Search

OBJECTIVE: The aim of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) ver-sus low-level laser therapy (LLLT) in treating chronic lateral epicondylitis (CLE). METHODS: In this prospective study, 52 patients (24 males, 28 females; mean age=48 years; age range=30–70 years) with a diagnosis of CLE were included and randomized into two groups (26 in each group): ESWT group (14 males, 12 females; mean age=48±10 years) or LLLT group (10 males, 16 females; mean age=48±11 years). ESWT was applied for 5 weeks with one session per week, while LLLT was applied with 15 sessions on consecutive days. All patients were evaluated using Disability of the Arm, Shoulder and Hand Questionnaire (DASH), Patient-Related Lateral Epicondy-litis Evaluation (PRTEE), and the 36-Item Short-Form Health Survey (SF-36) before and after the treatments. RESULTS: In the comparison of baseline data between treatment groups, significant differences were observed only in SF-Physical functioning and SF-Energy/fatigue scores (p=0.035 and p=0.038, re-spectively), which were 77.1±17.2 and 56.3±17.2 in ESWT group and 66.5±18.0 and 44.8±21.5 in LLLT group, respectively. In the comparison of post-treatment data between groups, there were sig-nificant differences in all scores (p0.05). CONCLUSION: Evidence from this study revealed that although both treatment modalities were effective in the treatment of CLE, ESWT seemed to more effective in pain relief and functional recovery than LLLT. LEVEL OF EVIDENCE: Level II, Therapeutic study

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: 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.

Background When conventional endoscopic treatment of bile duct stones is impossible or fails, advanced endoscopy-assisted lithotripsy can be performed by electrohydraulic lithotripsy (EHL), laser lithotripsy, or extracorporeal shock wave lithotripsy (ESWL). No systematic review has compared efficacy and safety between these techniques. Methods A systematic search was performed in PubMed, the Cochrane Library, and EMBASE for studies investigating EHL, laser lithotripsy, and ESWL in patients with retained biliary tract stones. Results After screening 795 studies, 32 studies with 1969 patients undergoing EHL (n = 277), laser lithotripsy (n = 426) or ESWL (n = 1266) were included. No randomized studies were available. Although each advanced lithotripsy technique appeared to be highly effective, laser lithotripsy had a higher complete ductal clearance rate (95.1 %) than EHL (88.4 %) and ESWL (84.5 %; P Conclusion This systematic review revealed that laser lithotripsy appeared to be the most successful advanced endoscopy-assisted lithotripsy technique for retained biliary tract stones, although randomized studies are lacking.

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.

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.

Background:Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain. Extracorporeal shock wave therapy (ESWT) has proven to be an effective treatment, but the relationship between therapeutic responses and sports activity levels has not been studied.Purpose:To compare the clinical outcomes of ESWT used to treat IATs between sports-active and nonsports-active patients over 5 years.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective study was conducted on 33 patients with IAT who received ESWT from October 2012 to September 2013. Patients were classified into 2 groups according to their preinjury Tegner activity level: a sports-active group, defined as patients who self-reported to be regular joggers (SA group; Tegner activity level >3; n = 16), and a nonsports-active group (control group; Tegner activity level ≤3; n = 17). The mean age was 31 ± 7 years for the SA group and 37 ± 10 years for the control group. The Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire scores and visual analog scale (VAS) pain scores were used to evaluate the clinical outcomes before treatment, immediately after treatment, and 5 years after treatment. Ultrasonography was also used to assess the insertional Achilles tendon quality.Results:Before treatment, there were no significant differences between the groups with regard to VAS scores, while the VISA-A score in the SA group was higher than that in the control group. After ESWT, both groups had increased VISA-A scores and decreased VAS scores, indicating improvement. At 5-year follow-up, the SA group had a significantly lower mean VAS score (0.3 ± 0.8 vs 1.6 ± 1.3; P = .001) and a significantly higher mean VISA-A score (90 ± 4 vs 78 ± 7; P < .001) compared with the control group. There was no significant difference between the groups regarding the calcification and neovascularization of the Achilles tendon based on ultrasonography.Conclusion:ESWT can improve the symptoms of Achilles tendinopathy, and patients with IAT who had greater sports activity levels had better therapeutic responses than nonsports-active patients after 5-year follow-up.

