Effects Of Extracorporeal Shock Wave Therapy Research Articles

Extracorporeal Shockwaves (ESW) Promote Proliferation and Differentiation of Keratinocytes In vitro-Histology and Immunohistochemistry

The objective of presented study was to evaluate in vitro effects of extracorporeal shockwave therapy (ESWT) on the keratinocyte morphology, cytoskeleton and mitotic activity. To determine in vitro effects of ESWT on keratinocytes, we applied 100 pulses with an energy flux density 0.1 mJ/mm2 and a frequency of 1 Hz at a distance of 5 cm between therapy head and culture flask. The treatment parameters were determined in a pilot study. Haematoxylin and Eosin staining, as well as immunohistochemistry for Ki-67, CK5, CK14 and CK10 was performed on the cultured keratinocytes and results were compared between ESW treated group and Controls. No pathomorphological abnormalities or alterations in the cells monolayer could be observed. When assessing histological images of all HE-stained sections of ESW-treated and untreated keratinocytes (control group), no morphological differences could be seen between or within the groups. The proliferation marker Ki-67 was found at a frequency of 14% for ESW-treated and 10% for untreated keratinocytes. There were also figures of 95% (CK5 staining) and 90% (CK14 staining) for ESW-treated, as well as 85% (CK5 staining) and 85% (CK14 staining) for untreated keratinocytes. CK10-positive cells showed a frequency of 24% in the ESWtreated and 33% in the untreated cell cultures. Immunohistochemical observations indicated an increased proliferation behaviour following treatment with extracorporeal shockwaves in vitro and maturation of the exposed keratinocytes. Our results suggest an increase in proliferation activity of keratinocytes after in vitro treatment with ESWT. Further investigations of the effects of ESWT on the keratinocyte expression of the chemokines and cytokines are underway.

Effect of extracorporeal shockwave therapy (ESWT) on pulpal blood flow after orthodontic treatment: a randomized clinical trial

The effect of non-invasive extracorporeal shockwaves on pulpal blood flow in orthodontic patients who have undergone active treatment was investigated. Seventy-two adult patients were enrolled in the clinical trial and allocated by block randomization to a treatment or a placebo group at a 1:1 ratio. The patients were required to be otherwise healthy. Blinding was performed for the subjects and the outcome assessor. The region of interest was the mandibular incisors and canines, which were vital, unrestored, and had experienced no trauma. The active treatment group received a single shockwave treatment with 1000 impulses at 0.19-0.23 mJ/mm(2) while the placebo group was treated with a deactivated shockwave applicator but acoustic sham. Pulpal blood flow was evaluated four times over a period of 6 months starting from the day of bracket removal, using a laser Doppler device. Thirty patients were evaluated in each group. Orthodontic patients who have undergone active treatment tend to have high levels of pulpal blood flow which decrease over a period of 6 months. Pulpal blood flow did not differ significantly over 6 months between the placebo and treatment group. Shockwave treatment was associated with no significant effect in respect of tooth type, age, sex, or mean blood pressure, and had no unintended pernicious effects. Extracorporeal shockwaves had no statistically significant effect on pulpal blood flow. Multiple applications of ESWT in a pathological setup may be needed in future studies to demonstrate significant differences. The absence of any adverse effects justifies further principal investigations of the use of shockwave treatment in the oral cavity.

Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions of femoral shaft fractures

IntroductionAs of now, the role of extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions is inconclusive. The purpose of the study was to investigate the effectiveness of ESWT and the role of this technology in the treatment of atrophic non-union of femurs. MethodsWe retrospectively analyzed 22 patients treated between July 1999 and September 2007 in our hospital with ESWT for atrophic non-unions of isthmic femoral shaft fractures that were initially treated surgically using closed reamed nailing procedure. Patients with open fractures, skeletal immaturity, on anti-osteoporotic medications, with infections, pathological fractures, smokers, with systemic disease compromising bone healing, and excessive deformity were excluded from this study. Due to incomplete follow-up one (1) patient who moved abroad after ESTW treatment was not included in this study and as part of the 22-patients cohort. Radiographs were obtained before treatment and once a month after treatment for 12 months. ResultsUsing ESWT we showed that 14 fractures out of 22 (63.6%) achieved bony union with an average union time of 9.2 months (range 6–13 months). The union rate was 100% (8 of 8 cases) when ESWT was performed within 12 months from closed reamed nailing surgery versus 42.9% (6 of 14 cases) when ESWT was performed after 12 months from initial surgery. The eight (8) patients out of the total 22 patients cohort, who did not achieve bony union after ESWT, received subsequent treatment with bone grafting with augmentative plating surgery and all achieved bony union within 5 months after intervention. ConclusionFor patients with atrophic non-unions of femoral shaft fractures, ESWT can be used as an alternative and effective non-invasive method of treatment. ESWT treatment does not negatively influence/compromise previous surgeries and if needed it can be followed by additional surgeries without any complications.

