Abstract
Conservative treatment, such as electrical stimulation and steroid injection, have been employed in an attempt to improve symptoms after peripheral nerve injury, without significant success. Although non-invasive and safe extracorporeal shockwave therapy (ESWT) can be a practical alternative, the therapeutic effects of ESWT on peripheral nerve remyelination has not been established. To investigate the effects of ESWT on peripheral nerve remyelination and gait function for 5 weeks in a sciatic nerve crush model. In total, we divided 97 rats into 5 groups: group 1 - a healthy negative control group; group 2 - 3 weeks after sciatic nerve crush and 3 sessions of ESWT; group 3 - 5 weeks after crush injury with 3 sessions of ESWT; group 4 - 3 weeks after crush injury with no ESWT; and group 5 - 5 weeks after crush injury with no ESWT. The focused ESWT was applied to the unilateral sciatic nerve injury site. One session consisted of 1,500 stimuli, and the session were performed at intervals of 1 week. The degree of myelination and expression of myelin basic protein at the distal part of the injured sciatic nerve tended to increase in the ESWT groups compared with the no-ESWT groups 3 and 5 weeks after crush injury. Regarding the functional gait recovery, the print width and area of the injured leg in the ESWT groups was significantly larger than that in the no-ESWT groups 3 and 5 weeks after crush injury. The ESWT may enhance peripheral nerve remyelination and gait function in a nerve crush model. Long-term follow-up after ESWT and investigation of molecular mechanisms will be needed to confirm these therapeutic effects.
Highlights
Trauma or entrapment, herniated intervertebral discs, and cancer metastasis can cause damage to the peripheral nervous system, resulting in various neuromuscular disorders, depending on the location and extent of the lesion
We investigated the effects of extracorporeal shockwave therapy (ESWT) on peripheral nerve remyelination and gait function for 5 weeks in a sciatic nerve crush model
In transmission electron microscopy (×3,000 magnification) and immunofluorescence staining, the degree of myelination tended to increase in the ESWT stimulation groups compared to the no-ESWT groups 3 and 5 weeks after crush injury (Fig. 2A,B)
Summary
Trauma or entrapment, herniated intervertebral discs, and cancer metastasis can cause damage to the peripheral nervous system, resulting in various neuromuscular disorders, depending on the location and extent of the lesion. These conditions present focal neuropathy, plexopathy and radiculopathy, all of which are associated with neuropathic pain and muscle paralysis. It has been suggested that these indications should be expanded to include muscle rigidity, muscular pain, knee degenerative arthritis, and lymphedema.[4] Conservative treatment, such as electrical stimulation and steroid injection, have been employed in an attempt to improve symptoms after peripheral nerve injury, without significant success. Non-invasive and safe extracorporeal shockwave therapy (ESWT) can be a practical alternative, the therapeutic effects of ESWT on peripheral nerve remyelination has not been established
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