Urolithiasis can affect all children even preschool ones. Diagnostic difficulties in the youngest children are due to the problems in locating pain and determining its character and severity. In keeping with the ALARA (As Low As Reasonably Achievable) protocol, the number of imaging tests possible to perform is very limited. Ultrasound is the first line exam of choice. After diagnosis of the presence of a stone, ESWL (Extracorporeal Shock Wave Lithotrypsy) should always be considered and offered to parents due to its high effectiveness and minimal invasiveness. If ESWL is contraindicated or not well-accepted by parents, authors suggest another minimal invasive approach: URS-L (Uretherorenoscopy-Lithotrypsy). Our study clinically analyzes 87 children, which were treated between 2009 and 2017 using the URS-L procedure. URS-L treatments were performed using Lithoclast until 2009, and after that time, using the holmium laser Ho:YAG. The overall effectiveness of treatments was 93.3%. There was no failure in the access to the stones. A macroscopic hematuria (Clavien-Dindo I grade) was observed through the second post-operative day in 9.2% of treated patients. No urosepsis was observed. Full metabolic evaluation was performed on all patients. Children remained under constant urological and nephrological observation. A recurrence of urolithiasis was observed in 35.6% of the cases. Treating ureteral lithiasis in young infants remains a big challenge. Our series shows that modern minimal invasive techniques used by very experienced pediatric urologists in high volume centers gives excellent results. In most cases, surgery should no longer need to be an option., info:eu-repo/semantics/published

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.

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.

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.

Purpose: To compare the efficacy of two independent groups of patients treated with ultrasound (US)-guided extracorporeal shock wave (ESW) therapy and with US-guided injection of platelet-rich plasma (PRP) for chronic lateral epicondylitis (LE) with a minimum of 2-year follow-up. Methods: We retrospectively evaluated 63 patients treated for chronic LE (31 patients with autologous US-guided PRP injection and 32 patients with US-guided focal ESW therapy) from 2009 to 2014. All the patients were evaluated by means of Roles–Maudsley (RM) score, quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, visual analogic scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) to retrospectively assess the pain relief, level of activity, the self-reported function and subjective satisfaction at minimum of 2-year follow-up. Results: Both US-guided autologous PRP injection and US-guided focal ESW administration proved effective in chronic LE with significant improvement in the QuickDASH, VAS, RM and PRTEE scores ( p < 0.0001). No adverse effects or complications were recorded in any groups. No differences were found in recurrence rate and final results of the QuickDASH, VAS, RM and PRTEE scores between the two groups ( p > 0.05). The mean time between treatment and symptom resolution was significantly shorter for the PRP treatment ( p = 0.0212); furthermore, the mean time to return to the normal activities was quicker for PRP group ( p = 0.0119). Conclusion: Both PRP injection and ESW therapy are feasible and safe options for the treatment of chronic LE with low risk of complications and with good long-term follow-up results. US-guided PRP injection has quick efficacy when compared with US-guided focal ESW therapy.

Objectives. This study aims to explore whether extracorporeal shockwave treatment (ESWT) based on the theory of fascial manipulation (FM) at select treatment points is superior to traditional local ESWT for pain relief in adhesive capsulitis of the shoulder. Methods. Data from patients with adhesive capsulitis of the shoulder who received weekly ESWT according to fascial manipulation theory (ESWT-FM) or local extracorporeal shockwave treatment (L-ESWT) during a 5-week treatment period were evaluated. Pain-on-movement numeric rating scale (p-NRS) and range of motion (ROM) testing were performed before the treatment period, after the first treatment, and after the fifth treatment. Results. There were significant reductions in pain scores in the ESWT-FM group (p<0.05) after the first treatment, and after the fifth treatment, both groups had marked, significant improvement (p<0.05), with a significantly greater reduction in pain (p-NRS) in the ESWT-FM group compared to the L-ESWT group (p<0.05). There was no significant difference in terms of ROM in the L-ESWT group, while there was slight improvement of forward flexion in the ESWT-FM group after the fifth treatment. Conclusions. ESWT-FM provided faster pain relief and slightly more notable improvement of function compared with L-ESWT for the patients with adhesive capsulitis of shoulder.

