Extracorporeal shockwave therapy enhances peripheral nerve remyelination and gait function in a crush model

ESWT Diminishes Axonal Regeneration following Repair of the Rat Median Nerve with Muscle-In-Vein Conduits but Not after Autologous Nerve Grafting

“…More importantly, despite some trends for a favorable functional outcome in the group of animals receiving ESWT in addition to nerve reconstruction with an ANG, our study's results do not support the positive reports of other preclinical works regarding the neuroregenerative effects of ESWT both on peripheral nerves [17,19,27,59,64] and the spinal cord [55,56,58]. The results of the grasping test did not verify a significant positive effect of ESWT on functional recovery following reconstruction of the median nerve with either ANGs or MVCs.…”

“…This study’s main hypothesis was that regeneration of the murine median nerve following reconstruction with ANGs, i.e., the gold-standard method, or with MVCs, i.e., nonneural tissue, can be enhanced by a single postoperative application of low-energy defocused ESWT. The pro-regenerative effects of ESWT have been shown in the context of various musculoskeletal and neurological diseases, including carpal tunnel syndrome [ 50 , 51 , 52 , 53 ], spinal cord injury [ 54 , 55 , 56 , 57 , 58 ] and PNI in vivo [ 17 , 19 , 20 , 27 , 58 , 59 , 60 ]. Of note, to the best of our knowledge, all the PNI studies were performed in the sciatic nerve model of the rat, and four of the seven studies we retrieved featured a sciatic crush injury [ 19 , 58 , 59 , 60 ], e.g., axonotmesis.…”

“…The pro-regenerative effects of ESWT have been shown in the context of various musculoskeletal and neurological diseases, including carpal tunnel syndrome [ 50 , 51 , 52 , 53 ], spinal cord injury [ 54 , 55 , 56 , 57 , 58 ] and PNI in vivo [ 17 , 19 , 20 , 27 , 58 , 59 , 60 ]. Of note, to the best of our knowledge, all the PNI studies were performed in the sciatic nerve model of the rat, and four of the seven studies we retrieved featured a sciatic crush injury [ 19 , 58 , 59 , 60 ], e.g., axonotmesis. In regard to the sciatic nerve injury model, it must be noted that this model has some significant disadvantages, the most noteworthy being the development of neuropathic pain and automutilations in case of neurotmesis injuries and difficulties assessing functional recovery by means of walking track or gait analysis [ 28 ].…”

“…Therefore, noninvasive treatment options to enhance axonal regeneration, target organ reinnervation and functional recovery [ 14 ] are sought for by the scientific community [ 15 , 16 ]. Among these approaches, extracorporeal shockwave therapy (ESWT) was reported by several authors to exert significant pro-regenerative effects on lesioned peripheral nerves [ 17 , 18 , 19 , 20 ]. Shockwaves, sonic pulses with high energy impact, exert their effects on target tissues by biochemical changes induced by mechanotransduction.…”

Immediate Effects of Extracorporeal Shock Wave Therapy in Fascial Fibroblasts: An In Vitro Study

“…The initial use of ESWs in medicine was in kidney stone fragmentation, but their application was quickly expanded to a variety of pathologies of the musculoskeletal system, such as the treatment of non-unions, tendinopathies, and soft tissue disorders [ 2 , 3 , 4 ]. A recent systematic review [ 5 ] revealed 100 studies that addressed the effects of ESWs on bone and cartilage tissue [ 6 , 7 , 8 ], 39 studies about the effects of ESWs on tenocytes or scar tissue [ 9 , 10 , 11 ], and 42 studies on muscle and nerve tissue [ 12 , 13 , 14 ]. No studies are present about the effects of ESWs on fascial tissues, nor if myofascial pain is considered a promising indication for their use [ 15 ].…”