga máxima aplicada y el módulo de elasticidad para cada uno de los grupos en estudio.ResultadosEl estudio a nivel histológico permitió registrar signos de consolidación –callo fracturario perióstico y endostal- considerablemente mayores en las tibias de los animales del grupo A (tratado con ondas de choque extracorpóreas) comparativamente con el Grupo B “control”.ConclusiónEn un modelo experimental original de pseudoartrosis atrófica generada por electrocauterización en tibia de conejos se registraron cambios significativos radiográficos e histológicos luego de la intervención del foco mediante ondas de choque extracorpóreas. Abstract Introduction: The effects of extracorporeal shock wave therapy (ESWT) have been investigated in human osteoblasts, fracture foci, nonunion and periosteum cells. The best results of nonunion treatment with ESWT have been documented for hypertrophic type. The objective of this study was to investigate the effects of ESWT in an atrophic nonunion focus generated in a rabbit tibia model.Methods: Three groups were included: A, fractures receiving ESWT; B (“control”), fractures not receiving ESWT, and C, no fractures (right leg). A total of 37 New Zealand white and skeletally mature rabbits (cuniculus NV) were treated. Periosteum was cauterized using bipolar electrocautery at 20 mm in both bone stumps (proximal and distal). Then ESWT was applied in one session. Staining with hematoxylin-eosin was used. A biomechanical analysis with a 3-point loading system was performed. Maximum load and elastic modulus were evaluated in each group.Results: Histological study evidenced signs of union (periosteal and endosteal fracture callus) which were considerably larger in tibias of Group A (treated with ESWT) as compared to the control group (Group B).Conclusion: In an experimental model of atrophic pseudarthrosis caused by electrocautery in tibias of rabbits, significant radiographic and histological changes were observed after focus intervention with the application of ESWT.

Tiansheng Liu,1,2 Jinchao Ma,3 Bin Su,4 Hao Wang,3 Qi Wang,3 Xinlong Ma1,2 1Department of Orthopaedic Surgery, The General Hospital of Tianjin Medical University, 2Department of Orthopaedic Surgery, Tianjin Hospital, 3Department of Orthopaedic Surgery, 4Department of Pneumology, the Affiliated Hospital of Logistics University of PAP, Tianjin, People’s Republic of China Objective: To investigate the long-term efficacy of a combination treatment of alendronate, extracorporeal shock and hyperbaric oxygen for osteonecrosis of the femoral head (ONFH) of post-severe acute respiratory syndrome (SARS) patients.Patients and methods: The retrospective study was performed including a total of 37 post-SARS ONFH patients (66 hip joints) in the Department of Orthopedics of the General Hospital of Tianjin Medical University between November 2003 and November 2015, consisting of 6 males (11 hip joints) and 31 females (55 hip joints), with age between 19 and 47years (average 29.9years). Visual analog scale (VAS) score, Harris score and Association Research Circulation Osseous (ARCO) stage of imaging examination were compared among those before treatment, and at 1, 3, 6, 9 and 12years after treatment. Paired t-test was used for statistical analysis of VAS and Harris score before and after treatment. Difference of effective rate on all stages was analyzed with Chi-square test.Results: With 12-year follow-up, significant improvements on VAS (6.81 of pre-treatment vs 3.94 of 12-year post-treatment) and Harris score (74.54 of pre-treatment vs 80.14 of 12-year post-treatment) were observed (all p

