The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders

Moya, Daniel; Ramón, Silvia; Schaden, Wolfgang; Wang, Ching‐Jen; Guiloff, Leonardo; Cheng, Jai-Hong

doi:10.2106/jbjs.17.00661

Cited by 114 publications

(154 citation statements)

References 154 publications

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“…An electromagnetic source can generate a shockwave by passing an electric current through a coil to produce a magnetic field, which results in a sudden deflection of the membrane and generation of pressure waves in a fluid. Subsequently, a lens is applied to focus these waves onto the diseased area of the body, and the length of the lens can be used to determine the therapeutic point [ 24 ]. Piezoelectric sources can produce shockwaves via a high-voltage discharge across piezoelectric elements (i.e., a large number (>1000) of piezo crystals) mounted in a sphere, which induces a pressure pulse in the surrounding water that increases to a shockwave.…”

Section: Extracorporeal Shockwavementioning

confidence: 99%

Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism

Xie

et al. 2020

Bioscience Reports

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Osteoarthritis (OA), the most common degenerative joint disease, is characterized by the cardinal symptoms of chronic pain and restricted joint activity. The complicated pathological changes associated with OA and unclear mechanistic etiology have rendered existing non-surgical OA management options unsatisfactory. Increasing clinical and experimental evidence suggests that extracorporeal shockwave therapy (ESWT) is beneficial in OA treatment. ESWT is found to have modifying effects on cartilage and subchondral bone alterations in OA progression, as well as the clinical complaints of patients, including chronic pain and limited joint activities. However, the specific treatment strategy regarding the dosage and frequency of ESWT is still underdetermined. This review discusses the existing evidence regarding the therapeutic indications and possible mechanism of ESWT for OA treatment.

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Section: Extracorporeal Shockwavementioning

confidence: 99%

Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism

Xie

et al. 2020

Bioscience Reports

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“…ESWT has been widely used for different musculoskeletal disorders. Although the exact mechanism of action of ESWT is not known, the clinical success of ESWT is supported by many indirect lines of evidence 27 . ESWT can reduce inflammation and apoptosis while stimulating the regeneration of various tissues 28,29 .…”

Section: Discussionmentioning

confidence: 99%

Protective effects of extracorporeal shockwave on rat chondrocytes and temporomandibular joint osteoarthritis; preclinical evaluation with in vivo 99mTc-HDP SPECT and ex vivo micro-CT

Kim

Bang

Son

et al. 2019

Osteoarthritis and Cartilage

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Objective: Extracorporeal shockwave therapy (ESWT) has been shown to have chondroprotective effects on arthritic diseases. We investigated the effects of ESWT on temporomandibular joint osteoarthritis (TMJOA) using rat chondrocytes and TMJOA rat models. Design: Cell viability and expression of pro-inflammatory cytokines, cartilage degradation, and apoptosis markers were measured in control, monosodium iodoacetate (MIA)-treated and ESWT plus MIA-treated chondrocytes in vitro, and intra-articular MIA injection (TMJOA) and ESWT on TMJOA rats in vivo. In vivo 99m Tc-hydroxymethylene diphosphonate (HDP) single-photon emission computerized tomography/ computerized tomography (SPECT/CT) and ex-vivo micro-CT and histologic examinations were performed in rat models. Results: ESWT plus MIA-treated chondrocytes showed increased cell viability significantly (P ¼ 0.007), while decreased genetic expression of pro-inflammatory cytokines [tumor necrosis factor-a (TNF-a), interleukin-1b (IL-1b), and interleukin-6 (IL-6); P < 0.001 for each] and cartilage degradation markers [matrix metalloproteinase-3 (MMP3), matrix metalloproteinase-13 (MMP13), and bone morphogenetic protein 7 (BMP7); P < 0.001 for each], and number of apoptotic cells (P < 0.001) compared to MIA-treated chondrocytes. Changes in cytochrome c and cleaved caspase-3 levels relative to procaspase-3 were decreased over MIA-treated chondrocytes. ESWT on TMJOA rat models was associated with a significant decrease in pro-inflammatory and cartilage degradation markers, as demonstrated by real-time PCR and immunohistochemistry stains (P < 0.001 for each). On 99m Tc-HDP SPECT/CT, the ESWT group showed a significantly lower uptake ratio compared to the TMJOA group (P ¼ 0.008). Micro-CT analysis revealed that the ESWT group showed improved structure and bone quality compared to the TMJOA control group. Conclusions: ESWT was associated with a protective effect on cartilage and subchondral bone structures of TMJOA by reducing inflammation, cartilage degradation, and chondrocyte apoptosis.

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“…The proposed mechanism of action for SWT is based on mechano-transduction [10]. The delivery of mechanical acoustic energy to the target tissue induces molecular, cellular and tissue responses [11]. Based on animal studies, SWT promotes the expression of various angiogenic and osteogenic growth factors such as vascular endothelial growth factor (VEGF) and bone morphogenetic protein (BMP), which promotes tissue regeneration [12].…”

Section: Introductionmentioning

confidence: 99%

The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression

Al-Abbad

Allen

Morris

et al. 2020

BMC Musculoskelet Disord

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Background: Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear. The objective of the current review is to evaluate changes in imaging outcomes of musculoskeletal conditions following SWT. Methods: A comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects. Results: Sixty-three studies were included, with data from 27 studies available for effect size pooling. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis (n = 11), plantar fasciitis (n = 7) and osteonecrosis of the femoral head (n = 9). There was an overall reduction in the size of measured lesion following SWT (MD 8.44 mm (95%CI 4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92 mm (95%CI 0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes. Conclusions: SWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review. Registration number: PROSPERO CRD42018091140.

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The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders

Cited by 114 publications

References 154 publications

Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism

Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism

Protective effects of extracorporeal shockwave on rat chondrocytes and temporomandibular joint osteoarthritis; preclinical evaluation with in vivo 99mTc-HDP SPECT and ex vivo micro-CT

The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression

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