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Purpose: The purpose of this study is to investigate the role of Bcl2/adenovirus E1B 19kDa protein-interacting protein 3 (BNIP3)-dependent mitophagy in immobilization-induced muscle atrophy and explore the potential mechanism responsible for ameliorating myogenic contracture through extracorporeal shock wave (ESW). Methods: A rat model of myogenic contracture was developed by immobilizing the knee joint, and muscle atrophy and mitophagy were assessed in vivo. Subsequently, we verified the role of mitophagy in muscle atrophy through in vitro. Finally, we examined the potential therapeutic effects of ESW on immobilization-induced muscle atrophy and myogenic contracture, and assessed the role of mitophagy in the observed alleviation of symptoms. Results: Immobilization had significant time-dependent effects on muscle atrophy. It triggered the production of excessive reactive oxygen species (ROS) and subsequently overactivated hypoxia-inducible factor (HIF)-1α/BNIP3-dependent mitophagy in the rectus femoris. Excessive mitophagy resulted in the elimination of mitochondria, leading to a shortage of adenosine triphosphate (ATP). As ATP homeostasis was crucial for maintaining muscle mass, the shortage of ATP resulted in reduced muscle mass and cross-sectional area, as well as slow-to-fast myofiber type transition. These findings were corroborated by an in vitro study that pretreatment with BNIP3 small interfering RNA (siRNA) reduced the level of BNIP3-dependent mitophagy and partially counteracted the inhibition of myogenic differentiation caused by high levels of ROS. Notably, ESW was found to suppress ROS generation, inhibit overactivated HIF-1α/BNIP3-dependent mitophagy, and preserve mitochondrial quantity in the rectus femoris. Conclusions: Our findings suggest that ESW can inhibit overactivated BNIP3-dependent mitophagy in immobilized muscles, which could be one of the potential therapeutic mechanisms attenuating immobilization-induced muscle atrophy and further improving myogenic contracture.

Objective: The aim of the study is to assess the effects on spasticity reduction of the association between focal extracorporeal shock wave therapy and botulinum toxin type A, versus the toxin only in brain injury patients. Design: Eighteen patients were included. The study had two phases: the first phase was observational, and botulinum toxin type A was used. The second was a prospective, deliberate intervention phase in which the toxin was injected and focal extracorporeal shock wave treatment was added (1 sessions/week, for 3 wks). The patients were followed up in the 1st, 4th, and 6th month, the Ashworth Scale criterion was applied, and for those with lower limb involvement and changes in walking, the 10-meter walk test was used. Results: Patients treated with toxin only showed a statistically significant improvement in spasticity, with 1 point on the Ashworth Scale from week 5, which disappeared at week 17. However, the combined therapy reduced spasticity by 2 points from week 1 to week 25 (P < 0.001), with a faster result in the 10-meter gait test (P = 0.004). Conclusions: Combined and simultaneous treatment with botulinum toxin and focal extracorporeal shock wave reduced spasticity in a more effective and prolonged way than treatment with botulinum toxin only. [ABSTRACT FROM AUTHOR]

Objective To analyze the effect of extracorporeal shock wave assisted drug therapy on clinical outcomes of patients with temporomandibular disorders (TMD). Methods A total of 86 TMD patients in our hospital from September 2018 to September 2019 were included and divided into group A (n=43) and group B (n=43) by random number table method. Group A (n=43) received oral glucosamine hydrochloride tablets on the basis of conventional treatment; group B (n=43) received extracorporeal shock wave therapy on the basis of group A. The pain degree, maximum mouth opening, temporomandibular joint function, temporomandibular joint bounce times, life quality and occurrence of adverse reactions were compared between the two groups. Results Compared with that before treatment, the visual analogue scale (VAS) scores, maximum mouth opening, temporomandibular joint dysfunction index (DI), palpation index (PI), Fricton craniomandibular index (CMI) level, joint bounce times and oral health impact scale (OHIP-14) score of two groups were significantly improved (P< 0.05), and all indexes in group B were significantly better than those in group A (P0.05). Conclusion Extracorporeal shock wave assisted drug therapy can effectively reduce joint bounce in TMD patients, relieve patients’ pain, improve patients’ life quality and temporomandibular joint function, and has good safety.

Abstract Background Rotator cuff calcific tendinitis (RCCT) is a common shoulder disease whose main symptoms include shoulder pain, limited mobility, and calcification deposits in the shoulder. Traditional treatment methods have certain limitations, so finding new treatment methods has become the focus of research. Extracorporeal shock wave (ESW) and platelet-rich plasma (PRP) treatments have attracted much attention due to their non-invasive and tissue repair-promoting properties; however, the efficacy of their combined treatment in RCCT remains unclear. Methods This study is designed as a single-center, assessment-blind, randomized controlled clinical trial with three parallel groups. Sixty subjects will be recruited and randomly divided into the ESW group, PRP group, and ESW combined with PRP group, in a 1:1:1 ratio. The entire intervention period is 4 weeks, and the follow-up period is 4 weeks. Outcomes will be measured at baseline (T0), after 1 week of intervention (T1), after 2 weeks of intervention (T2), after 4 weeks of intervention (T3), and after an additional 4 weeks of follow-up period (T4). The primary endpoint is the VAS score. Secondary endpoints are ASES, CMS, UCLA, and the location and size of calcified areas. Discussion This study aims to evaluate the efficacy of ESW therapy combined with PRP in treating RCCT. We compare the effects of single and combined treatments to explore their impact on disease symptoms, functional improvement, and calcification regression. This provides a scientific basis for identifying more effective treatment options. Trial registration ClinicalTrials.gov NCT06372600. Registered on April 17, 2024; version 1.