Objective: To know if pre-morbid factors such as maximum power, maximum frequency, repeated extracorporeal shock wave lithotripsy (ESWL), age, hypertension, diabetic, nutrition, blood coagulation disorders, kidney function disorders, pain perception, stone burden, and stone location, can be use to predict ESWL complication. Material & methods: This study is done retrospectively. Analysis was done on 50 patients undergoing ESWL between July 2014 to December 2015. Free variables which evaluated were maximum power, maximum frequency, repeated ESWL, age, hypertension, diabetic, nutrition, blood coagulation disorders, kidney function disorders, pain perception, stone burden, and stone location. Dependent variable which evaluated was steinstrasse event, post ESWL fever, post-ESWL renal colic, post-ESWL hematuria. Age variable were distributed normally and done bivariate analysis by student T-test. Others were abnormally distributed and analyzed univariately by Mann U Whitney. Results: During study period, 50 patients were collected. Among them, 60% were men and 40% were women. Mean age of patients undergo ESWL were 50.9 +12.7 years. Mean stone size that undergo ESWL were 172.7 + 277.8 mm2. Patients with hypertension before ESWL were 9 patients. Stones were mostly located on kidney pyelum (29 patients), inferior calix (11 patients), superior calix (5 patients), middle calix (4 patients), and 1 patients has staghorn stone. After ESWL, none of the patients complaining severe pain, 35 patient complaining mild pain, and 15 patient complaining moderate pain. Repeated ESWL done in 16 patients (32%). Post-ESWL complication such as hematuria happened on 12 patients, steinstrasse on 1 patient, and colic on 6 patients. None of patients complaining fever. Repeated ESWL happened on 32% patients and have complication risk of hematuria (p=0.043). Hypertension is significantly effecting on hematuria event after ESWL (p=0.015). Conclusion: Hypertension and repeated ESWL can be used as predicting factor of hematuria complication.

Aim: The aim of this study is to investigate the short and mid term effects of extracorporeal shock wave theraphy (ESWT) in lateral epicondylitis (LE). Method: Fifty six elbows of 48 patients (35 female, 13 male) which were applied ESWT at least for 3 sessions for lateral epicondylitis were retrospectively evaluated. VAS scores recorded before treatment and scores recorded at first week and 3rd month after treatment and clinical evaluation scores for LE of Werhaar et al were evaluated. Results: Significant recovery was found when pain levels before and after treatment were compared. The mean pain score before treatment decreased to 4,82±1,87 at 1st week and to 3,98±2,07 from 7,07±1,73. According to Verhaar LE evaluation score, the number of good and excellent scores were increased while the number of bad scores decreased. Conclusion: As ESWT is a painless, effective method with less side effects, it is a method to perform before surgery in cases which did not respond to other conservative treatment modalities. Key Words: Extracorporeal Shockwave therapy, Lateral Epicondylitis DOI: 10.12973/ejms.2014.126p

The paradigm of erectile dysfunction (ED) treatment was fundamentally altered following the introduction of oral phosphodiesterase type 5 inhibitors. Unfortunately, a significant number of men exhibit a suboptimal response and require additional management strategies. One of the novel, minimally invasive strategies being developed is low-intensity extracorporeal shock wave therapy. Used in the hope of delaying placement of an inflatable penile prosthesis, the final phase of ED treatment, low-intensity extracorporeal shock wave therapy is a unique application of an established technology that may hopefully one day expand the medical options for patients with ED. This commentary will highlight the physiology underlying this technique and summarize the most recent studies.

Slipped capital femoral epiphysis (SCFE) is rare in nonambulatory patients, as mechanical factors play important roles in the development of the disease. We report a case of SCFE, which occurred in a 12-year-old girl with a nonambulatory status after cerebral infarction. SCFE occurred after she received passive range of motion exercise and extracorporeal shock wave treatment for neurogenic heterotopic ossification around the hip joint. The patient was successfully managed by a stepwise approach, with radiological and clinical improvements.

