Application Of Shock Waves Research Articles

Ultrasound and shock-wave stimulation to promote axonal regeneration following nerve surgery: a systematic review and meta-analysis of preclinical studies

Limited regeneration after nerve injury often leads to delayed or incomplete reinnervation and consequently insufficient muscle function. Following nerve surgery, application of low-intensity ultrasound or extracorporeal shock waves may promote nerve regeneration and improve functional outcomes. Because currently clinical data is unavailable, we performed a meta-analysis following the PRISMA-guidelines to investigate the therapeutic effect of ultrasound and shock wave therapies on motor nerve regeneration. Ten ultrasound-studies (N = 445 rats) and three shock-wave studies (N = 110 rats) were identified from multiple databases. We calculated the difference in means or standardized mean difference with 95% confidence intervals for motor function, nerve conduction velocity and histomorphological parameters of treated versus sham or non-treated animals. Ultrasound treatment showed significantly faster nerve conduction, increased axonal regeneration with thicker myelin and improved motor function on sciatic functional index scale (week two: DM[95%CI]: 19,03[13,2 to 25,6], 71 animals; week four: 7,4[5,4 to 9,5], 47 animals). Shock wave induced recovery improvements were temporarily significant. In conclusion, there is significant evidence for low-intensity ultrasound but not for extracorporeal shock wave treatment to improve nerve regeneration. Prospective clinical trials should therefore investigate available FDA-approved ultrasound devices as adjunct postoperative treatment following nerve surgery.

Efficacy of cardiac shock wave therapy in patients with stable angina: The design of randomized, triple blind, sham-procedure controlled study

Objective:Despite revascularization and optimal medical treatment (OMT), patients with angina often have a reduced quality of life due to inadequate relief from symptoms. Recent studies have shown that the application of shock waves may reduce angina symptoms and improve quality of life, exercise capacity, and myocardial perfusion due to the stimulation of angiogenesis. However, there is limited evidence due to small, single-arm, single-center studies of low to moderate quality. The purpose of this study is to evaluate the impact of cardiac shock wave therapy (CSWT) on exercise tolerance and angina symptoms in patients with coronary artery disease and objective evidence of myocardial ischemia who cannot undergo traditional revascularization and experience angina despite OMT in comparison to sham procedure.Methods:We designed a randomized, triple-blind, placebo-controlled, multicentre trial (NCT02339454) to assess the efficacy of CSWT in addition to OMT in patients with stable angina and myocardial ischemia documented by exercise treadmill test (ETT). All patients were treated with stable doses of standard medical treatment 4 weeks before screening. An increase in the total exercise duration on ETT by ≥90 s from the baseline at the end of the study was set as the primary endpoint. Secondary endpoints included angina class, Seattle angina questionnaire scores, symptoms, and ECG changes during stress test. Patients underwent nine sessions of CSWT or corresponding sham procedure applied to all segments of the left ventricle, within 9 weeks. Endpoint assessments were performed at 6-month follow-up. The imaging substudies assessed the potential of CSWT to reduce stress-induced myocardial ischemia detected by dobutamine stress echocardiography, cardiac single-photon emission computed tomography, and cardiac magnetic resonance imaging.Results:At two centers, 72 of the 323 screened patients were randomized in two groups (ratio 1:1): active treatment and placebo control. Study patients were predominantly males (70.8%); the mean age of the patients was 68.4±8.3 years. Of these, 44 patients had angina Canadian Cardiovascular Society class III, and 66.7% of the patients had a history of myocardial infarction.Conclusion:Using sham applicators, blinding study participants, investigators, and endpoints assessors to the study data as well as centralized randomization ensures rigorous methodology and low risk of bias in this large randomized controlled CSWT study.

Experimental evaluation of near wellbore stimulation – using electrical explosion shockwave on tight sand reservoir

In recent years, the application of electrical explosion shockwave as a stimulation technology is increasing in oil fields, but lacks relevant theoretical knowledge to support it. In view of this problem, a research was carried out on experimental study of electrical explosion shockwave stimulation on the tight sand reservoir to determine the effective range of the resulting effects. An experimental platform for testing electrical explosion shockwave is established. Porosity, permeability and other mechanical parameters of tight sand stone samples are tested before and after electrical explosion shockwave treatment. The result shows clear improvement of the above mentioned parameters and the effective range.

