Extracorporeal shockwave therapy in musculoskeletal disorders.
Wang CJ1.
1 Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan. w281211@adm.cgmh.com.tw
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.
Extracorporeal Shock Wave Therapy Accelerates Regeneration After Acute Skeletal Muscle Injury.
Zissler A1, Steinbacher P1, Zimmermann R2, Pittner S1, Stoiber W1, Bathke AC3, Sänger AM1.
1 Department of Cell Biology, University of Salzburg, Salzburg, Austria.
2 Department of Urology and Andrology, Salzburg General Hospital, Salzburg, Austria.
3 Department of Mathematics, University of Salzburg, Salzburg, Austria.
Abstract
BACKGROUND:
Muscle injuries are among the most common sports-related lesions in athletes; however, optimal treatment remains obscure. Extracorporeal shock wave therapy (ESWT) may be a promising approach in this context, because it has gained increasing importance in tissue regeneration in various medical fields.
HYPOTHESIS:
ESWT stimulates and accelerates regenerative processes of acute muscle injuries.
STUDY DESIGN:
Controlled laboratory study.
METHODS:
Adult Sprague-Dawley rats were divided into 4 experimental groups (2 ESWT+ groups and 2 ESWT- groups) as well as an uninjured control group (n ≥ 6 in each group). An acute cardiotoxin-induced injury was set into the quadriceps femoris muscle of rats in the experimental groups. A single ESWT session was administered to injured muscles of the ESWT+ groups 1 day after injury, whereas ESWT- groups received no further treatment. At 4 and 7 days after injury, 1 each of the ESWT+ and ESWT- groups was euthanized. Regenerating lesions were excised and analyzed by histomorphometry and immunohistochemistry to assess fiber size, myonuclear content, and recruitment of satellite cells.
RESULTS:
The size and myonuclear content of regenerating fibers in ESWT+ muscle was significantly increased compared with ESWT- muscle fibers at both 4 and 7 days after injury. Similarly, at both time points, ESWT+ muscles exhibited significantly higher contents of pax7-positive satellite cells, mitotically active H3P+ cells, and, of cells expressing the myogenic regulatory factors, myoD and myogenin, indicating enhanced proliferation and differentiation rates of satellite cells after ESWT. Mitotic activity at 4 days after injury was doubled in ESWT+ compared with ESWT- muscles.
CONCLUSION:
ESWT stimulates regeneration of skeletal muscle tissue and accelerates repair processes.
CLINICAL RELEVANCE:
We provide evidence for accelerated regeneration of damaged skeletal muscle after ESWT. Although further studies are necessary, our findings support the view that ESWT is an effective method to improve muscle healing, with special relevance to sports injuries
ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study.
Vitali M1, Naim Rodriguez N2, Pironti P1, Drossinos A1, Di Carlo G3, Chawla A3, Gianfranco F1.
1 Department of Orthopedics and Traumatology, San Raffaele Scientific Institute, Milan, Italy.
2 Department of Surgery, Geneva University Hospital, Switzerland.
3 International MD Program, Vita-Salute San Raffaele University, Milan, Italy.
Abstract
Objective: The purpose of this study was to determine the efficacy of Extracorporeal Shock Wave Therapy (ESWT) in combination with the dietary supplement Tendisulfur Forte in the treatment of
shoulder tendinopathy, lateral epicondylitis, and Achilles tendinopathy. Methods: Patients were sub-divided for each pathology into two equal sized groups of 15: one treated with ESWT supplemented with Tendisulfur Forte, and the other treated with ESWT only. Shoulder functionality was measured through the UCLA shoulder score. Treatment of epicondylitis was assessed with the Mayo elbow score. Achilles tendinopathy was measured with the VISA-A score. Pain through the various groups of the study was measures with the Visual Analog Scale (VAS). Results: Patients in the Tendisulfur Forte group had overall better functional and VAS scale scores for shoulder tendinopathy, elbow epicondylitis, and Achilles tendinopathy. UCLA scores for shoulder tendinopathy showed significant results at 60 days in the Tendisulfur Forte group (p = 0.0002). Mayo scores in the treatment of lateral epicondylitis was significant at 60 days in the study group (p < 0.0001). Achilles tendinopathy was improved in the study group at 30 days (p < 0.0001). VAS scales were significant for each pathology at 60 days (p < 0.0001). In addition, NSAIDs consumption was greatly reduced and, in most cases, stopped in the Tendisulfur Forte Groups. Conclusion: Concerning the results obtained, this paper underlines the effectiveness of combined treatment of ESWT plus Tendisulfur Forte, in the absence of side-effects. Indeed, oral supplementation lead to a faster recovery and better outcomes with a significant reduction in NSAIDs consumption.