Introduction: Urinary calculi is the second common chronic renal disease. Todays, the extracorporeal shock wave lithotripsy (ESWL) is the most common method of treatment of kidney calculi, though this method was invented 30 years ago. This study was conducted to compare the effects of oral diclofenac sodium versus acetaminophen codein on pain during ESWL. Methods: After signing informed consent, 90 patients with urinary calculi were randomly allocated into three equal groups (n = 30). In this study, one hour before the ESWL, 30 patients received the acetaminophen codeine (acetaminophen 650 mg plus codeine 20 mg) orally and 30 patients received diclofenac sodium 50 mg orally and 30 patients did not receive any drug. Severity of pain was assessed by the four-point scale during the procedure. Results: The results of our study showed that there was no statistically significant difference among the three groups regarding gender, weight, age, overall satisfaction, and pain severity during ESWL. Although morphine consumption and pain severity in groups of acetaminophen codeine and diclofenac sodium was lower than in the third group, this different was not statistically significant (P = 0.086). Conclusion: Oral prescription of acetaminophen codeine and diclofenac sodium, one hour before ESWL, has a similar effect on pain management.

This study tested the hypothesis that extracorporeal shock wave (ECSW) treatment can improve ischemia-induced left ventricular (LV) dysfunction in mini-pig with co-existing chronic kidney disease (CKD). LV ischemia in mini-pigs was induced by applying an ameroid constrictor over mid-left anterior descending artery (LAD), while model of CKD was established by right nephrectomy with partial ligation of left renal arterioles 2 weeks before LAD constriction. Thirty mini-pigs were randomly divided into group 1 (sham-control), group 2 (LV-ischemia), group 3 (LV-ischemia + CKD), Group 4 [LV-ischemia + ECSW (applied 1200 shots at 0.1 mJ/m2/equally to 4-ischemic regions by day-90 after LAD constriction], and group 5 (LV-ischemia-CKD + ECSW). By day-180 after CKD induction, echocardiography showed that LV ejection fraction (LVEF) was highest in group 1, lowest in group 3, significantly lower in group 2 than that in groups 4 and 5, and significantly lower in group 5 than that in group 4, whereas LV-end systolic and diastolic dimensions displayed an opposite pattern (all p

BACKGROUND: Substantial evidence exists to show the positive effects of radialextracorporeal shock wave therapy (ESWT) on bone formation. However, it is unknown whether rESWT can act locally at the growth plate level to stimulate linear bone growth. One way to achieve this is to stimulate chondrogenesis in the growth plate without depending on circulating systemic growth factors. We wished to see whether rESWT would stimulate metatarsal rat growth plates in the absence of vascularity and associated systemic growth factors. QUESTIONS/PURPOSES: To study the direct effects of rESWT on growth plate chondrogenesis, we asked: (1) Does rESWT stimulate longitudinal bone growth of ex vivo cultured bones? (2) Does rESWT cause any morphological changes in the growth plate? (3) Does rESWT locally activate proteins specific to growth plate chondrogenesis? METHODS: Metatarsal bones from rat fetuses were untreated (controls: n = 15) or exposed to a single application of rESWT at a low dose (500 impulses, 5 Hz, 90 mJ; n = 15), mid-dose (500 impulses, 5 Hz, 120 mJ; n = 14) or high dose (500 impulses, 10 Hz, 180 mJ; n = 34) and cultured for 14 days. Bone lengths were measured on Days 0, 4, 7, and 14. After 14 days of culturing, growth plate morphology was assessed with a histomorphometric analysis in which hypertrophic cell size (> 7 µm) and hypertrophic zone height were measured (n = 6 bones each). Immunostaining for specific regulatory proteins involved in chondrogenesis and corresponding staining were quantitated digitally by a single observer using the automated threshold method in ImageJ software (n = 6 bones per group). A p value < 0.05 indicated a significant difference. RESULTS: The bone length in the high-dose rESWT group was increased compared with that in untreated controls (4.46 mm ± 0.75 mm; 95% confidence interval, 3.28-3.71 and control: 3.50 mm ± 0.38 mm; 95% CI, 4.19-4.72; p = 0.01). Mechanistic studies of the growth plate’s cartilage revealed that high-dose rESWT increased the number of proliferative chondrocytes compared with untreated control bones (1363 ± 393 immunopositive cells per bone and 500 ± 413 immunopositive cells per bone, respectively; p = 0.04) and increased the diameter of hypertrophic chondrocytes (18 ± 3 µm and 13 ± 3 µm, respectively; p < 0.001). This was accompanied by activation of insulin-like growth factor-1 (1015 ± 322 immunopositive cells per bone and 270 ± 121 immunopositive cells per bone, respectively; p = 0.043) and nuclear factor-kappa beta signaling (1029 ± 262 immunopositive cells per bone and 350 ± 60 immunopositive cells per bone, respectively; p = 0.01) and increased levels of the anti-apoptotic proteins B-cell lymphoma 2 (718 ± 86 immunopositive cells per bone and 35 ± 11 immunopositive cells per bone, respectively; p < 0.001) and B-cell lymphoma-extra-large (107 ± 7 immunopositive cells per bone and 34 ± 6 immunopositive cells per bone, respectively; p < 0.001). CONCLUSION: In a model of cultured fetal rat metatarsals, rESWT increased longitudinal bone growth by locally inducing chondrogenesis. To verify whether rESWT can also stimulate bone growth in the presence of systemic circulatory factors, further studies are needed. CLINICAL RELEVANCE: This preclinical proof-of-concept study shows that high-dose rESWT can stimulate longitudinal bone growth and growth plate chondrogenesis in cultured fetal rat metatarsal bones. A confirmatory in vivo study in skeletally immature animals must be performed before any clinical studies.