Extracorporeal Shockwave Therapy Increases Growth Factor Release from Equine Platelet-Rich Plasma In Vitro.

Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) are common treatments for soft tissue injuries in horses. Shockwave triggers cell specific responses to promote healing. Growth factors released from PRP also promote healing. It has been hypothesized that greater growth factor release would amplify the healing process. The combination of ESWT and PRP could promote healing in injured tendons and ligaments in the horse. The objective of this study was to determine if application of shockwaves to PRP samples increases the concentration of transforming growth factor-β1 (TGF-β1) and platelet-derived growth factor ββ (PDGF-ββ) released from the platelets in vitro. PRP was produced from blood drawn from six horses. The PRP from each horse was exposed to the following treatments: (1) positive control (freeze-thaw cycle), (2) untreated negative control, or shockwaves with either (3) a "standard probe" (ESWT-S) with a 2 cm focal width and medium energy density or (4) a "power probe" (ESWT-P) with a 1 cm focal width and high energy density. After each treatment, the samples were centrifuged, and the supernatant was harvested. The supernatant was then used for growth factor quantification via commercially available ELISA kits for TGF-β1 and PDGF-ββ. Concentrations of TGF-β1 and PDGF-ββ in PRP that underwent a freeze-thaw cycle were significantly increased compared with all other treatments. Both ESWT-S and ESWT-P resulted in significantly increased TGF-β1 concentrations, 46 and 33%, respectively, when compared with the negative control. Both ESWT-S and ESWT-P resulted in significantly increased PDGF-ββ concentrations, 219 and 190%, respectively, when compared with the negative control. These data indicate that the application of ESWT to PRP increases the expression of growth factors in vitro. This suggests that the combination therapy of local PRP injection followed by ESWT may stimulate release of growth factors from platelets after they have been injected into the area of injury. The combination of PRP and ESWT might result in synergism of two modalities previously utilized individually for tendon and ligament injuries in horses.

Primary blast-induced traumatic brain injury: lessons from lithotripsy

Traumatic injury caused by explosive or blast events is traditionally divided into four mechanisms: primary, secondary, tertiary, and quaternary blast injury. The mechanisms of blast-induced traumatic brain injury (bTBI) are biomechanically distinct and can be modeled in both in vivo and in vitro systems. The primary bTBI injury mechanism is associated with the response of brain tissue to the initial blast wave. Among the four mechanisms of bTBI, there is a remarkable lack of information regarding the mechanism of primary bTBI. On the other hand, 30 years of research on the medical application of shock waves (SWs) has given us insight into the mechanisms of tissue and cellular damage in bTBI, including both air-mediated and underwater SW sources. From a basic physics perspective, the typical blast wave consists of a lead SW followed by shock-accelerated flow. The resultant tissue injury includes several features observed in primary bTBI, such as hemorrhage, edema, pseudo-aneurysm formation, vasoconstriction, and induction of apoptosis. These are well-described pathological findings within the SW literature. Acoustic impedance mismatch, penetration of tissue by shock/bubble interaction, geometry of the skull, shear stress, tensile stress, and subsequent cavitation formation are all important factors in determining the extent of SW-induced tissue and cellular injury. In addition, neuropsychiatric aspects of blast events need to be taken into account, as evidenced by reports of comorbidity and of some similar symptoms between physical injury resulting in bTBI and the psychiatric sequelae of post-traumatic stress. Research into blast injury biophysics is important to elucidate specific pathophysiologic mechanisms of blast injury, which enable accurate differential diagnosis, as well as development of effective treatments. Herein we describe the requirements for an adequate experimental setup when investigating blast-induced tissue and cellular injury; review SW physics, research, and the importance of engineering validation (visualization/pressure measurement/numerical simulation); and, based upon our findings of SW-induced injury, discuss the potential underlying mechanisms of primary bTBI.

Potential applications of low-energy shock waves in functional urology.