Background: Rotator cuff calcific tendinitis (RCCT) is a common shoulder disease whose main symptoms include shoulder pain, limited mobility, and calcification deposits in the shoulder. Traditional treatment methods have certain limitations, so finding new treatment methods has become the focus of research. Extracorporeal shock wave (ESW) and platelet-rich plasma (PRP) treatments have attracted much attention due to their non-invasive and tissue repair-promoting properties; however, the efficacy of their combined treatment in RCCT remains unclear. Methods: This study is designed as a single-center, assessment-blind, randomized controlled clinical trial with three parallel groups. Sixty subjects will be recruited and randomly divided into the ESW group, PRP group, and ESW combined with PRP group, in a 1:1:1 ratio. The entire intervention period is 4 weeks, and the follow-up period is 4 weeks. Outcomes will be measured at baseline (T0), after 1 week of intervention (T1), after 2 weeks of intervention (T2), after 4 weeks of intervention (T3), and after an additional 4 weeks of follow-up period (T4). The primary endpoint is the VAS score. Secondary endpoints are ASES, CMS, UCLA, and the location and size of calcified areas. Discussion: This study aims to evaluate the efficacy of ESW therapy combined with PRP in treating RCCT. We compare the effects of single and combined treatments to explore their impact on disease symptoms, functional improvement, and calcification regression. This provides a scientific basis for identifying more effective treatment options. Trial registration: ClinicalTrials.gov NCT06372600. Registered on April 17, 2024; version 1. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. Methods: 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. Results: After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. Conclusion: ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients. Implications for Rehabilitation: Extracorporeal shock wave therapy represents a useful non-invasive, additional modality for reduction of foot spasticity and equinus deformity in chronic stroke patients. The application of such a modality improves limb posture, range of motion, and muscle extensibility. Early extracorporeal shock wave rehabilitative intervention in stroke patients reduces fat infiltration and fibrosis replacement of spastic muscle. [ABSTRACT FROM AUTHOR]

Purpose: Joint contracture is a common disease in clinical practice, joint bleeding is an important factor affecting the progression of joint contracture. This study aimed to explore the effect of extracorporeal shock wave on alleviating joint capsule fibrosis caused by intra-articular hemorrhage in rats. Methods: Forty two SD rats were randomly divided into seven groups. Perform simple fixation and fixation after blood injection separately. Measure the range of motion of each group's knee joints and calculate the corresponding degree of contraction. Use HE staining and Masson staining to detect the number of anterior joint capsule cells and collagen deposition. Detection of changes in Wnt1, β-catenin protein expression in joint capsule using Western blotting. Results: Compared to group C, the degree of knee joint contracture in M1 and M2 groups of rats increased, and collagen deposition, cell number and Wnt1, β-catenin protein expression also increased accordingly. Compared to M1 and M2 groups, the degree of knee contraction in E1 and E2 groups were reduced, while collagen deposition, cell number and Wnt1, β-catenin protein expression were decreased, and the degree of joint contracture in NR1 and NR2 groups showed no significant improvement. Compared to NR1 and NR2 groups, the degree of knee contraction in E1 and E2 groups were reduced, while collagen deposition, cell number and Wnt1, β-catenin protein expression were decreased. Conclusions: Both rat models of knee joint contracture were successful, and joint bleeding can exacerbate joint contracture. Extracorporeal shock waves alleviate joint capsule fibrosis caused by intra-articular bleeding in rats. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the efficacy of low‐intensity, high‐frequency shock waves in the treatment of temporomandibular joint disorders. Methods: Twenty‐six patients with temporomandibular joint disorder admitted to the Second Hospital of Shanxi Medical University from August 2022 to December 2022 were selected as study subjects and randomly divided into two groups, A and B, with 13 patients each. In Group A, there were 5 males and 8 females with an average age of 38.85 ± 11.03 years. In Group B, there were 4 males and 9 females with an average age of 39.15 ± 11.16 years. Group A was the control group, which received routine treatment (manual massage + transcutaneous electrical nerve stimulation + ultrashort wave therapy) plus sham shock wave therapy; Group B was the experimental group, which received routine treatment (manual massage + transcutaneous electrical nerve stimulation + ultrashort wave therapy) plus shock wave therapy. The routine treatment was administered once/day, five times per week for a total of 2 weeks of treatment. In addition, shock wave therapy was administered once every 5 days, and the treatment was administered three times. The treatment period was 2 weeks, and the two groups were compared before treatment, at the end of the treatment period, and 4 weeks after treatment. The pain level of the two groups was assessed by the visual analogue scale (VAS) before and after treatment, and the temporomandibular opening index (TOI) before and after treatment was compared between the two groups. VAS and TOI scores were evaluated using the Mann–Whitney U‐test, the Kruskal–Wallis H‐test and two‐way ANOVA. Results: There was no significant difference in the VAS score and temporomandibular opening index between the two groups before treatment (p =.829 and.75, respectively). After 2 weeks of treatment, the VAS score and temporomandibular joint opening index of both groups were significantly improved compared to those before therapy. In addition, the VAS score and temporomandibular joint opening index in the experimental group were significantly better than those in the control group (p <.001 and <.001, respectively). There was a small increase in scores 4 weeks after the treatment compared to just after the treatment period, but the difference was not significant. Conclusion: This is a preliminary small sample study that demonstrates the positive effect of using low‐intensity, high‐frequency shock waves on the treatment of temporomandibular joint disorders and is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Extracorporeal shock wave therapy, as its potential benefits for various musculoskeletal diseases, has received widespread attention. Increasingly studies have demonstrated that it has excellent effects such as pain relief and functional recovery. However, bibliometric analysis in the domain of extracorporeal shock wave therapy for pain is relatively lacking. OBJECTIVE: To visually analyze the studies related to extracorporeal shock wave therapy for pain and to sort out the knowledge structure and explore its research status as well as hot trends in this field at home and abroad. METHODS: The publications related to extracorporeal shock wave therapy for pain from 2002 to 2022 in Web of Science Core Collection database and CNKI database were searched. Visual analysis using Citespace software was performed to produce the diagrams and interpret their meanings. RESULTS AND CONCLUSION: A total of 2 101 studies were included. The number of documents issued showed a fluctuating upward trend and the United States and China had certain advantages in the number of documents issued. The issuing institutions are mainly universities and hospitals and the issuing authors mostly belonged to independent teams. The exchange between issuing institutions and authors needed to be strengthened and the degree of crossinstitutional and cross-regional cooperation was low. Keyword visual analysis indicated that extracorporeal shock wave therapy has been widely used in musculoskeletal diseases and further studies should focus on multidisciplinary in-depth study and observation of the clinical efficacy of combined therapy. The studies on the topic of extracorporeal shock wave therapy treating pain mainly focus on musculoskeletal diseases, including plantar fasciitis, scapulohumeral periarthritis, and tennis elbow. In recent years, combined treatment with ultrasound-guided injection therapy, traditional Chinese treatment techniques and expansion of new fields become research trends and hotspots of concern. [ABSTRACT FROM AUTHOR]

