Effect of Extracorporeal Shock Waves on Bone: A Review of Shock Wave Experiments and the Mechanism of Shock Wave Action

Delius, Michael; Draenert, K.; Draenert, Y.; Borner, Marc

doi:10.1007/978-3-642-80427-4_3

Cited by 10 publications

(9 citation statements)

References 24 publications

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“…3,4 The technique is widely reported to be safe, but there is a potential for haemorrhage and local soft-tissue damage which are more likely with high doses. 29 No significant adverse effects were noted which is in agreement with the experience of others. [3][4][5]24,26 No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.…”

Section: Discussionsupporting

confidence: 91%

Extracorporeal shock-wave therapy for tendonitis of the rotator cuff

Speed

Richards

Nichols

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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W e have performed a double-blind placebo-controlled trial of moderate doses of extracorporeal shock-wave therapy (ESWT) for non-calcific tendonitis of the rotator cuff. Adults (74) with chronic tendonitis of the rotator cuff were randomised to receive either active (1500 pulses ESWT at 0.12 mJ/mm 2 ) or sham treatment, monthly for three months. All were assessed before each treatment, and at one and three months after the completion of treatment. The outcome was measured with regard to pain in the shoulder, including a visual analogue score for night pain, and a disability index. There were no significant differences between the two groups before treatment. The mean duration of symptoms in both groups was 23.3 months. Both showed significant and sustained improvements from two months onwards. There was no significant difference between them with respect to change in the Shoulder Pain and Disability Index (SPADI) scores or night pain over the six-month period. A mean (±SD; range) change in SPADI of 16.1 ± 27.2 (0 to 82) in the treatment group and 24.3 ± 24.8 (-11 to 83) in the sham group was noted at three months. At six months the mean changes were 28.4 ± 25.9 (-24 to 69) and 30.4 ± 31.2 (-12 to 88), respectively. Similar results were noted for night pain.We conclude that there is a significant and sustained placebo effect after moderate doses of ESWT in patients with non-calcific tendonitis of the rotator cuff, but there is no evidence of added benefit when compared with sham treatment. Extracorporeal shock-wave therapy (ESWT) by singlepressure pulses of microsecond duration can be guided by ultrasound to focus on a specific site. Having revolutionised the treatment of urolithiasis, ESWT has more recently been used in the treatment of a number of musculoskeletal conditions, including tendinopathies and enthesopathies, at doses of 10% to 20% of those used in lithotripsy for renal calculi.1-5 The theoretical benefits are the stimulation of tissue healing and the breakdown of calcification. [4][5][6][7] In spite of the increasing popularity of this method of treatment, there has been no randomised, controlled trial of its use in specific musculoskeletal conditions. Benefit from ESWT has been demonstrated in calcific tendonitis of the rotator cuff. 4 We present our findings of a double-blind, randomised, controlled trial in non-calcific tendonitis of the rotator cuff. Patients and MethodsWe recruited adult patients with a clinical diagnosis of tendonitis of the rotator cuff. Informed consent was obtained. The patients were more than 18 years of age and had had pain in the shoulder for at least three months with clinical signs of a unilateral tendonitis of the rotator cuff. These included a painful arc and/or an impingement sign and pain, without weakness on resisted testing of one or more musculotendinous units of the rotator cuff. Exclusion criteria were demonstrable shoulder pathology including glenohumeral or acromioclavicular arthritis, instability, polyarthritis, neck pain, a local dermatological condition, n...

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Section: Discussionsupporting

confidence: 91%

Extracorporeal shock-wave therapy for tendonitis of the rotator cuff

Speed

Richards

Nichols

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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“…Although the technique is widely reported to be safe, there is a potential for haemorrhage and local soft tissue damage through cavitation [4]. This appears to be more likely with the high doses that were avoided in our study [4]. Significant adverse effects were not noted, in agreement with the experience of others [1, 6,11,14,16,17].…”

Section: Discussionsupporting

confidence: 86%

“…In order to identify any significant side effects of treatment we used a wide dosage interval in comparison to those used by others in multiple treatment regimes (commonly 1 week) [3,7]. Although the technique is widely reported to be safe, there is a potential for haemorrhage and local soft tissue damage through cavitation [4]. This appears to be more likely with the high doses that were avoided in our study [4].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial

Speed

Nichols

Wies

et al. 2003

Journal Orthopaedic Research

159

107

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Background: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach in the management of a number of tendinopathies. Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non-calcific disorders is limited.Aims: To perform a double blind randomised controlled trial of moderate dose shock wave therapy in plantar Fasciitis. Methods: Adults with plantar fasciitis for at least 3 months were randomised to receive either active treatment (0.12 mJlmm') or sham therapy, monthly for 3 months. Pain in the day, nocturnal pain and morning start-up pain were assessed at baseline, before each treatment and 1 and 3 months after completion of therapy.Results: Eighty-eight subjects participated and no differences existed between the groups at baseline. At 3 months, 37%0 of the subjects in the ESWT group and 24%) in the sham group showed a positive response (50% improvement from baseline) with respect to pain. Positive responses in night pain occurred in 41% and 31Y0 in the ESWT and sham groups, respectively. Positive responses in start-up pain occurred in 370/0 and 36% in the ESWT and sham groups, respectively. Both groups showed significant improvement over the course of the study, but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6-month period.Conclusions: There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis. Efficacy may be highly dependent upon machine types and treatment protocols. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints.

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“…Mechanical alterations are principally due to shearing effects, while chemical phenomena appear mainly to be due to the development of free radicals. 13,14 Shock waves can destroy cells acutely as a result of the production of free radicals and cell lines appear to differ in their susceptibility to destruction. 15 Most cells which survive the shock continue to function and divide normally, irrespective of the cell cycle at the time of exposure.…”

Section: Effects Of Shock Waves On Soft Tissuesmentioning

confidence: 99%