A shock wave, which carries energy and can propagate through a medium, is a type of continuous transmitted sonic wave with a frequency of 16Hz-20MHz. It is accompanied by processes involving rapid energy transformations. The energy associated with shock waves has been harnessed and used for various applications in medical science. High-energy extracorporeal shock wave therapy is the most successful application of shock waves, and has been used to disintegrate urolithiasis for 30years. At lower energy levels, however, shock waves have enhanced expression of vascular endothelial growth factor, endothelial nitric oxide synthase, proliferating cell nuclear antigen, chemoattractant factors and recruitment of progenitor cells; shock waves have also improved tissue regeneration. Low-energy shock wave therapy has been used clinically with musculoskeletal disorders, ischemic cardiovascular disorders and erectile dysfunction, through the mechanisms of neovascularization, anti-inflammation and tissue regeneration. Furthermore, low-energy shock waves have been proposed to temporarily increase tissue permeability and facilitate intravesical drug delivery. The present review article provides information on the basics of shock wave physics, mechanisms of action on the biological system and potential applications in functional urology.

On the long-range detection and study of undamped directed temperature waves generated during the interaction between a cavitating water jet and targets

The features of the propagation of undamped thermal (temperature) waves in air are investigated. The presence of these waves is a consequence of solution of the heat equation taking into account the relaxation of local thermal perturbation. It is shown that such waves can exist only in media with a finite (nonzero) time of local thermal relaxation, and their frequencies are determined by this time. The time of relaxation in air depends on the gas composition, its temperature and increases with a decrease in pressure. Under normal conditions, the minimum frequency of undamped waves in air corresponds to 70–80 MHz. One of the methods for exciting these waves is associated with pulsed heating of the surface of a medium bordering air. Pulsed heating on account of the application of shock waves generated during water jet cavitation is used. It is shown for the first time that these waves with frequencies in the range of 70–500 MHz can propagate in air without damping over a distance of up to 2 m.

Application of extracorporeal shockwaves in the treatment of scoliosis: a case report.

[Purpose] In a pilot investigation, extracorporeal shockwave therapy was applied to patients with idiopathic scoliosis. This case report aimed to describe the effects of repeated extracorporeal shockwave therapy on the clinical signs of a patient with scoliosis due to a functional tethered cord syndrome. [Subject and Methods] In June 2016, a 13-year-old girl presented with a left thoracic curvature. Radiograph showed a left thoracic curve of 24°. An angle of trunk rotation of 21° was measured using a scoliometer. Extracorporeal shockwave therapy was proposed to support conservative treatment. Five sessions of extracorporeal shockwave therapy were applied. Finger-floor distance and the angle of trunk rotation before and after each application of extracorporeal shockwave therapy were measured. [Results] The average finger-floor distances before and after extracorporeal shockwave therapy were 22.6 cm and 15.6 cm, respectively. The average angles of trunk rotation before and after the therapy were 13° and 10.2°, respectively. [Conclusion] The short-term effect of extracorporeal shockwave therapy was revealed in this study. The neural structures that inhibited free mobility of the spine were mobilized. Furthermore, deformity was reduced by applying extracorporeal shockwave therapy.

Recent advances in lithotripsy technology and treatment strategies: A systematic review update

IntroductionShock wave lithotripsy (SWL) is a well – established treatment option for urolithiasis. The technology of SWL has undergone significant changes in an attempt to better optimize the results while reducing failure rates. There are some important limitations that restrict the use of SWL. In this review, we aim to place these advantages and limitations in perspective, assess the current role of SWL, and discuss recent advances in lithotripsy technology and treatment strategies. MethodsA comprehensive review was conducted to identify studies reporting outcomes on ESWL. We searched for literature (PubMed, Embase, Medline) that focused on the physics of shock waves, theories of stone disintegration, and studies on optimising shock wave application. Relevant articles in English published since 1980 were selected for inclusion. ResultsEfficacy has been shown to vary between lithotripters. To maximize stone fragmentation and reduce failure rates, many factors can be optimized. Factors to consider in proper patient selection include skin – to – stone distance and stone size. Careful attention to the rate of shock wave administration, proper coupling of the treatment head to the patient have important influences on the success of lithotripsy. ConclusionProper selection of patients who are expected to respond well to SWL, as well as attention to the technical aspects of the procedure are the keys to SWL success. Studies aiming to determine the mechanisms of shock wave action in stone breakage have begun to suggest new treatment strategies to improve success rates and safety.