ObjectiveThis study synthesized the highest level of evidence to analyse the effectiveness and safety of using extracorporeal shock wave therapy (ESWT) to treat upper limb tendonitis, which was unknown.DesignWe conducted a systematic review and meta-analysis of 18 randomized controlled trials (RCTs) in PubMed, Embase, Web of Science, Medline, and the Cochrane Library.MethodsTwo researchers performed the screening, data extraction, literature quality assessment, and heterogeneity analysis of the searched RCTs.ResultsThe main types of morbidity included rotator cuff tendonitis, lateral epicondylitis, finger tendonitis, and long bicipital tendonitis. The results of the meta-analysis showed that ESWT was effective in relieving pain in all four types of tendonitis. In addition, ESWT was more effective in relieving pain in patients with upper limb tendonitis than placebo at the 3- and 6-month follow-ups, especially with radial ESWT (RESWT). Data analysis of the forest plot showed that the experimental group with ESWT as an intervention had a significant improvement in function in patients with rotator cuff tendonitis at the 3-month follow-up. However, subgroup analysis showed that low-energy ESWT was effective in improving function in patients with calcified and non-calcified rotator cuff tendonitis, whereas it was not effective in relieving pain.ConclusionESWT can effectively improve the functional activity in patients with rotator cuff tendonitis and may produce positive analgesic effects in patients with upper limb tendonitis. The incidence of adverse effects is low.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023403594, identifier: PROSPERO, CRD42023403594.

ObjectiveTo explore the effect of extracorporeal shock wave (ESW) therapy on different types of lumbar disc herniation (LDH).MethodsA total of 3,454 patients with LDH admitted to the Department of Orthopedics and Traumatology of the Third Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, Qujing Hospital of Traditional Chinese Medicine, Xuanhan County People's Hospital from February 2020 to February 2023 were selected. According to the different types of LDH, the patients were divided into the central disc herniation group (1,231 cases), the paracentral disc herniation group (1,081 cases) and the lateral disc herniation group (1,142 cases). All patients received ESW therapy and functional exercise guidance. The visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores were compared among the three groups before treatment, on the 2nd and 6th day of treatment, and at the end of treatment. The inflammatory markers (IL-6, TNF-α) were evaluated before and after treatment, and the intervention effects of ESW in the three groups were comprehensively evaluated.ResultsThere was no significant difference in gender, age, course of disease and stage among the three groups (P>0.05). The VAS score of the three groups after 2 and 6 days of treatment and at the end of the treatment period were all significantly lower than those before treatment (PPP>0.05). In terms of JOA score, all the three groups showed a significantly higher score after 2 days, 6 days, and at the end of the treatment period, than those before treatment and the differences were statistically significant (PPP>0.05). In terms of inflammatory markers (IL-6, TNF-α), the level of IL-6 and TNF-α in the three groups after treatment were significantly lower than those before treatment, and the differences were statistically significant (PP

Background: The treatment for Achilles tendinopathy varies widely, and there is no consensus regarding the optimal treatment for both non-insertional and insertional Achilles tendinopathy. The purpose of this study was to evaluate the clinical efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of insertional and non-insertional Achilles tendinopathy (AT). Methods: Sixty patients with AT were invited to participate in this study. Patients were allocated to one of two groups according to the site of the AT, including an insertional AT (IAT) group and a non-insertional AT (NIAT) group. ESWT was performed once a week for five weeks for both groups. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) score and the visual analog scale (VAS) were used five times to evaluate the clinical outcomes, including before treatment, immediately after treatment, as well as one month, three months, and five years after treatment. Results: At three months after treatment, the IAT group exhibited a significantly higher VISA-A score (82 ± 6 vs. 76 ± 11; p = 0.01) and a significantly lower VAS score (1 ± 1 vs. 2 ± 1; p

To investigate the intervention effect of extracorporeal shock wave combined with manual traction on fixation‐induced knee contracture and its influence on PTEN‐PI3K/AKT signaling pathway. Thirty‐six SD male rats were randomly divided into six groups. The left knee joints were not fixed in the control group (C group). Rats in other groups underwent brace fixation in the extended position of the left knee. After 4 weeks of bracing, it is randomly divided into five groups: Model group (M group), natural recovery group (NR group), extracorporeal shock wave treatment group (ET group), manual traction group (MT group), and extracorporeal shock wave combined with manual traction group (CT group). Joint range of motion (ROM) of left knee was carried out to assess joint function. Hematoxylin and eosin (HE) staining and Masson staining were respectively used to assess the cell number and collagen deposition expression. Immunohistochemical staining and Western blot were used to assess protein levels of phosphatase and tensin homolog (PTEN), phosphatidylinositol 3‐kinase (PI3K), and protein kinase B (AKT). The combined therapy was more effective than extracorporeal shock wave therapy or manual traction alone against the joint ROM, cell number and the collagen deposition, low‐expression of PTEN, and overexpression of PI3K/AKT in the anterior joint capsule of rats with knee extension contracture. Extracorporeal shock wave combined with manual traction can promote the histopathological changes of anterior joint capsule fibrosis, upregulate the protein expression of PTEN and downregulate the protein expression of PI3K/AKT in the fibrotic joint capsule in a rat joint contracture model. [ABSTRACT FROM AUTHOR]

