ESWT

There have been very minimal adverse effects reported for ESWT treatment, with the most common being transient pain after treatment, ecchymosis/ petechiae, and dyesthesia.

The use of ESWT in the treatment of musculoskeletal disorders has gained traction worldwide due to its efficacy and minimal adverse effects, and can be considered for the aforementioned conditions.

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Objective: The aim of this study was to investigate the effect of radial extracorporeal shock wave therapy (rESWT) on the treatment of trigger finger.

Conclusion: rESWT is an effective method to decrease pain severity and improve general functional capacity, range of motion, grip strength, and pinch strength in patients with trigger finger. We concluded that the treatment of rESWT might be a non-invasive option to treat the trigger finger. However, randomized controlled trials are needed to provide more evidence of this treatment.

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Abstract: Extracorporeal shock wave therapy (ESWT) had been proved to be beneficial in calcific tendinosis; however, the treatment efficacy in noncalcific tendinosis of rotator cuff still remains controversial. The present study was to compare the outcomes ESWT among the noncalcific rotator cuff tendinosis and different types of calcific tendinosis on the basis of similar shoulder functional status.

Conclusion: The present match-controlled analysis demonstrated a positive efficacy of ESWT for chronic shoulder tendinosis, with superior outcomes in patients with type II and type III calcification as compared with type I calcification and noncalcified tendinosis at the 1-year follow-up point. The results indicated that an alternative procedure to ESWT should be considered for patients with type I calcification and noncalcified tendinitis owing to the lower satisfaction rate following treatment in these patients.

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Abstract: Cellulite is a multifactorial condition that is present in 80% to 90% of postpubertal women and is one of the most intolerable esthetic imperfections. There are several theories on the pathophysiology of cellulite, and a number of different therapeutic regimens have been developed, from topical treatments to mechanical or energy-based devices. In this brief review, we summarize the scientific landscape to determine the clinical evidence with regard to the safety and efficacy of cellulite treatment options. Clinical protocols and the author’s experience using a combination of internal and external procedures are also discussed. Studies using laser and light modalities along with radiofrequency have shown improvements in cellulite and a good safety profile, but acoustic wave therapy, subcision, and the 1440-nm Nd:YAG minimally invasive laser have demonstrated the most beneficial results in cellulite reduction.

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Shockwave therapy is a more recent development than the 20-year-old blue pill of Viagra, having been first published in European research papers at the turn of the 2010s and only arriving in Singapore in 2014.

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Aim: To record the intensity of the pain, the functionality of the upper and lower limbs and quality of life before treatment with shockwaves, immediately after the treatment and the 4-week follow-up.

Conclusion: Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice because of its effectiveness and safety.

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Background: A substantial body of evidence supports the use of focused extracorporeal shock wave therapy (fESWT) in the non-invasive treatment of fracture nonunions. On the other hand, virtually no studies exist on the use of radial extracorporeal shock wave therapy (rESWT) for this indication.

Conclusions: Radial extracorporeal shock wave therapy appears to be an effective and safe alternative in the management of fracture nonunions of superficial bones if diagnosed early and no fESWT device is available. The promising preliminary results of the present case series should encourage the implementation of randomized controlled trials for the early use of rESWT in fracture nonunions.

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Purpose: The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardized non-surgical treatment for swift return-to-football.

Conclusion: Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shockwave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma.

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Background: Sacroiliac joint (SIJ) pain can cause lower back pain and pelvic discomfort. However, there is no established standard treatment for SIJ pain. Extracorporeal shock wave therapy (ESWT) is a novel, non-invasive therapeutic modality for musculoskeletal disorders. The mechanism underlying shockwave therapy is not fully understood, but the frequency with which ESWT is applied clinically has increased over the years.

Objective: We evaluated the efficacy of using ESWT to treating SIJ pain.

Conclusions: ESWT represents a potential therapeutic option for decreasing SIJ pain.

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Introduction: Low back pain is a disease that frequently occurs in daily life. Apart from headache, it is the most common pain experienced by humans. Approximately 80% of people in the entire population experience low back pain at least once during their lives. This pain is one of the factors that greatly affect the quality of life of patients because it leads to socioeconomic problems associated with increases in the costs of treatment, together with problems in daily living activities.

Simple low back pain can often be prevented by forming the habit of sitting with a proper posture and avoiding maintaining a sitting posture for prolonged periods. However, many types of low back pain are treated with therapeutic methods that are as diverse as the causes of low back pain. In most cases, therapeutic methods such as bed rest, assistive devices, traction treatment, hyperthermia, electric stimulation, and manual therapy are the first choice treatments. When these fail, invasive therapeutic methods such as selective nerve root blocks and epidural injections are used, and surgery is performed if no response to the other treatments is seen, or if the condition of the disease is serious. Recently, new conservative treatments have been adopted, including extracorporeal shock wave therapy (ESWT).

ESWT is a therapeutic method that applies shock waves to lesions from the outside of the body to promote revascularization and to stimulate or reactivate the curing process of connective tissues including tendons and bones, thereby relieving pain and improving function. ESWT can be used for pain relief as well as for muscle strength improvement through appropriate motor stimulation of muscles and tendons by the shock waves.

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Abstract: Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization. As a result of these characteristics we initiated a series of experiments evaluating the effect of LI-ESWT on the cavernosal tissue of patients with vasculogenic ED. The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects. Although further extensive research is needed, LI-ESWT may create a new standard of care for men with vasculogenic ED.

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Abstract: The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.

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Abstract: In this case study of an unique instance, effects of medium-energy, high-focused extracorporeal generated shock waves (ESW) onto the skin and the underlying fat tissue of a cellulite afflicted, 50-year-old woman were investigated. The treatment consisted of four ESW applications within 21 days. Diagnostic high-resolution ultrasound (Collagenoson) was performed before and after treatment. Directly after the last ESW application, skin samples were taken for histopathological analysis from the treated and from the contra-lateral untreated area of skin with cellulite. No damage to the treated skin tissue, in particular no mechanical destruction to the subcutaneous fat, could be demonstrated by histopathological analysis. However an astounding induction of neocollageno- and neoelastino-genesis within the scaffolding fabric of the dermis and subcutis was observed. The dermis increased in thickness as well as the scaffolding within the subcutaneous fat-tissue. Optimization of critical application parameters may turn ESW into a noninvasive cellulite therapy.

Conclusion: The application of external and internal forces are considered to be able to regulate gene expression and cell behavior. In particular, cell stretch is considered to be a stimulus supporting cell proliferation (skin expanders). The signaling pathways linking mechanical stretch to cell proliferation and survival (eg, activation of anti-apoptotic kinase PKB/Act) are still not well described.

These encouraging results put forward that optimization of critical application parameters may turn ESW into a noninvasive cellulite therapy, not by reduction of subcutaneous fat, but by strengthening the skin’s scaffolding fabric, particularly of the dermis and the subcutaneous fat tissue.

Further studies should show whether parameters such as the patient’s age (adolescent, adult or elderly females), body-composition (obesity), and the stage of cellulite have an influence on the outcome of ESW treatment. In our case, a histological analysis was possible by a planned operation symmetrical and at the same sites. In implementing a study with many participants, a noninvasive method of analysis must be applied such as high-resolution ultrasound.

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