Effectiveness of Extracorporeal Shock Wave Therapy and kinesio taping in calcific tendinopathy of the shoulder: a randomized controlled trial.
Frassanito P1, Cavalieri C2, Maestri R3, Felicetti G2.
1 Unit of Neuromotor Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS Rehabilitation Center Montescano, Pavia, Italy - paolo.frassanito@icsmaugeri.it.
2 Unit of Neuromotor Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS Rehabilitation Center Montescano, Pavia, Italy.
3 Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri IRCCS Rehabilitation Center Montescano, Pavia, Italy.
Abstract
BACKGROUND:
Extracorporeal Shock Wave Therapy (ESWT) is effective in the treatment of calcific tendinopathy of the rotator cuff, eliciting an analgesic/anti-inflammatory action and promoting tissue regeneration. Kinesio taping (KT), another recently-introduced rehabilitative tool, exerts an analgesic and biomechanical action on joints and muscles. ESWT and KT may have a synergic effect when used in combination, but the effectiveness of the association has not been established.
AIM:
The aim of this study was to test if the association of KT with ESWT is superior to ESWT alone in the treatment of rotator cuff calcific tendinopathy.
DESIGN:
Randomized controlled trial.
SETTING:
Rehabilitation Institute outpatients.
POPULATION:
Forty-two patients with rotator cuff calcific tendinopathy were randomly assigned to the experimental group (ESWT+KT, N.=21) or control (ESWT, N.=21).
METHODS:
In the experimental group, patients underwent three sessions (once a week for 3 weeks) of ESWT with KT applied at the end of each session. Controls underwent three sessions of ESWT only. All patients were assessed before treatment (T0) and at 1 (T1), 4 (T2) and 12 weeks (T3) after the end of treatment with the following outcome measures: a visual analogue scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Subjective Shoulder Rating Questionnaire (SSRQ), and Oxford Shoulder Score (OSS).
RESULTS:
Both groups showed significant improvement in all outcome measures, but the time course differed between the two groups. At T1 vs. T0, the improvement was significantly better in ESWT+KT than ESWT on VAS (P=0.007), DASH (P<0.0001) and SSRQ (P=0.0001). Successive improvements at T2 vs. T1 and T3 vs. T2 did not differ significantly between the groups. At the end of follow-up, ESWT+KT still showed significantly greater improvement than ESWT on VAS (P=0.02) and SSRQ (P=0.038).
CONCLUSIONS:
KT associated with ESWT seems to improve the recovery in rotator cuff calcific tendinopathy with a faster therapeutic response compared to ESWT only.
CLINICAL REHABILITATION IMPACT:
Our results suggest the effectiveness of using KT as adjuvant therapy to ESWT in rotator cuff calcific tendinopathy, through enhancing the short-term analgesic action and the medium- to long-term biological-regenerative effects.
Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs.
Sun J1, Gao F, Wang Y, Sun W, Jiang B, Li Z.
1 aThe Graduate School of Peking Union Medical College bCentre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China cDepartment of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China.
Abstract
BACKGROUND:
Plantar fasciitis (PF) is the most common reason for heel pain. The efficacy of extracorporeal shock wave therapy (ESWT) as an ideal alternative to conservative treatments and surgery is controversial, and almost all previous articles compared general ESWT with placebo without indicating the kind of shock wave. We undertook a meta-analysis to compare the efficacy of general ESWT, focused shock wave (FSW), and radial shock wave (RSW) with placebo, to assess their effectiveness in chronic PF.
METHODS:
The PubMed, Medline, EmBase, Web of Science, and Cochrane library databases were searched for studies comparing FSW or RSW therapy with placebo in chronic PF. Clinical outcomes included the odds ratios (ORs) of pain relief, pain reduction, and complications. Relevant data were analyzed using RevMan v5.3.
RESULTS:
Nine studies involving 935 patients were included. ESWT had higher improvement rates than the placebo group (OR 2.58, 95% confidence interval [CI] 1.97-3.39, P < .00001). ESWT had markedly lower standardized mean difference than placebo, with heterogeneity observed (standardized mean difference 1.01, 95% CI -0.01 to 2.03, P = .05, I = 96%, P < .00001). FSW and RSW therapies had greater therapeutic success in pain relief than the placebo group (OR 2.17, 95% CI 1.49-3.16, P < .0001; OR 4.63, 95% CI 1.30-16.46, P = .02), but significant heterogeneity was observed in RSW therapy versus placebo (I = 81%, P = .005).
CONCLUSION:
This meta-analysis suggested that FSW therapy can relieve pain in chronic PF as an ideal alternative option; meanwhile, no firm conclusions of general ESWT and RSW effectiveness can be drawn. Due to variations in the included studies, additional trials are needed to validate these conclusions