Wound healing requires the coordinated interaction of dermis cells, the proper deposition of extracellular matrix, re-epithelialization, and angiogenesis. Extracorporeal shock wave (ESW) is a promising therapeutic modality for chronic wounds. This study determined the biological mechanisms activated under ESW, facilitating the healing of pressure ulcers (PUs). A group of 10 patients with PUs received two sessions of radial ESW (300 + 100 pulses, 2.5 bars, 0.15 mJ/mm2, 5 Hz). Histomorphological and immunocytochemical assessments were performed on tissue sections obtained from the wound edges before the ESW (M0) and after the first (M1) and second (M2) ESW. The proliferation index of keratinocytes and fibroblasts (Ki-67), the micro-vessels' density (CD31), and the number of myofibroblasts (α-SMA) were evaluated. The involvement of the yes-associated protein (YAP1) in sensing mechanical strain, and whether the nuclear localization of YAP1, was shown. The increased proliferative activity of epidermal cells and skin fibroblasts and the increased number of myofibroblasts, often visible as integrated cell bands, were also demonstrated as an effect of wound exposure to an ESW. The results indicate that the major skin cells, keratinocytes, and fibroblasts are mechanosensitive. They intensify proliferation and extracellular matrix remodeling in response to mechanical stress. A significant improvement in clinical wound parameters was also observed. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of extracorporeal shock wave (ESW) combined with autologous platelet-rich plasma (PRP) therapy on knee osteoarthritis (KOA) with meniscus injury in terms of pain relief, functional outcome and complications. Methods: This is a retrospective observational study. Clinical data of 144 patients with KOA accompanied by medial meniscus injury, who received treatment in Jilin Provincial People's Hospital from March 2021 to December 2022, were retrospectively evaluated. A total of 128 patients (81 males and 47 females) were finally included in the study after screening. Of them, 45 patients received PRP treatment (PRP-group), 43 patients received ESW treatment (ESW-group), and 40 patients received ESW combined with PRP treatment (Combined-group). The relief of knee joint pain and functional improvement among three groups of patients were compared. Results: After treatment, visual analogue scale (VAS), Lequesne, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores of patients in the Combined-group were significantly lower than those in the other two groups (p<0.05). Combined ESW-PRP treatment was associated with significantly greater joint range of motion of patients compared to ESW and PRP alone (p<0.05). The total incidence of related complications in the Combined-group was lower compared to the other two groups (p<0.05). Conclusions: Compared with PRP or ESW treatment alone, ESW combined with PRP for KOA with meniscus injury can better alleviate pain, achieve faster functional recovery, and significantly reduce complications. [ABSTRACT FROM AUTHOR]

This study tested the hypothesis that ITRI Biofilm prevents adhesion of the chest cavity. Combined extracorporeal shock wave (ECSW) + bone marrow-derived autologous endothelial progenitor cell (EPC) therapy was superior to monotherapy for improving heart function (left ventricular ejection fraction [LVEF]) in minipigs with ischemic cardiomyopathy (IC) induced by an ameroid constrictor applied to the mid-left anterior descending artery. The minipigs (n = 30) were equally designed into group 1 (sham-operated control), group 2 (IC), group 3 (IC + EPCs/by directly implanted into the left ventricular [LV] myocardium; 3 [+]/3[–] ITRI Biofilm), group 4 (IC + ECSW; 3 [+]/[3] – ITRI Biofilm), and group 5 (IC + EPCs–ECSW; 3 [+]/[3] – ITRI Biofilm). EPC/ECSW therapy was administered by day 90, and the animals were euthanized, followed by heart harvesting by day 180. In vitro studies demonstrated that cell viability/angiogenesis/cell migratory abilities/mitochondrial concentrations were upregulated in EPCs treated with ECSW compared with those in EPCs only (all P s < 0.001). The LVEF was highest in group 1/lowest in group 2/significantly higher in group 5 than in groups 3/4 (all P s < 0.0001) by day 180, but there was no difference in groups 3/4. The adhesion score was remarkably lower in patients who received ITRI Biofilm treatment than in those who did not (all P s <0.01). The protein expressions of oxidative stress (NOX-1/NOX-2/oxidized protein)/apoptotic (mitochondrial-Bax/caspase3/PARP)/fibrotic (TGF-β/Smad3)/DNA/mitochondria-damaged (γ-H2AX/cytosolic-cytochrome-C/p-DRP1), and heart failure/pressure-overload (BNP [brain natriuretic peptide]/β-MHC [beta myosin heavy chain]) biomarkers displayed a contradictory manner of LVEF among the groups (all P s < 0.0001). The protein expression of endothelial biomarkers (CD31/vWF)/small-vessel density revealed a similar LVEF within the groups (all P s < 0.0001). ITRI Biofilm treatment prevented chest cavity adhesion and was superior in restoring IC-related LV dysfunction when combined with EPC/ECSW therapy compared with EPC/ECSW therapy alone. [ABSTRACT FROM AUTHOR]