Pseudoarthrosis and delayed bone union are the main complications in the healing process of long bones fractures. The surgical intervention is currently the treatment of choice, but there is a number of non-operative interventions are being developed, such as extracorporeal shock wave therapy (ESWT). There is a range of issues related to the proper qualification, monitoring, and outcome assessment measures. Bone scintigraphy (BS) exclusively allows the assessment of the bone turnover dynamics in non-invasive, semi quantitative method.The study group comprised of 31 subjects with bone healing complications. The study population was divided in two subgroups as related to the treatment outcome assessed 24 weeks after ESWT procedure. Group I (n = 19) included the cases with no complete bone union. Group II (n = 12) covered the subjects with complete bone union. BS was performed right before ESWT and 2 weeks after the procedure.Increase of agent uptake after ESWT procedure was noted in both groups which proves that ESWT increases bone metabolism dynamics in most patients. Significantly higher uptake increase was noted in patients with complete bone union. In patients with unsuccessful treatment the agent uptake before ESWT was much higher. Two weeks after ESWT procedure BS reveals an increase in bone metabolism in the area of complicated fracture proving positive reaction of bony tissue on mechanical waves.Scintigraphy may facilitate qualification patients with bone union disorders for further mode of treatment. One can suppose that positive bone reaction is achievable only in bone where the metabolism is lowered.

Introduction: Neurogenic heterotopic ossification (NHO) is a complication of a neurological injury following traumatic brain injury (TBI) and may be present around major synovial joints. It is often accompanied by severe pain, which may lead to limitation in activities of daily living. Currently, a common intervention for NHO is surgery, which has been reported to carry many additional risks. This study was designed to assess the effect of extracorporeal shock wave therapy (ESWT) on pain in patients with TBI with chronic NHO. Methods: A series of single-case studies (n = 11) was undertaken with patients who had TBI and chronic NHO at the hip or knee. Each patient received four applications of high-energy EWST delivered to the affected joint over 8 weeks. Two-weekly follow-up assessments were carried out, and final assessments were made 3 and 6 months post-intervention. Pain was measured using the Faces Rating Scale, and X-rays were taken at baseline and 6-months post-intervention to physiologically measure the size of the NHO. Results: The application of high-energy ESWT was associated with significant overall reduction of pain in patients with TBI and NHO (Tau-0.412, 95% confidence interval −0.672 to −0.159, p = 0.002). Conclusions: ESWT is a novel non-invasive intervention for reducing pain resulting from NHO in patients with TBI.

Objectives: To compare the effect of pulsed electromagnetic field (PEMF) extracorporeal shock wave therapy (ESWT) on healing of delayed as well as non-united tibial fractures. Methods: This study was carried out on 60 adult patients suffering from delayed or non-union tibial fractures in spite of previous conservative treatment by (closed reduction and casting), or operative treatment by: ORIF by (IMN, plate and screws or gliding nail), or external fixation. They were divided according to line of treatment into 2 equal groups. The first group received (PEMF) therapy at the site of fracture of 12 Hz, 3 mT for 60 minutes per session, for 3 months, the patient of the second group were treated by focused (ESWT) at the site of fracture 3 sessions of 2500-3000 impulses each given at 0.25-0.84 mJ/mm2, at interval of 48-72 h between sessions, a maximum of 3 cycles of treatment was given at 3 months intervals. Clinical and radiological assessments were done before, after and then 6 months later as follow up. However functional assessment was done after treatment and 6 months later as follow up. Results: Our results showed better and earlier improvement of clinical, radiological as well as functional scores in group II more than group I. Conclusion: The best significant as well as more rapid clinical, radiological and functional improvement in cases of delayed or non-united tibial fractures was obtained with ESWT compared to PEMF therapy.

Focused extracorporeal shock wave for osteonecrosis of the femoral head with leukemia after allo-HSCT: a case series