Objective To determine the effect of extracorporeal shock wave (ESWT) on liposomal bupivacaine in a tibial-plateau-leveling osteotomy model. Study design In vitro study. Sample population Ten samples per group. Methods In addition to a control group (sham treatment), five treatment groups were defined as A, energy (E) 3 (0.22 mJ/mm2 ), 360 pulses per minute (p/m); B, E6 (0.29 mJ/mm2 ), 360 p/m; C, E8 (0.39 mJ/mm2 ), 360 p/m; D, E6, 480 p/m; E, E8 480 p/m. Two-milliliter aliquots of liposomal bupivacaine were placed in a gelatin chamber and treated with 1000 pulses according to group. All samples remained in the chamber for 170 seconds to reflect the longest treatment group. Free bupivacaine concentrations were determined after treatment with high-performance liquid chromatography. Results The median free bupivacaine concentration was reported as control, 1.90 mg/mL; A, 2.10 mg/mL; B, 2.03 mg/mL; C, 2.94 mg/mL; D, 2.71 mg/mL; E, 4.35 mg/mL. Groups C (P = .027), D (P = .034), and E (P = .002) were different from the control group. Groups C (P = .0025) and D (P = .0025) were different from group E. Additional intertreatment group differences were found. Conclusion Extracorporeal shock wave therapy caused a dose-dependent release of bupivacaine; however, there was no significant release of bupivacaine from liposomes when ESWT was applied at currently recommended therapeutic settings in this model. Clinical significance This in vitro study provides evidence that concurrent electrohydraulic ESWT and liposomal bupivacaine is likely safe at currently recommended settings, however, higher energy and pulse frequency settings should be avoided.