Jingjun Xie,1 Jinxia Li,2 Qi Sun1 1Department of Acupuncture, The First People’s Hospital of Huzhou, Zhejiang, 313000, People’s Republic of China; 2Department of Acupuncture, Huzhou Hospital of Traditional Chinese Medicine, Affiliated to Zhejiang Chinese Medical University, Zhejiang, 313000, People’s Republic of ChinaCorrespondence: Jinxia Li, Email lijinxia310@163.comObjective: The purpose of this study was to evaluate the clinical efficacy of extracorporeal shock wave combined with warm acupuncture for external humeral epicondylitis.Methods: Eighty-two patients with external humeral epicondylitis were randomly divided into an observation group and a control group. Patients in the control group were treated with extracorporeal shock waves while those in observation group with warm acupuncture on the basis of the control group. Patients in both groups were evaluated by Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) before and after treatment. The inflammatory factors such as IL-6, IL-10, TNF-ɑ and clinical outcomes were contrasted before and after treatment.Results: There were statistically significant differences in VAS score, MEPS score and DASH score between the two groups before and after treatment (P< 0.05), and the improvement of each score in the observation group was more obvious than that in the control group. After treatment, the inflammatory factors of the two groups were lower than those before treatment, and the difference was statistically significant (P< 0.05). The decrease of inflammatory factors in the observation group was more obvious than that in the control group. The total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P< 0.05).Conclusion: Extracorporeal shock wave combined with warm acupuncture could effectively improve the pain symptoms and dysfunction of external humeral epicondylitis and reduce the expression of inflammatory factors, and its effect may be better than that of extracorporeal shock wave treatment alone.Clinical Trial Registration: ChiCTR2200066075.Keywords: extracorporeal shock wave, warm acupuncture, external humeral epicondylitis, a randomized clinical trial

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

BACKGROUND: Segmental bone defects are prone to non-unions, and its treatment is a formidable clinical challenge. Additionally, the aging population and prevalence of osteoporosis-related fractures make it urgent to further explore a novel strategy to induce osteogenesis in this special population with limited bone generation ability. OBJECTIVE: To evaluate the novel strategy of bone marrow mesenchymal stem cells-loaded platelet-rich plasma combined with extracorporeal shock wave in reconstruction of segmental bone defects in osteoporosis. METHODS: The bone marrow mesenchymal stem cells pretreated by extracorporeal shock wave were co-cultured with platelet-rich plasma and the cell biocompatibility was tested by CCK-8 and live-death staining. Osteogenic differentiation of bone marrow mesenchymal stem cells was detected by alkaline phosphatase staining, alizarin red staining, and RT-PCR detection. New-Zealand rabbit models of osteoporosis were established and segmental bone defects of the radius were prepared. The combined treatment strategy of bone marrow mesenchymal stem cells-loaded platelet-rich plasma implantation and extracorporeal shock wave was used. The bone regeneration of radius samples was analyzed by Micro-CT and histological evaluation. RESULTS AND CONCLUSION: (1) In vitro, platelet-rich plasma combined with extracorporeal shock wave significantly promoted bone marrow mesenchymal stem cells proliferation and migration, as well as induced osteogenic differentiation of bone marrow mesenchymal stem cells by upregulating the deposition of calcium nodule, and expression of alkaline phosphatase, runt-related transcription factor-2 (Runx-2) and osteocalcin. (2) In vivo, Micro-CT analysis and histological evaluation indicated this combination strategy of bone marrow mesenchymal stem cells-loaded plateletrich plasma implantation combined with extracorporeal shock wave significantly enhanced bone regeneration in osteoporotic segmental bone defects. (3) The results indicated that this novel strategy of bone marrow mesenchymal stem cells-loaded platelet-rich plasma implantation combined with extracorporeal shock wave could improve the poor osteogenic microenvironment associated with osteoporosis and show the potential for enhancing healing in segmental bone defects with osteoporosis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to observe the therapeutic effect of extracorporeal shock wave (ESW) on extensional joint contracture of knee joint in rats and its mechanism on articular capsule fibrosis. Thirty-two SD rats were randomly divided into blank control, immobilization, natural recovery, and ESW intervention groups. Except for the control group, the left knee joints of other rats were fixed with external fixation brace for 4 weeks when they were fully extended to form joint contracture. The effect of intervention was assessed by evaluating joint contracture, total cell count and collagen deposition in joint capsule, and protein expression levels of TGF-β1, p-Smad2/3, Smad2/3, p-JNK, JNK, I and III collagen in joint capsule. ESW can effectively reduce arthrogenic contracture, improve the histopathological changes of anterior joint capsule, inhibit the high expression of target protein and the excessive activation of TGF-β1/Smad2/3/JNK signal pathway. Inhibition of excessive activation of TGF-β1/Smad2/3/JNK pathway may be one of the potential molecular mechanisms by which extracorporeal shock wave can play a role. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Mild to moderate CTS is the most common median nerve compression disease in middle-aged and elderly women, mainly manifested by hand numbness and pain. This paper analyzes the extracorporeal shock wave of patients with mild to moderate CTS after nerve mobilization. Methods The clinical data of 92 patients with CTS from June 2020 to June 2022 are analyzed and randomly divided into extracorporeal shock wave group (n = 47) and routine group (n = 45). The routine group undergoes nerve mobilization, and the extracorporeal shock wave group receives extracorporeal shock wave therapy on the basis of the routine group. The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function scores, and ADL scores before and after treatment are observed. The Spearman correlation coefficient is used to analyze the correlation between upper limb function and ADL score, and the incidence of complications after treatment is analyzed. Results The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function score, ADL score and the incidence of complications in the extracorporeal shock wave group are significantly better than those in the conventional group (P