Advances in the treatment of ischemia-reperfusion injury have created an opportunity for plastic surgeons to apply these treatments to flaps and implanted tissues. Using an extended inferior epigastric artery skin flap as a flap ischemia-reperfusion injury (IRI) model, we examined the capability of extracorporeal shock wave treatment (ESWT) to protect tissue against IRI in a rat flap model. Twenty-four rats were used and randomly divided into three groups (n=8 for each group). Group I was the sham group and did not undergo ischemic insult; rather, the flap was raised and immediately sutured back (non-ischemic control group). Group II (ischemia control) and Group III (ESWT) underwent 3h of ischemic insult. During reperfusion Group III was treated with ESWT and Group II was left untreated. Histological evaluation was made to investigate treatment induced tissue alterations. Survival areas were assessed at 5d postoperatively. Skin flap survival and perfusion improved significantly in the ischemic animals following ESWT (p0.001, respectively). The tissue protecting effect of ESWT resulted in flap survival areas and perfusion data equal to non-ischemic, sham operated flaps. In line with the observation of better flap perfusion, tissue from ESWT-treated animals (Group III) revealed a significantly increased frequency of CD31-positive vessels compared to both the ischemic (Group II; p=0.003) and the non-ischemic, sham operated control (Group I; p0.005) and an enhanced expression of pro-angiogenic genes. This was accompanied by a mild suppression of pro-inflammatory genes. Our study suggests that ESWT improves flap survival in IRI by promoting angiogenesis and inhibiting tissue inflammation. The study identifies ESWT as a low-cost and easy to use technique for surgical techniques that aim at reducing ischemia-reperfusion-induced tissue injury.

Background: Nonunion or delayed union of fractures in the proximal aspect of metatarsals 1 to 4 and Zone 2 of the fifth metatarsal were treated by high energy extracorporeal shock wave treatment (ESWT) to study the safety and efficacy of this method of treatment in a FDA study of the Ossatron device. Materials and Methods: In a prospective single-arm, multi-center study, 34 fractures were treated in 32 patients (two subjects had two independent fractures) with ESWT. All fractures were at least 10 (range, 10 to 833) weeks after injury, with a median of 23 weeks. ESWT application was conducted using a protocol totaling 2,000 shocks for a total energy application of approximately 0.22 to 0.51 mJ/mm2 per treatment. The mean ESWT application time for each of the treatments was 24.6 ± 16.6 minutes, and anesthesia time averaged 27.1 ± 10.4 minutes. All subjects were followed for 1 year after treatment at intervals of 12 weeks, 6, 9, and 12 months. Results: The overall success rate at the 12-week visit was 71% with low complications, significant pain improvement as well as improvement on the SF-36. The success/fail criteria was evaluated again at the 6- and 12-month followup, showing treatment success rates of 89% (23/26) and 90% (18/20), respectively. The most common adverse event was swelling in the foot, reported by five subjects (15.6%). Conclusion: High-energy ESWT appears to be effective and safe in patients for treatment of nonunion or a delayed healing of a proximal metatarsal, and in fifth metatarsal fractures in Zone 2. Level of Evidence: IV, Retrospective Case Series

The paper develops a new theory of chronic pain and pain relief by extracorporeal shock wave treatment. Chronic pain without underlying anatomical disorder is looked at as a pathological control function of memory. Conditioned reflexes are considered to be engraved memory traces linking sensory input of afferent signals with motor response of efferent signals. This feature can be described by associative memory functions of the nervous system. Some conditioned reflexes may cause inappropriate or pathological reactions. Consequently, a circulus vitiosus of pain sensation and muscle and/or vessel contraction is generated when pain becomes chronic (pain spiral). The key feature is a dedicated engram responsible for a pathological (painful) reaction. The pain memory may be explained by the concept of a holographic memory model published by several authors. According to this model it is shown how nervous systems may generate and recall memory contents. The paper shows how extracorporeal shock wave treatment may reorganize pathologic memory traces, thus giving cause to real and permanent pain relief. In a generalized manner, the idea of associative memory functions may help in the understanding of conditioning as a learning process and explain extracorporeal shock wave application as an efficient treatment concept for chronic pain. This concept may open the door for new treatment approaches to chronic pain and several other disorders of the nervous system.

This retrospective study investigated the efficacy and safety of extracorporeal shock wave (EPSW) combined with hyaluronic acid (HA) for patients with knee osteoarthritis (KOA). This retrospective study included 70 patients with KOA. Of those subjects, 35 of them received EPSW combined HA, and were allocated to a treatment group, while the other 35 participants received HA alone and were allocated to a control group. Patients in both groups were treated for a total of 8 weeks. The primary outcome was measured by visual analog scale (VAS). The secondary outcomes were measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee injury and osteoarthritis outcome score (KOOS). In addition, adverse events (AEs) were also evaluated. All outcomes were measured before and after the treatment. After the treatment, patients in the treatment group exhibited better efficacy in VAS (P

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 signicantly 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.

