Extracorporeal Shock Wave Therapy in Musculoskeletal Disorders: A Review

Abstract

Regenerative therapy is one of the most challenging and intriguing branches of modern medicine. Basic research has demonstrated the effectiveness of extracorporeal shockwaves (ESWT) in stimulating biological activities that involve intra-cell and cell-matrix interactions. These interactions are at the basis of the current clinical applications, and open the horizons to new applications in tissue regeneration. It is also feasible that shock waves could be used to treat various orthopaedic pathologies, removing the need for surgery. However, suitable translational studies need to be performed before ESWT can become a valid alternative to surgery.

Update of Extracorporeal Shockwave Therapy in Myofascial Pain Syndrome

“…Animal studies show that ESWT has an influence on pain transmission by acting on substance P, calcitonin gene-related peptide (CGRP) expression in the dorsal root ganglion and on neurovascular sprouting. [9][10][11][12][13][14][18][19][20][21][22][23] ESWT uses biphasic acoustic energy that goes from positive high peak pressures (10-100 MPa (mega pascals) for fESWT;0.1-1 MPa for rESWT) to negative phase (10 MPa); short rise times (10-100 ns for F-ESWT;0.5-1 ms for rESWT), short duration (0.2-0.5 ms for fESWT;0.2-0.5 ms for rESWT). Focused and radial shockwaves are generated in different ways.…”

“…Focused shockwaves are generated electrically, either within the applicator (electrohydraulic technique), or externally to it in the focal zone (electromagnetic or piezoelectric techniques), and then propagate to a designated focal point in order to treat it. Radial shockwaves are ballistic pressure waves generated at lower pressures over a longer time and propagate divergently within the tissue [9][10][11][12][13][14][18][19][20][21][22][23] The induced energy is propagating in the tissue and converges into a focal or radial area, depending on the equipment used and the settings selected for intensity, angle and other parameters. The effect varies, depending on the tissue through which the wave passes and how it absorbs, reflects, refracts or transmits the energy, depending on the specific impedance.…”

Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight and obese patients

“…A weight-bearing lateral heel radiograph was used for computer-aided linear measurements of CSL defined from the tip to the base of the spur delineated by a line presenting the calcaneal border, as defined previously [17] (Fig. 1).…”

“…The calcaneal spur length (CSL) is measured reliably in weight-bearing lateral heel radiographs with the help of computer-aided linear measurement technique [16,17]. According to our knowledge, there was not enough study on the effect of ESWT on the CSL and pain severity measured objectively in overweight and obese patients whose calcaneal spurs measured on lateral foot X-ray.…”

Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome

“…Another clinical trial evaluated the effect of SW on CTS surgical complications ("pillar sindrome"), looking at pain regression and the improvement of surgical scarring. 3 Treatment using alpha lipoic acid (ALA) based nutraceuticals, conjugated linoleic acid (GLA), and multivitamins is used in treating compressive neuropathies. 7,8 These have anti-oxidant, antiinflammatory, and repairing properties for the myelin sheath.…”