Copyright of Journal of Hainan Medical University is the property of Journal of Hainan Medical College Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Mild to moderate CTS is the most common median nerve compression disease in middle-aged and elderly women, mainly manifested by hand numbness and pain. This paper analyzes the extracorporeal shock wave of patients with mild to moderate CTS after nerve mobilization. Methods: The clinical data of 92 patients with CTS from June 2020 to June 2022 are analyzed and randomly divided into extracorporeal shock wave group (n = 47) and routine group (n = 45). The routine group undergoes nerve mobilization, and the extracorporeal shock wave group receives extracorporeal shock wave therapy on the basis of the routine group. The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function scores, and ADL scores before and after treatment are observed. The Spearman correlation coefficient is used to analyze the correlation between upper limb function and ADL score, and the incidence of complications after treatment is analyzed. Results: The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function score, ADL score and the incidence of complications in the extracorporeal shock wave group are significantly better than those in the conventional group (P < 0.05). ADL scores are negatively correlated. Conclusion: Extracorporeal shock wave combined with nerve mobilization has a significant effect in the treatment of CTS patients, which can significantly improve the symptoms and pain scores of patients, and enhance the function of patients' upper limbs. At the same time, the incidence of complications in patients is less, and it has high safety. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the efficacy and safety of extracorporeal shock wave therapy for knee osteoarthritis (KOA) by Meta analysis.MethodsThe CNKI database, Wanfang Data, China Science and Technology Journal Database (VIP), CBMdisc, PubMed and Cochrane Library were searched from inception to October 2020 for randomized controlled trials (RCTs) of extracorporeal shock wave therapy for KOA. Outcome measures included overall efficiency, visual analogue scale (VAS), Lequesne index score, Western Ontario and McMaster University Osteoarthritis Index score (WOMAC), and incidence of adverse reactions. Literature screening and data extraction were carried out independently by two researchers, and the literature quality was evaluated according to the Cochrane Collaboration Network standard. RevMan 5.3 software was used for data analysis. Relative risk (RR) was used to analyze the binary variables; and the continuous variables with the same unit and measurement method were described by mean difference (MD), while the continuous variables with different measurement methods or units were described by standardized mean difference (SMD). The random-effects model was used for analysis when the included studies were heterogeneous (I2≥50%, PI2P>0.1).ResultsA total of 13 RCTs with 1 132 cases were included, 577 in the observation group and 555 in the control group. The results of meta-analysis showed that the overall efficiency of the observation group was significantly higher than that of the control group, and the difference was statistically significant [RR=1.13, 95% CI(1.05, 1.22), P=0.000 8]; the Lequesne index score of the observation group decreased more significantly after treatment than that of the control group, and the difference was statistically significant [SMD=0.68, 95% CI(0.47, 0.90), PPPRR=0.42, 95% CI(0.13, 1.33), P=0.14].ConclusionExtracorporeal shock wave therapy is safe and efficient in the treatment of patients with KOA, and is recommended for clinical application. Due to the quality limitations of the included studies, high-quality, multi-center RCTs with large sample size are still needed to verify the clinical effects in the future.

Background Hypertrophic scars cause aesthetic concerns and negatively affect the quality of life. A gold standard treatment for hypertrophic scars has not been established due to various responses of modalities. Extracorporeal shock wave therapy (ESWT) is a noninvasive and affects scar remodeling by fibroblast regulation. This study investigated the effectiveness of ESWT for hypertrophic scars.

Wound healing requires the coordinated interaction of dermis cells, the proper deposition of extracellular matrix, re-epithelialization, and angiogenesis. Extracorporeal shock wave (ESW) is a promising therapeutic modality for chronic wounds. This study determined the biological mechanisms activated under ESW, facilitating the healing of pressure ulcers (PUs). A group of 10 patients with PUs received two sessions of radial ESW (300 + 100 pulses, 2.5 bars, 0.15 mJ/mm2, 5 Hz). Histomorphological and immunocytochemical assessments were performed on tissue sections obtained from the wound edges before the ESW (M0) and after the first (M1) and second (M2) ESW. The proliferation index of keratinocytes and fibroblasts (Ki-67), the micro-vessels’ density (CD31), and the number of myofibroblasts (α-SMA) were evaluated. The involvement of the yes-associated protein (YAP1) in sensing mechanical strain, and whether the nuclear localization of YAP1, was shown. The increased proliferative activity of epidermal cells and skin fibroblasts and the increased number of myofibroblasts, often visible as integrated cell bands, were also demonstrated as an effect of wound exposure to an ESW. The results indicate that the major skin cells, keratinocytes, and fibroblasts are mechanosensitive. They intensify proliferation and extracellular matrix remodeling in response to mechanical stress. A significant improvement in clinical wound parameters was also observed.

Injuries at the tendon-bone interface are very common in the field of sports medicine, and healing at the tendon-bone interface is complex. Injuries to the tendon-bone interface can seriously affect a patient’s quality of life, so it is essential to restore stability and promote healing of the tendon-bone interface. In addition to surgical treatment, the healing of tendons and bones can also be properly combined with extracorporeal stimulation therapy during the recovery process. In this review, we discuss the effects of extracorporeal shock waves (ESWs), low-intensity pulsed ultrasound (LIPUS), and mechanical stress on tendon-bone healing, focusing on the possible mechanisms of action of mechanical stress on tendon-bone healing in terms of transcription factors and biomolecules. The aim is to provide possible therapeutic approaches for subsequent clinical treatment.