One of major limitations of applying distraction osteogenesis for craniofacial skeleton hypoplasia is the long duration for bony consolidation. This study investigated whether extracorporeal shock wave therapy (ESWT) could accelerate bony consolidation in distraction osteogenesis of the rat mandible.An L-shape osteotomy was performed unilaterally in the hemimandible of Sprague-Dawley rats. An internal distracter was employed to create a 7-mm distraction gap in the mandible. One hundred twenty rats were divided into three groups. The distraction zone of the mandible was received no treatment as controls (group I). Group II received ESWT (500 impulses at 14 kV) at 2 weeks postoperatively. Group III treated with 500 ESW impulses at 21 kV at 2 weeks postoperatively.Dual-energy X-ray absorptiometry and material testing showed that optimal dosage of ESWT in group II significantly increased mineral density and enhanced biomechanical strength of the bone tissue. In histomorphological analysis, the mandibular tissue in group II showed intense osteoblastic cell recruitment, new bone formation, and vascularization. The osteoblasts in the distracted zone in group II indicated significantly strong immunoreactivities for proliferating cell nuclear antigen, vascular endothelial growth factor, and bone morphogenetic protein-2, when compared with other groups.Optimal dosage of ESWT was beneficial for accelerating facial skeleton consolidation and bone regeneration in the distracted rat mandible tissue. The mechanism was presumably associated with the up-regulation of neovascularization, cell proliferation, and osteogenic growth factor expression in bone microenvironment.

This study highlights the emerging use of extracorporeal shock waves to treat nonunions and delayed unions. An overview of previous work performed in this area is presented. A feasibility study conducted by OssaTron (HealthTronics) is also reviewed, showing the results of high-energy extracorporeal shock wave for the treatment of nonunions in the proximal fifth metatarsal. Preliminary results support its effectiveness as a safe and less invasive means of treating difficult cases of nonunions or delayed unions. More research is needed to demonstrate the physiology of bone-healing induced by the use of shock wave therapy.

Objective Various studies have shown the benefit of the extracorporal shock wave therapy in the treatment of the calcific tendinitis. It was the aim of this study to examine the energy needed to disintegrate a calcific deposit. Method By using the in vitro model of the pig shoulder the mechanical effects of different energy levels and impulse rates on the calcifying deposits are investigated. Results The results are showing the energy- and impulse-depending effect of the shockwaves. The disintegration of the implanted "bonn-stones" with development of an large amount of fragments smaller then 1000 microns requires an energy of 0.42 mJ/mm2 and between 2000 and 3000 impulses. Conclusions According to the experimental results a instant mechanical effect on the calcifying deposits using the ordinary parameter is unlikely. The absorption of the calcifying deposits in likely induced through cellular clearing function. Clinical trials confirmed the good therapeutical results after two sessions with at least 1500 pulses and an energy of 0.28-0.30 mJ/mm2.

The effect of extracorporeal shock wave (ESW) therapy on skin flap survival and growth factor expression was investigated in a rat model using epigastric skin flap. Treatment and control groups each contained 20 animals. ESW effectively enhanced epigastric skin flap survival by significant reduction of areas of necrotic zones. At day 7 after the operation, necrotic zones of 4.2% were found in the ESW-treated group compared with 18.3% in the control group ( P < 0.01). Concomitantly, in tissue samples adjacent to the necrosis areas, increased vascular endothelial growth factor expression was observed in the ESW-treated animals (median 84.5%, range 57.4 to 94.5%) compared with the control group (median 46.7%, range 29.1 to 93.1%; P < 0.1). However, for expression of basic fibroblast growth factor, no difference was found between the two groups. The authors conclude that the success of the shock wave treatment may partly be due to modulation of growth factor expression.