The Effectiveness of Radial Extracorporeal Shock Waves for Treatment of Carpal Tunnel Syndrome: A Randomized Clinical Trial

This study examined the effectiveness of radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome (CTS). Forty patients with mild to moderate CTS were allocated to two groups: (i) shock wave + wrist splint and (ii) wrist splint. Patients used wrist splints followed by three sessions of low-energy shock wave therapy in the intervention group and wrist splints alone in the other group. The QuickDASH Questionnaire, visual analogue scale and nerve conduction studies were used to evaluate the patients before the study and at 3, 8 and 12 wk after the start of the treatment. At the end of the study, both groups saw the same clinical benefits. However, a significantly greater improvement in the median nerve distal sensory latency was noted in the shock wave group compared with the control group. We suggest that application of shock wave with alternative protocols may be effective in the treatment of CTS in future studies.

Numerical study of laser ablation on aluminum for shock-wave applications: development of a suitable model by comparison with recent experiments

In order to control laser-induced shock processes, two main points of interest must be fully understood: the laser–matter interaction generating a pressure loading from a given laser intensity profile and the propagation of induced shock waves within the target. This work aims to build a predictive model for laser shock-wave experiments with two grades of aluminum at low to middle intensities (50 to 500 GW/cm2) using the hydrodynamic Esther code. This one-dimensional Lagrangian code manages both laser–matter interaction and shocks propagation. The numerical results are compared to recent experiments conducted on the transportable laser shocks generator facility. The results of this work motivate a discussion on the shock behavior dependence to elastoplasticity and fracturation models. Numerical results of the rear surface velocity show a good agreement with the experimental results, and it appears that the response of the material to the propagating shock is well predicted. The Esther code associated to this developed model can therefore be considered as a reliable predictive code for laser ablation and shock-wave experiments with pure aluminum and 6061 aluminum in the mentioned range of parameters. The pressure–intensity relationship generated by the Esther code is compared to previously established relationships.

Shock Wave-Induced Damage and Poration in Eukaryotic Cell Membranes

Shock waves are known to permeabilize eukaryotic cell membranes, which may be a powerful tool for a variety of drug delivery applications. However, the mechanisms involved in shock wave-mediated membrane permeabilization are still poorly understood. In this study, the effects on both the permeability and the ultrastructural features of two human cell lineages were investigated after the application of underwater shock waves in vitro. Scanning Electron Microscopy of cells derived from a human embryo kidney (HEK)-293 and Michigan Cancer Foundation (MCF)-7 cells, an immortalized culture derived from human breast adenocarcinoma, showed a small amount of microvilli (as compared to control cells), the presence of hole-like structures, and a decrease in cell size after shock wave exposure. Interestingly, these effects were accompanied by the permeabilization of acid and macromolecular dyes and gene transfection. Trypan blue exclusion assays indicated that cell membranes were porated during shock wave treatment but resealed after a few seconds. Deformations of the cell membrane lasted for at least 5min, allowing their observation in fixed cells. For each cell line, different shock wave parameters were needed to achieve cell membrane poration. This difference was correlated to successful gene transfection by shock waves. Our results demonstrate, for the first time, that shock waves induce transient micro- and submicrosized deformations at the cell membrane, leading to cell transfection and cell survival. They also indicate that ultrastructural analyses of cell surfaces may constitute a useful way to match the use of shock waves to different cells and settings.

The Application of Clinical Lithotripter Shock Waves to RNA Nucleotide Delivery to Cells

The delivery of genes into cells through the transfer of ribonucleic acids (RNAs) has been found to cause a change in the level of target protein expression. RNA-based transfection is conceptually more efficient than commonly delivered plasmid DNA because it does not require division or damage of the nuclear envelope, thereby increasing the chances of the cell remaining viable. Shock waves (SWs) have been found to induce cellular uptake by transiently altering the permeability of the plasma membrane, thereby overcoming a critical step in gene therapy. However, accompanying SW bio-effects include dose-dependent irreversible cell injury and cytotoxicity. Here, the effect of SWs generated by a clinical lithotripter on the viability and permeabilisation of three different cell lines in vitro was investigated. Comparison of RNA stability before and after SW exposure revealed no statistically significant difference. Optimal SW exposure parameters were identified to minimise cell death and maximise permeabilisation, and applied to enhanced green fluorescent protein (eGFP) messenger RNA (mRNA) or anti-eGFP small interfering RNA delivery. As a result, eGFP mRNA expression levels increased up to 52-fold in CT26 cells, whereas a 2-fold decrease in GFP expression was achieved after anti-eGFP small interfering RNA delivery to MCF-7/GFP cells. These results indicate that SW parameters can be employed to achieve effective nucleotide delivery, laying the foundation for non-invasive and high-tolerability RNA-based gene therapy.