Osteoarthritis (OA) is a common joint disease, but there is no effective treatment except surgery at present. Extracorporeal shock wave (ESW) is an emerging therapy widely used in various medical fields. In this study, we mainly investigated the effects of ESW on apoptosis and autophagy of osteoarthritic chondrocytes by analyzing the cell apoptosis and the expression of autophagy markers' mRNAs and proteins, respectively. Primary chondrocytes were isolated from articular cartilage tissue of rats. Results showed that ESW effectively inhibited the interleukin-1β-induced (IL-1β-induced) chondrocyte apoptosis. Moreover, ESW treatment elevated the mRNA and the protein expression levels of Beclin 1, Atg5, LC3B, and Collagen II. Beclin 1 plays a key role in autophagy, positively regulating autophagic activity. Atg5 is a marker of autophagic activity, and LC3 is a specific marker of autophagosome. Collagen II is an important indicator to judge the functional activity of chondrocytes. In contrast, the mRNA and the protein expression levels of P62, which is a measure of autophagic flux and is thought to be negatively correlated with autophagic degradation, were decreased in the ESW treated cells. This study reveals the role of ESW in promoting chondrocyte autophagy and suppressing cell apoptosis. Thus, ESW may protect chondrocytes against IL-1β-induced apoptosis and promote autophagy in an in vitro model of osteoarthritis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Extracorporeal shock wave is a new treatment method that has been widely used in various medical fields and plays an important role in the occurrence and development of osteoarthritis. OBJECTIVE: To investigate the effects of extracorporeal shock wave on the proliferation and autophagy of chondrocytes from osteoarthritis rats in vitro and to explore the mechanism of extracorporeal shock wave in the treatment of osteoarthritis. METHODS: Primary chondrocytes were isolated and cultured from the articular cartilage of extremities of 1-week-old clean-grade Sprague-Dawley rats. Chondrocytes at passage 3 were randomly divided into control group (without any treatment), interleukin-1β group (10 μg/L interleukin-1β for 24 hours), extracorporeal shock wave group (1.5×105 Pa extracorporeal shock wave for 500 times), interleukin-1β+extracorporeal shock wave group (10 μg/L interleukin1β for 24 hours+1.5×105 Pa extracorporeal shock wave for 500 times). The viability and proliferation of chondrocytes were detected by cell counting kit-8 method. The mRNA expressions of Beclin 1, P62, Atg5 and LC3 were detected by real-time fluorescence quantitative PCR. RESULTS AND CONCLUSION: Stimulation with interleukin-1β for 24 hours decreased the viability and proliferation of chondrocytes compared with the control group (P < 0.05). Compared with the interleukin-1β group, chondrocyte viability and proliferation were increased in the interleukin-1β+extracorporeal shock wave group (P < 0.05). The expression of Beclin 1, Atg5 and LC3 was down-regulated and P62 expression was increased in the interleukin-1β group compared with the control group (P < 0.05), whilst the expression of Beclin 1, Atg5 and LC3 was significantly increased and the expression of P62 was decreased in the interleukin-1β+extracorporeal shock wave group compared with the interleukin-1β group (P < 0.05). These results suggest that extracorporeal shock wave can promote the proliferation and autophagy of osteoarthritic chondrocytes, thus regulating the progression of osteoarthritis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Morton's neuroma is a common cause of forefoot pain, typically occurring in the third metatarsal space and characterized by symptomatic nerve compression. This condition often leads to significant functional impairment, affecting weight-bearing activities and limiting appropriate footwear due to pain and discomfort. Objective This study aims to evaluate the outcomes of conservative interventional treatment for Morton's neuroma, specifically focusing on corticosteroid injections. Methodology We reviewed 10 cases of Morton's neuroma in the field of physical medicine and rehabilitation. The average age of the patients was 45 years, with a higher prevalence among females. Diagnoses were confirmed through clinical assessment and ultrasound imaging. Results All 10 patients (100%) received conservative interventional treatment with corticosteroid injections. This approach effectively alleviated symptoms in 9 out of 10 patients (90%). Surgical options were considered only if symptoms did not improve with this treatment. Conclusions All 10 patients (100%) were treated with corticosteroid injections, which alleviated symptoms in 9 out of 10 patients (90%). Surgical options were considered only if this treatment was insufficient. This analysis highlights the effectiveness of this approach as a first-line management strategy for Morton's neuroma., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jaai et al.)

Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo Zuzhi Gongcheng Yanjiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

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

Background Hypertrophic scars cause aesthetic concerns and negatively affect the quality of life. A gold standard treatment for hypertrophic scars has not been established due to various responses of modalities. Extracorporeal shock wave therapy (ESWT) is a noninvasive and affects scar remodeling by fibroblast regulation. This study investigated the effectiveness of ESWT for hypertrophic scars. Methods Twenty-nine patients were enrolled. All patients underwent ESWT once a week for 6 consecutive weeks. Their scarswere assessed using the Patient and Observer Scar Assessment Scale (POSAS), erythema index, melanin index, and scar pliability before treatment and again 4 weeks after treatment completion. Results Thirty-four hypertrophic scars in this study had persisted for between 6 months and 30 years. Most scars developed after surgical incision (55.88%). The chest and upper extremities were the predominant areas of occurrence (35.29% each). Most of the POSAS subscales and total scores were significantly improved 4 weeks after treatment (p<0.05). Furthermore, the pain, itching, and pigmentation subscale were improved. The pliability, melanin index, and erythema index were also improved, but without significance. The patients were satisfied with the results and symptoms alleviation, although subjective score changes were insignificant. No serious adverse events were found. The patients reported pruritus in 62.5% and good pain tolerance in 37.5%. Subgroup analyses found no differences in scar etiologies or properties at different parts of the body. Conclusion The ESWT is a modality for hypertrophic scar treatment with promising results. Most of POSAS subscales were significantly improved. [ABSTRACT FROM AUTHOR]

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.

Objective To observe the clinical efficacy of external radiative shock wave combined with sodium hyaluronate injection in the treatment of knee osteoarthritis（KOA）. Methods Sixty-two patients with KOA be divided into observation group and control group randomly,with 31 cases in each group. The observation group included 13 males and 18 females,the mean age was（62.35±9.70） years old,and the course of disease was（3.06±1.49） years. There were 16 males and 15 females in the control group,the mean age was (60.87±1.56) years old,and the course of disease was (2.74±1.53) years. The Extracorporeal Shockwave therapy (ESWT) was given firstly,then the Intra-articular injection of hyaluronic acid（HA） was injected 2 days later in the observation group.The control group was treated with HA only 1 week.Both of the groups were treated once a week for 5 weeks.The Visual Analogue Scale (VAS) and Western Ontario and Mc Master University Osteoarthritis Index (WOMAC）were used to evaluate the difference in efficacy between the two groups,at the time of before the treatment,1 week after the treatment and 3 months after that.KOA patients were divided into observation groupⅡ and control groupⅡaccording to Kellgren-Lawrence grading (Ⅱ，Ⅲ). VAS score and WOMAC score of observation groupⅢ and control groupⅢwere compared before and after treatment,respectively.Results The VAS score and WOMAC score in both group were significantly lower than those before at the time of 1 week and 3 months after treatment (P<0.05),while 1 week after treatment and 3 months after treatment the VAS and WOMAC scores in the observation group were lower than those in the control group (P<0.05). The WOMAC score of the observation group was further decreased after 3 months than 1 week after treatment (P<0.05). In kellgren-Lawrence class Ⅱ and Ⅲ patients,the scores of observation group and control group decreased after treatment compared with before treatment (P<0.05),VAS of observation group decreased 1 week after treatment in classⅡgroup,but the difference was not statistically significant,WOMAC score decreased (P<0.05).VAS and WOMAC scores of kellgren-Lawrence gradeⅢpatients were lower than those of control group 3 months after treatment (P<0.05),VAS and WOMAC scores of Kellgren-Lawrence grade Ⅲ patients were lower than those of control group 1 week and 3 months after treatment (P<0.05).Conclusion The ESWT combined with HA can significantly reduce the joint pain and improve knee joint mobility more effectively than HA alone in the treatment of KOA. [ABSTRACT FROM AUTHOR]

