Editorial Comment

Abstract

The potential for using different types of externally applied energy to rectify or ameliorate musculoskeletal disorders has been explored for decades. Transcutaneous stimulation certainly is widely used for pain management. Bioelectrical, biomagnetic, and ultrasound devices have been assessed to try to attain osseous union in patients with delayed union or nonunion of fractures. Approximately 20 years ago, numerous centers in Germany explored the clinical application of controlled shock waves to fragment renal stones. 5 Since then, this method of nonoperative intervention has become the gold standard for the initial treatment of urolithiasis. Incidental observations during animal studies found an osteoblastic response pattern that engendered an interest in the potential application of extracorporeal shock wave therapy to numerous orthopaedic challenges. 2,3 The use of extracorporeal shock wave therapy has gained significant acceptance in Europe, especially Germany, Austria, Italy, and in Taiwan, and has led to the formation of the International Society for Musculoskeletal Shockwave Therapy. 3 (Levitt RL, Ogden JA, Selesnick H: FDA study for chronic lateral epicondylitis. Presented at the Third Congress of the International Society for Musculoskeletal Shockwave Therapy. Naples, Italy, June 1–3, 2000 and Ogden JA, Alvarez R, Levitt R, Cross GL: Chronic heel pain: results of FDA shockwave study. Presented at the Third Congress of the International Society for Musculoskeletal Shockwave Therapy. Naples, Italy, June 1–3, 2000.) This organization has sponsored several international conferences. Many of the studies presented in this symposium have come from this venue. During the last 5 years, several studies have been commenced under the aegis of the United States Food and Drug Administration. (Levitt RL, Ogden JA, Selesnick H: FDA study for chronic lateral epicondylitis. Presented at the Third Congress of the International Society for Musculoskeletal Shockwave Therapy. Naples, Italy, June 1–3, 2000 and Ogden JA, Alvarez R, Levitt R, Cross GL: Chronic heel pain: results of FDA shockwave study. Presented at the Third Congress of the International Society for Musculoskeletal Shockwave Therapy. Naples, Italy, June 1–3, 2000.) These studies differ from most of the studies in the literature in that they are prospective, randomized, double-blinded evaluations comparing treatment with the extracorporeal shock wave therapy device with a placebo (sham) treatment. One such study, included in this symposium, assessed the efficacy of extracorporeal shock wave therapy for chronic proximal plantar fasciitis. 6 This study was accepted by the Food and Drug Administration, resulting in an approval of the specific shock wave device for this indication in October 2000. Given the nature of our specialty and its practitioners, other potential uses and applications of this technology undoubtedly will arise. Studies approved by the Food and Drug Administration are ongoing for lateral epicondylitis (tennis elbow) and fracture delayed union and nonunion. (Levitt RL, Ogden JA, Selesnick H: FDA study for chronic lateral epicondylitis. Presented at the Third Congress of the International Society for Musculoskeletal Shockwave Therapy. Naples, Italy, June 1–3, 2000.) European investigators are assessing calcific tendinitis of the shoulder, avascular (ischemic) necrosis of the capital femur, and stimulation of new bone formation to restabilize loosening press-fit total hip replacements. 3,4 Some investigators have been exploring the use of shock waves to enhance treatments for patients with tumors. 1,7 We hope this symposium will serve as an overview of the emerging technology of shock waves and their clinical applicability for musculoskeletal disorders. We also appreciate the insight and forward thinking of the Editor-in-Chief and the Associate Editors of Clinical Orthopaedics and Related Research for agreeing to the presentation of this exciting new technology to our readership.