Historical ESWT Paradigms Are Overcome: A Narrative Review

Abstract

Extracorporeal Shock Wave Therapy (ESWT) is a conservative treatment modality with still growing interest in musculoskeletal disorders. This narrative review aims to present an overview covering 20-year development in the field of musculoskeletal ESWT. Eight historical paradigms have been identified and put under question from a current perspective: energy intensity, focus size, anesthesia, imaging, growth plates, acuteness, calcifications, and number of sessions. All paradigms as set in a historical consensus meeting in 1995 are to be revised. First, modern musculoskeletal ESWT is divided into focused and radial technology and the physical differences are about 100-fold with respect to the applied energy. Most lesions to be treated are easy to reach and clinical focusing plays a major role today. Lesion size is no longer a matter of concern. With the exception of nonunion fractures full, regional, or even local anesthesia is not helpful in musculoskeletal indications. Juvenile patients can also effectively be treated without risk of epiphyseal damage. Further research is needed to answer the question about if and which acute injuries can be managed effectively. Treatment parameters like the number of sessions are still relying on empirical data and have to be further elucidated.

Potential applications of low‐energy shock waves in functional urology

“…This pressure wave that propagates into the body as a spherical or ball‐shaped wave is different from focused SWs . Nowadays, radial ESWT is a general method with comparable results for superficial musculoskeletal disorders …”

“…However, it should be noted that high energy levels (>0.12 mJ/mm 2 ) of SW induce irreversible alterations to the cell structure and organelles . Low energy levels (<0.12 mJ/mm 2 ) of SW, in contrast, induce cell membrane modifications and functional changes, and conduct a series of cell signaling and activation of biological processes, such as cell proliferation, angiogenesis, peripheral nerve regeneration, increased cell permeability and anti‐inflammation …”

“…42 However, it should be noted that high energy levels (>0.12 mJ/mm 2 ) of SW induce irreversible alterations to the cell structure and organelles. 19,34,43,44 Low energy levels (<0.12 mJ/mm 2 ) of SW, in contrast, induce cell membrane modifications and functional changes, and conduct a series of cell signaling and activation of biological processes, such as cell proliferation, angiogenesis, peripheral nerve regeneration, increased cell permeability and anti-inflammation. 16,19,34,35 How LESW works LESWs have effects on induction of cell proliferation, angiogenesis, nerve regeneration, anti-inflammation and a temporary increase of membrane permeability, through the modulation of various mechanisms, depending on tissue type and condition.…”

Terapia de ondas de choque focal para osteoartrose de joelho: um ensaio clínico randomizado duplo-cego

“…lightning, eruptions of volcanoes) and can be generated when an aircraft breaks the sound barrier. 11 Medical use of ESWT began in 1980 for lithotripsy, and in the 1990s it began to be used for musculoskeletal disorders. 11 ESWT creates a micro-trauma which induces angiogenesis, [12][13][14][15][16] potentially reducing inflammation and improving the quality of cartilage.…”

“…11 Medical use of ESWT began in 1980 for lithotripsy, and in the 1990s it began to be used for musculoskeletal disorders. 11 ESWT creates a micro-trauma which induces angiogenesis, [12][13][14][15][16] potentially reducing inflammation and improving the quality of cartilage. 9,[17][18][19][20] It decreases nerve conduction velocity, which could explain the immediate antinociceptive effect.…”