Aspects Regarding Shock Wave Mitigation Through Different Media

Abstract The main application of underwater detonation since the Second World War is to destroy military ships. Nowadays, a lot of studies are performed in order to discover a controlled and safe application of shock waves through different media. The paper presents the results of a research on a bubble curtain behaviour subjected to shock waves generated by an underwater TNT blast. The main objective was to analyze the mitigation solution of underwater explosion effects by means of gas bubbles. Simulations using ANSYS AUTODYN and explicit dynamics procedures were performed on a 3D model, in order to better understand the physical process of formation and propagation of a shock wave in the biphasic medium which represents the purpose of many researchers. The numerical simulations were performed taking into account the interaction between a shock wave and the bubble curtain considering a random distribution in space and bubble dimensions.

ChemInform Abstract: Direct Observation of an Abrupt Insulator‐to‐Metal Transition in Dense Liquid Deuterium.

AbstractAbrupt insulator‐to‐metal transition is experimentally observed in dense liquid D2 by application of magnetic shock waves of several hundred GPa to a cryocell containing D2 (22 K, density of 0.167 g/cm3) at the Sandia Z machine (Albuquerque, New Mexico, USA) for pulsed power research.

Heating a plasma by a broadband stream of fast electrons: Fast ignition, shock ignition, and Gbar shock wave applications

An exact analytic solution is found for the steady-state distribution function of fast electrons with an arbitrary initial spectrum irradiating a planar low-Z plasma with an arbitrary density distribution. The solution is applied to study the heating of a material by fast electrons of different spectra such as a monoenergetic spectrum, a step-like distribution in a given energy range, and a Maxwellian spectrum, which is inherent in laser-produced fast electrons. The heating of shock- and fast-ignited precompressed inertial confinement fusion (ICF) targets as well as the heating of a target designed to generate a Gbar shock wave for equation of state (EOS) experiments by laser-produced fast electrons with a Maxwellian spectrum is investigated. A relation is established between the energies of two groups of Maxwellian fast electrons, which are responsible for generation of a shock wave and heating the upstream material (preheating). The minimum energy of the fast and shock igniting beams as well as of the beam for a Gbar shock wave generation increases with the spectral width of the electron distribution.

Tandem shock waves in medicine and biology: a review of potential applications and successes

Shock waves have been established as a safe and effective treatment for a wide range of diseases. Research groups worldwide are working on improving shock wave technology and developing new applications of shock waves to medicine and biology. The passage of a shock wave through soft tissue, fluids, and suspensions containing cells may result in acoustic cavitation i.e., the expansion and violent collapse of microbubbles, which generates secondary shock waves and the emission of microjets of fluid. Cavitation has been recognized as a significant phenomenon that produces both desirable and undesirable biomedical effects. Several studies have shown that cavitation can be controlled by emitting two shock waves that can be delayed by tenths or hundreds of microseconds. These dual-pulse pressure pulses, which are known as tandem shock waves, have been shown to enhance in vitro and in vivo urinary stone fragmentation, cause significant cytotoxic effects in tumor cells, delay tumor growth, enhance the bactericidal effect of shock waves and significantly increase the efficiency of genetic transformations in bacteria and fungi. This article provides an overview of the basic physical principles, methodologies, achievements and potential uses of tandem shock waves to improve biomedical applications.

Multiple Extracorporeal Shock Wave Therapy Degrades Capsular Fibrosis after Insertion of Silicone Implants