Context As a novel therapeutic method for erectile dysfunction (ED), low-intensity extracorporeal shock wave treatment (LI-ESWT) has been applied recently in the clinical setting. We feel that a summary of the current literature and a systematic review to evaluate the therapeutic efficacy of LI-ESWT for ED would be helpful for physicians who are interested in using this modality to treat patients with ED. Objective A systematic review of the evidence regarding LI-ESWT for patients with ED was undertaken with a meta-analysis to identify the efficacy of the treatment modality. Evidence acquisition A comprehensive search of the PubMed and Embase databases to November 2015 was performed. Studies reporting on patients with ED treated with LI-ESWT were included. The International Index of Erectile Function (IIEF) and the Erection Hardness Score (EHS) were the most commonly used tools to evaluate the therapeutic efficacy of LI-ESWT. Evidence synthesis There were 14 studies including 833 patients from 2005 to 2015. Seven studies were randomized controlled trials (RCTs); however, in these studies, the setup parameters of LI-ESWT and the protocols of treatment were variable. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference: 2.00; 95% confidence interval [CI], 0.99–3.00; p p =0.01). Therapeutic efficacy could last at least 3 mo. The patients with mild-moderate ED had better therapeutic efficacy after treatment than patients with more severe ED or comorbidities. Energy flux density, number of shock waves per treatment, and duration of LI-ESWT treatment were closely related to clinical outcome, especially regarding IIEF improvement. Conclusions The number of studies of LI-ESWT for ED have increased dramatically in recent years. Most of these studies presented encouraging results, regardless of variation in LI-ESWT setup parameters or treatment protocols. These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of ED patients. The publication of robust evidence from additional RCTs and longer-term follow-up would provide more confidence regarding use of LI-ESWT for ED patients. Patient summary We reviewed 14 studies of men who received low-intensity extracorporeal shock wave treatment (LI-ESWT) for erectile dysfunction (ED). There was evidence that these men experienced improvements in their ED following LI-ESWT.

目的：观察体外冲击波治疗早期股骨头坏死的临床疗效。方法：对2013年3月至2015年3月入住临沂市人民医院股骨头专科符合纳入和排除标准的40例(48髋)早期股骨头坏死患者给予体外冲击波治疗，每周2次，连续治疗8次为一个疗程，共3个疗程，观察并记录治疗前、治疗后第3、6、12、18、24个月时髋关节疼痛视觉模拟(VAS)评分、髋关节Harris评分。结果：体外冲击波治疗后，每次随访时髋关节VAS评分、髋关节Harris评分与治疗前相比有明显的改善(p < 0.05)。结论：体外冲击波是一种治疗早期股骨头坏死的有效方法，能够显著减轻髋关节疼痛、改善髋关节功能。 Objective: To observe the clinical curative effect of extracorporeal shock wave in the treatment of early osteonecrosis of the femoral head. Methods: Totally 40 cases (48 hips) early osteonecrosis of the femoral head with extracorporeal shock wave treatment, who satisfied inclusion and exclusion criteria during March 2013 to March 2013 in Linyi City People’s Hospital of the femoral head specialist, twice a week, eight consecutive treatment for a period of treatment, a total of three courses. The visual analogue scale and the Harris score were observed and recorded before the treatment and 3, 6, 12, 18 and 24 months after treatment. Results: After treatment with extracorporeal shock wave, the VAS score of the hip joint and the Harris score of the hip joint were significantly improved compared with the previous treatment (p < 0.05). Conclusion: Extracorporeal shock wave is an effective treatment for early osteonecrosis of the femoral head, which can significantly reduce the pain of the hip joint and improve the function of the hip joint.

Numerous randomized controlled trials (RCTs) demonstrated efficacy and safety of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciopathy (cPF). However, only two such RCTs investigated a follow-up period of more than 1 year, both applying focused ESWT. Corresponding data for radial ESWT (rESWT) have not yet been reported. We therefore tested the hypothesis that rESWT is effective and safe for the management of cPF with long-term follow-up of 2 years. To this end n = 50 patients with cPF were randomly allocated to either two sessions of rESWT (one session per week; 2,000 shock waves with energy flux density of 0.16 mJ/mm2 per session) (n = 25) or to placebo treatment (n = 25). Evaluation was by change in Visual Analog Scale (VAS) score and Roles and Maudsley (RM) score. Mean pretreatment VAS scores for the rESWT and placebo groups were 8.5 and 8.9, respectively. 1, 3, 6, 12, and 24 months after treatment, the mean VAS scores for the rESWT and placebo groups were 0.6, 1.1, 0.5, 2.3, and 1.4 and 7.6, 7.7, 7.4, 6.9, and 5.6 (p

Physical treatment and rehabilitation play major roles in recovery and maintenance of the equine athlete, and many therapeutic measures are accessible by the veterinarian in general practice. An accurate diagnosis of the condition undergoing treatment is a requirement, and measurable parameters obtained at diagnosis allows for quantification of treatment outcomes. Therapeutic modalities accessible to the general practicing veterinarian are reviewed. Mechanisms of action, indications, and treatment protocols of thermal therapy, therapeutic ultrasound, extracorporeal shock wave, and laser are discussed. Manipulative therapies, including stretching and use of core strengthening exercises and equipment, are outlined.

