Overview of shock waves in medicine

Abstract

A brief overview of three applications of shock waves is presented. Shock wave lithotripsy (SWL) has been in clinical use for more than 20 years. In the United States it is used to treat more than 80% of kidney stone cases and has wide acceptance with patients because it is a noninvasive procedure. Despite SWLs enormous success there is no agreement on how shock waves comminute stones. There is also a general acceptance that shock waves lead to trauma to the soft tissue of the kidney. Yet there has been little forward progress in developing lithotripters which provide comminution with less side-effects, indeed the original machine is still considered the gold standard. The last decade has seen the advent of new shock wave devices for treating principally musculoskeletal indications, such as plantar fasciitis, tennis elbow, and bone fractures that do not heal. This is referred to as shock wave therapy (SWT). The mechanisms by which SWT works are even less well understood than SWL and the consequences of bioeffects have also not been studied in detail. Shock waves have also been shown to be effective at enhancing drug delivery into cells and assisting with gene transfection. [Work partially supported by NIH.]