Fracture of the humerus represents a common problem among the young and elderly populations. Although humerus fractures usually heal uneventfully, nonunions can sometimes occur. We present a case of humeral nonunion managed with shock wave therapy in the outpatient setting. A 62-year-old woman with a closed comminuted fracture of the proximal third of the humerus came to our attention 6 months after the trauma with a hypertrophic nonunion. Radiographs showed a hypertrophic callus with a fracture gap of 4 mm. We performed ten shock wave treatments in the outpatient department, with an interval of 60 days between each single treatment. Each session consisted of 2000 impulses at 0.86 mJ/mm2 applied in two planes. No anesthesia was given during the treatment. The patient received a sling to support the treated arm during the first days following each treatment. Follow-up assessment by radiographic and physical examination, performed after 4 weeks and at 3, 6, 12, 18 and 24 months, showed complete bony union and cortical bridging, achieved at the end of the treatment. We believe that this method is a safe and effective alternative to surgery for the treatment of chronic hypertrophic nonunions. Moreover, in case such treatment is unsuccessful, subsequent surgery is not precluded.

Plantar fasciitis is a common cause for heel pain and is the result of a degenerative process of the plantar fascia at its calcaneal attachment. Age, obesity, excessive weight bearing and tight Achilles tendon are the common predisposing factors. Though this is a self-limiting condition, the time for resolution of symptoms is highly variable. Commonly used treatments are rest, analgesics, heat and cold application, stretching exercises, splints and orthoses. Local infiltration with steroids, radiotherapy, extracorporeal shock wave treatment and surgery are used in more resistant cases. We review the current understanding and concepts in the treatment of this condition.

Since 1992 extracorporeal shock wave therapy (ESWT) has been used in the treatment of pain, in various tendinopathies, including plantar fascitis, heel spur, epicondylitis, calcific and non-calcific tendonitis of the rotator cuff. The exact mechanism by which ESWT relieves tendon-associated pain is not known; however, numerous controlled and noncontrolled studies have demonstrated the efficacy of ESWT in the treatment of various tendinopathies, including plantar fascitis, heel spur and epicondylitis. Based on personal experiences and analysis of the literature, this review confirmed that ESWT is an effective therapeutic procedure with no side-effects in the treatment of calcific rotator cuff tendonitis, and which can be considered a valuable alternative to conventional treatments.

Aim Extracorporeal shock wave treatment of infantile skeleton diseases is theoretical reasonable. The aim of this study was to investigate if extracorporeal shock wave therapy (ESWT) may cause damage to the epiphysis within the energy range of human application doses. Method 18 rabbits were treated with 800 extracorporeal shock waves (Philips lithotripter LDM-E, energy density 0.32 mJ/mm(2)) at the proximal tibia epiphysis. At 72 hours, 14 days and 4 weeks each after shock wave application 6 rabbits were sacrificed. Results Histological examination showed no damage to the epiphysis in all treated subjects. Conclusion This experimental study demonstrates that, under the conditions used in human shock wave therapy, no damage to the rabbit epiphysis occurs.

Resume Objectifs. – Evaluer les effets du traitement par ondes de choc extracorporelles des paraosteoarthropathies entrainant une gene fonctionnelle. Methodes. – Vingt-six patients porteurs de POA, ont recu des seances d'ondes de choc (4 000 chocs, 3/seconde), d'energie comprise entre 0,54 et 1,06 mJ/mm2, a raison d'une seance hebdomadaire pendant quatre semaines consecutives. L'evaluation intermediaire, faite un mois apres la derniere seance, a porte sur la douleur (EVA), l'arthrometrie, l'independance fonctionnelle (MIF), la distance de marche d'une traite (lorsque la marche etait possible), l'aspect radiologique, la calcemie et les phosphatases alcalines. A l'interieur de ce groupe, un suivi moyen de 11 mois a ete effectue, par questionnaire, sur 18 patients porteurs de POA sur prothese de hanche (PTH). Resultats. – Les POA etaient d'origine neurologique dans cinq cas et non neurologique dans 21 cas. L'anciennete moyenne des POA etait de 32 ± 21 mois. Les parametres ameliores de facon significative, lors de l'evaluation intermediaire, etaient : douleur, avec une decroissance moyenne de l'EVA de 4,32 a 1,14 ; flexion, avec un gain de 8,18 ± 11,9°; distance de marche passant de 1 126 a 2 776 m. Dans les 18 cas de PTH, une diminution des bons resultats precoces est observee a 11 mois. Toutefois ces resultats restent superieurs a l'etat clinique avant traitement. Conclusion. – Le traitement par ondes de choc apparait interessant dans les POA et peut etre propose en complement du traitement medical classique, de la reeducation et avant une eventuelle intervention chirurgicale.