Objective:To observe the effect of extracorporeal shock wave combined with occupational therapy therapy on forearm pronation disorder in children with spastic cerebral palsy(SCP).Methods:A total of 42 children with SCP were randomly divided into the control group and the observation group, with 21 cases in each group in the children rehabilitation department of the affiliated Nanhai maternity and children's Hospital of Guangzhou university of traditional Chinese medicine from January to December 2019.The control group was given targeted occupational therapy, including upper limb forearm pronator stretching therapy, neurophysiological therapy(Bobath technology), proprioceptive neuromuscular facilitation therapy(PNF); game type occupational training including placing objects in forearm supination position, supination grasping stick, supination fetching game, palm and back game, etc..The above training was conducted once a day, 30 minutes per time, six times a week, three months as a course of treatment, continuous treatment for two courses.The observation group was given extracorporeal shock wave therapy on the basis of the control group.The child with SCP was in a comfortable position and the forearms of the upper limbs were placed on the plane so that it could free its own gravity.The abdomen of pronator teres muscle was impacted with the probe of shock wave therapeutic instrument(pressure intensity: 1.0-1.5 bar;frequency: 8-10 Hz;impact times: 1 000-2 000 times).Three to five minutes each time, once every three days, twice a week, three months as a course of treatment, continuous treatment for two courses.Before treatment, after treatment for three months and six months, the modified Ashworth scale(MAS)was used to evaluate the spasticity of forearm pronator muscles;the active range of motion(AROM)of forearm supination was measured by joint range of motion protractor;and the fine motor quotient(FMQ)of hands was evaluated by Peabody development motor scale-fine motor(PDMS-FM).Results:Before treatment, there was no significant difference in MAS score, AROM angle and FMQ score between two groups(P>0.05).Compared with before treatment, the MAS scores of the two groups decreased significantly after treatment for three and six months, and the AROM angle and FMQ score increased significantly, the difference was statistically significant(PP

Objective To systematically evaluate the efficacy and safety of extracorporeal shock wave (ESWT) in the treatment of knee osteoarthritis(KOA). Methods From the establishment of the database to July 2020, the clinical randomized controlled trials related to ESWT in the treatment of KOA which were searched by computer from CNKI, WanFang, WangFang Medical Network, VIP, Zhangqiao Research, Doctor Search, CBM, Chinese Medical Journal Full Text Database. According to inclusion and exclusion criteria, the literature were screened with 2 researchers, the data and the quality of the included literature were extracted and evaluated. The documents which meeting the inclusion criteria were analyzed by Revman version 5. 3 statistical software. Results A total of 16 articles were included in the study, with a total of 1 259 patients. Meta-analysis results suggest that after ESWT treatment of KOA, the test group patients' visual analogue scoring method score [mean difference (MD) = 1.76, 95% confidence interval (95%CI) (0. 92,2. 61), P <0. 000 01], osteoarthritis index score [ MD=4. 63,95 %CI (-1. 05,10. 31),P =0.11], Lequesne osteoarthritis se-verity index [MD =1. 27,95%CI (0.86, 1.68), P<0. 000 01], Lysholm score [MD= —9. 48, 95 %CI ( —14. 69, —4. 26), P =0.000 4], clinical total effective rate [relative risk was 0. 85, 95 %CI (0. 76,0. 96),P = 0. 006] were better than those of the control group. Conclusion Evidence at this stage shows that ESWT has a certain positive effect on relieving pain and improving joint range of motion in the treatment of KOA patients, and it has a reliable effect and is worthy of clinical recommendation. [ABSTRACT FROM AUTHOR]

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

Therapeutic strategies to boost the effect of botulinum toxin may lead to some advantages, such as long lasting effects, the injection of lower botulinum toxin dosages, fewer side effects, and lower costs. The aim of this study is to investigate the combined effect of botulinum toxin A (BTA) injection and extracorporeal shock wave therapy (ESWT) for the treatment of spasticity in children with spastic cerebral palsy (CP). Fifteen patients with spastic CP were recruited through a retrospective chart review to clarify what treatment they received. All patients received a BTA injection on gastrocnemius muscle (GCM), and patients in group 1 underwent one ESWT session for the GCM immediately after BTA injection and two consecutive ESWT sessions at weekly intervals. Ankle plantar flexor and the passive range of motion (PROM) of ankle dorsiflexion were measured by a modified Ashworth scale (MAS) before treatment and at 1 and 3 month(s) post-treatment. In group 1, the shear wave velocity (SWV) of GCM was measured. The PROM and MAS in group 1 and 2 before treatment significantly improved at 1 and 3 month(s) after treatment. The change in PROM was significantly different between the two groups at 1 and 3 month(s) after treatment. The SWV before treatment significantly decreased at 1 month and 3 months after treatment in group 1. Our study has shown that the combination of BTA injection and ESWT would be effective at controlling spasticity in children with spastic CP, with sustained improvement at 3 months after treatment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]