Objective To evaluate the efficacy of radial extracorporeal shock wave therapy (rESWT) compared with local corticosteroid injection (LCsI) in reducing pain and improving the function of patients with mild and moderate carpal tunnel syndrome (CTS) over 6 months. Patients and methods We studied 40 patients with mild and moderate CTS, where 20 patients received single-dose rESWT and the second group was treated with LCsI. Both groups had been assessed at baseline and at 1, 3, and 6 months after treatment using Boston self-assessment questionnaire (BQ) and visual analog scale (VAS) and at baseline and after 3 months using neurophysiological studies. Our prospective study compared efficacy in relieving pain and improving clinical function between single-dose rESWT and LCsI over 6 months. We subdivided our patients into mild and moderate groups and comparing improvement in outcome variables after treatment with rESWT and LCsI. Results There was a significantly higher improvement in symptom severity scores, functional scores, and BQ scores and decrease in VAS at 3 and 6 months, with significant improvement in sensory nerve conduction parameters at 3 months in the rESWT group compared with the LCsI group. When compared with the baseline, there was a significant reduction of VAS and functional score, symptom severity scores, BQ scores at third and sixth months, and electrophysiologic parameters at third month in the rESWT group. The LCsI group had no statistically significant improvement in all outcome variables at sixth month. Moreover, there were highly positive significant correlations between peak sensory latency of median nerve and the clinical outcomes (VAS and BQ score) at the sixth month after rESWT and between motor latency of median nerve and BQ score in mild and moderate CTS groups. Conclusion Single-dose rESWT is a noninvasive and convenient method for treating mild and moderate CTS with long-term beneficial effect lasting up to 6 months compared with LCsI.

Background This study investigated the efficacy of extracorporeal shock wave (ESW) application in stimulating dermal thickness, vascularity, and collagen synthesis of facial skin in a large animal model. Materials and methods The facial skin of the maxillary and mandibular areas of goats (n = 6 per group) was treated with ESWs of different intensities (0.15 and 0.45 mJ/mm2; 1000 pulses). After 4 d, histology and immunohistochemistry were used to evaluate the following: dermal thickness, total number and abundance of microvessels, amount of type 1 collagen, and α-smooth muscle actin expression. Results Dermal thickness, number and abundance of microvessels, and collagen synthesis increased after ESW application at both intensities (each P Conclusions A single-session application of focused low-energy ESWs to facial skin can increase dermal thickness by stimulating collagen production and local microcirculation. These findings commend the technique for future investigation for pretreatment of local or microvascular skin flaps to enhance tissue healing.

Introduction: Renal stones are endemic in low income countries among children below 15 years old. This should not be underestimated due to high association with other morbidity and highly recurrence rate when compared with adults. Objective : To explore the Effectiveness of Extracorporeal Shock Wave In Pediatric Renal Stones. Methodology: Study the case of a child girl reported with renal stone, clinical and laboratory data were obtained , Radiological investigations as US and CT were done, The patient underwent dj stent, then patient received one session of Extracorporeal Shock Wave 4000 us guided storz eswl Lithotripsy for urinary Stones then uralyt-u pediatric dose and allpourinol 100 mg once daily then start to passing stones gravels Results: Follow up by CT for the patient after 3 months revealed no stone, renal scan split function from 12 to 18%. Conclusion: Renal stones could be presented even among pediatric group even with negative family history. Ultrasound is the first choice imaging modality for diagnosis of suspected renal stones , CT could be used for follow up. Dihydroxyadenine stones could be missed during routine diagnosis of renal stones so imaging is mandatory and stones analysis should be done.