Capsular fibrosis is the most frequent long-term complication after insertion of silicone devices. Today, mainly direct immunostimulation and subclinical infection are held responsible for inducing and maintaining inflammatory reactions, which lead to overwhelming extracellular matrix formation. Extracorporeal shock waves (ESWs) are capable of inhibiting inflammatory processes and revealing antibacterial capacity. In our previous study, we observed decelerated capsule development after application of a single shock wave immediately after surgery. The purpose of this study was to evaluate the effects of multiple ESWT after insertion of silicone implants in the same rodent model. Therefore, silicone prostheses were inserted into a submuscular pocket in 12 additional male Lewis rats, and shock waves were administered over a 14-d interval. At 35 d (n = 6) and 100 d (n = 6) after insertion, silicone implants and surrounding capsule tissue were removed and prepared for histologic and immunohistochemical analysis, as well as polymerase chain reaction (Ccl2, CD68, transforming growth factor β1, matrix metalloproteinase 2). Compared with the control group, multiple ESWT had no effect on day 35, but resulted in a significantly thinner capsule on day 100 (825.8 ± 313.2 vs. 813.3 ± 47.9, p = 0.759, and 1062.3 ± 151.9 vs. 495.4 ± 220.4, p < 0.001, respectively). The capsule was even thinner than after a single shock wave application, which had been found to result in thinner capsules at every time point in our previous study. This active degradation of the fibrous envelope caused by multiple ESWs was accompanied by synergistic alterations in pro- and anti-fibrotic proteins (transforming growth factor β1 and matrix metalloproteinase 2, respectively). In conclusion, after insertion of silicone devices, single ESWT is capable of decelerating capsule formation in contrast to multiple ESWT, which degrades fibrotic tissue. These findings seem to be associated with inhibition of inflammation and beneficial effects on pro- and anti-fibrotic proteins.

The histomorphological findings of kidneys after application of high dose and high-energy shock wave lithotripsy.

IntroductionIn this animal study, we reviewed the histomorphological findings in rabbit kidneys after a high number of high-energy shock wave applications and observed if there were any cumulative effects after repeated sessions.Material and methodsWe formed 2 groups, each consisting of 8 rabbits. Group 1 received 1 session and group 2 received 3 sessions of ESWL with a 7 day interval between sessions, consisting of 3500 beats to the left kidney and 5500 beats to the right kidney per session. The specimens of kidneys were examined histomorphologically after bilateral nephrectomy was performed. For statistical analysis, 4 groups of specimens were formed. The first and second groups received 1 session, 3500 and 5500 beats, respectively. The third and fourth groups received 3 sessions, at 3500 and 5500 beats per each session, respectively. The sections were evaluated under a light microscope to determine subcapsular thickening; subcapsular, intratubular and parenchymal hemorrhage; subcapsular, intersitital, perivascular and proximal ureteral fibrosis; paranchymal necrosis; tubular epithelial vacuolization; tubular atrophy; glomerular destruction and calcification.ResultsIn histopathological examinations capsular thickening, subcapsular hematoma, tubuloepithelial vacuolisation, glomerular destruction, parenchymal hemorrhage, interstitial fibrosis, and perivascular fibrosis were observed in all groups. In statistical analysis, on the basis of perivascular fibrosis and tubular atrophy, there was a beats per session dependent increase of both.ConclusionsThe detrimental effects from ESWL are dose dependent but not cumulative for up to 3 sessions. Histopathological experimental animal studies will aid in understanding local and maybe, by means of these local effects, systemic effects.

Short-term effects of extracorporeal shock waves on microcirculation

BackgroundExtracorporeal shock wave application (ESWA) has the potential to qualify as an adjuvant therapy option for soft tissue disorders such as chronic wounds. As of today, little is known about its exact mechanism of action. For a better understanding of the pathophysiology, we investigated the effect of ESWA on microcirculation and leukocyte–endothelial interaction. Materials and methodsIntravital fluorescent microscopy was used to quantify microcirculatory parameters in the ears of hairless mice (n = 30). Values were obtained just before and 10 min after the ESWA (500 shots, 1 Hz, duration 500 s). Mice were randomly divided into three groups undergoing different shock wave intensities (energy flux density: control: 0.00 mJ/mm2; low level: 0.015 mJ/mm2; and higher level (hl): 0.04 mJ/mm2; n = 10 mice per group). Histologic evaluations were taken after completion of the experiments. ResultsA significant increase in the venular diameter was observed in both the groups that underwent ESWA compared with the control group (hl: 118%, low level: 117%, and control: 96%; P < 0.004). Edema formation increased significantly in group I (P = 0.002). ESWA provoked an arteriolar constriction (hl: 93% versus control: 104%; P = 0.019) 10 min after treatment. The highest value of venular blood flow was found in group hl. Moreover, shock waves increased significantly the number of sticking leukocytes immediately after application (hl: 274%, P = 0.003). ConclusionsESWA has a significant and immediate impact on microcirculation with endothelial integrity loss and increase of adherent leukocytes as part of a proinflammatory process. Although a dilation of venules was caused, arterioles primarily show a constriction. The study shows alterations in microcirculation that could help understand the mechanism of action in the future.