This aims to investigate the effect of combined use of radial extracorporeal shock wave therapy (rESWT) and conventional rehabilitation therapy on postoperative rehabilitation of children with spastic cerebral palsy. Children with spastic cerebral palsy 6 weeks after multistage surgery were randomly divided into treatment group (received rESWT and conventional rehabilitation therapy) and control group (received conventional rehabilitation only). Before treatment, 2 weeks and 1 month after treatment, the Gross Motor Function Measure (GMFM), modified Ashworth Scale (MAS) of the hamstrings and triceps, plantar area and plantar pressure were examined for efficacy assessment. A total of 82 children with spastic cerebral palsy were recruited, including 43 children in treatment group and 39 children in control group. There was no significant difference in the age, MAS score, and GMFM score between the 2 groups before treatment. There were statistically significant differences between the 2 groups at 2 weeks and 4 weeks after treatment, including the MAS score, GMFM score, plantar area and plantar pressure (P

We tested the hypothesis that extracorporeal-shock-wave (ECSW)-assisted adipose-derived stromal vascular fraction (SVF) therapy was better than either one for restoring the blood flow in critical limb ischemia (CLI). Adult male-SD rats were categorized into group 1 (sham-operated-control), group 2 (CLI), group 3 [CLI + ECSW (280 impulses/0.10 mJ/mm2) applied to left inguinal area at 3 h after CLI], group 4 [CLI + SVF (1.2 × 106) implanted into CLI area at 3 h after CLI], group 5 (CLI + ECSW-SVF). In vitro studies showed that ECSW significantly enhanced angiogenesis in human umbilical-vein endothelial cells and carotid-artery ring, and SVF significantly suppressed inflammation (TNF-α/NF-Κb/IL-1s/MMP-9) in smooth-muscle cells treated by LPS (all p

Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292). Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.

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.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.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.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.ESW was found to be safe and effective. The mechanism of ESW action is still under investigation.

The Achilles tendon is subject to two main pathologies: rupture and tendinopathy. The anatomy and biomechanical properties of both the Achilles and the plantaris tendon have a role to play in these. The histology in tendinopathy is primarily non-inflammatory. The available treatment options are eccentric stretching exercises, injection therapies, extracorporeal shock wave treatment, endoscopic, percutaneous or open surgery. The Achilles tendon is the most commonly ruptured tendon and the incidence of rupture is increasing. The injury can be treated with functional rehabilitation or surgery, which may be open, endoscopic or percutaneous.

We evaluated the possible effects of noise created by high energy shock waves on the hearing function of children treated with extracorporeal shock wave lithotripsy.A total of 65 children with normal hearing function were included in the study. Patients were divided into 3 groups, ie those becoming stone-free after 1 session of shock wave lithotripsy (group 1, 22 children), those requiring 3 sessions to achieve stone-free status (group 2, 21) and healthy children/controls (group 3, 22). Extracorporeal shock wave lithotripsy was applied with patients in the supine position with a 90-minute frequency and a total of 2,000 shock waves in each session (Compact Sigma, Dornier MedTech, Wessling, Germany). Second energy level was used with a maximum energy value of 58 joules per session in all patients. Hearing function and possible cochlear impairment were evaluated by transient evoked otoacoustic emissions test at 1.0, 1.4, 2.0, 2.8 and 4.0 kHz frequencies before the procedure, 2 hours later, and 1 month after completion of the first shock wave lithotripsy session in groups 1 and 2. In controls the same evaluation procedures were performed at the beginning of the study and 7 weeks later.Regarding transient evoked otoacoustic emissions data, in groups 1 and 2 there was no significant alteration in values obtained after shock wave lithotripsy compared to values obtained at the beginning of the study, similar to controls.A well planned shock wave lithotripsy procedure is a safe and effective treatment in children with urinary stones and causes no detectable harmful effect on hearing function.