Effectiveness of extracorporeal shockwave therapy in three major tendon diseases.

BackgroundExtracorporeal shockwave therapy is a conservative treatment for several painful musculoskeletal disorders. The aim of the study was the assessment of the relief from pain by the shockwave therapy in a population of consecutive patients affected by specific pathologies.Materials and methodsA group of consecutive patients were studied and treated. They were affected by calcific tendonitis of the shoulder (129 patients), chronic Achilles tendinopathy (102 patients), and lateral epicondylitis of the elbow (80 subjects). Each patient had 3 applications with a monthly interval, and was followed up at 1, 6, and 12 months after treatment. Results were evaluated by the numeric rating scale (NRS) in all cases, the Constant Murley Score for the assessment of the shoulder function, the American Orthopaedic Foot and Ankle Society Score for subjects affected by chronic Achilles tendinopathy, and the Oxford Elbow Score for those affected by a lateral epicondylitis of the elbow.ResultsOne year after treatment, the results were considered satisfactory with an almost complete resolution of symptoms. There were statistically significant results at the 12-month follow-ups regarding the mean NRS score (from 6.25 to 0.2), the Constant Murley Score (from 66.7 to 79.4), the Oxford Elbow Score (from 28 to 46), and the AOFAS (from 71 to 86).ConclusionsExtracorporeal shockwave therapy may be considered a safe, economic, and effective treatment for several chronic musculoskeletal disorders, allowing satisfactory pain relief and improvement of function ability.Level of evidenceLevel IV.

The efficacy of ultrasound-guided extracorporeal shockwave therapy in patients with cervical spondylosis and nuchal ligament calcification

We investigated the effects of extracorporeal shockwave therapy (ESWT) on the rehabilitation of cervical spondylosis with nuchal ligament (NL) calcification under X-ray and ultrasound guidance. Sixty patients with cervical spondylosis and calcification of NL were selected and randomly assigned to three groups: A, B, and C. Patients in Group A received rehabilitation with 20 minutes of hot packs and underwent 15 minutes of intermittent cervical traction three times/week for 6 weeks. Patients in Group B received the same rehabilitation as those in Group A and ESWT (2000 impulses, 0.27 mJ/mm2) over the calcified NL guided by X-ray image. Patients in Group C received the same treatment as those in Group B, but the ESWT was guided by musculoskeletal sonography. The therapeutic effects were evaluated by: changes in range of motion (ROM) of the cervical spine including flexion, extension, lateral bending, and rotation; visual analog pain scale; and Neck Disability Index before and after treatment and at follow up 3 months later. We found a significant reduction in pain in each treated group after treatment and at follow up. However, patients in Groups B and C showed more improvements in ROM and neck pain relief after treatment and a decrease in Neck Disability Index. Furthermore, patients in Group C showed better cervical ROM at follow up than Group B. ESWT is an adjuvant treatment in the management of cervical spondylosis with calcification of NL and ultrasound-guided ESWT results in more functional improvements.

The effectiveness of shockwave therapy on achilles and patellar tendinopathy: a systematic review and meta-analysis

Background: Sports related injuries such as lower limb tendinopathies can result in long-standing impairment of athletic performance. The prevalence of jumpers’ knee is estimated at over 14% (range, 0–45%) in elite athletes across a range of sports with a mean symptom duration >2.5 years (Oystein et al., 2005). In recent years, treatment interventions like eccentric exercises, Platelet Rich Plasma (PRP) injections and Extracorporeal Shockwave Therapy (ESWT) have gained popularity among physiotherapists and other sports clinicians treating tendon related pathologies, but evidence of their effectiveness is limited. Purpose: To investigate the effectiveness of ESWT on Achilles and Patellar tendinopathy. Methods: A systematic review and meta-analysis was conducted using MEDLINE, EMBASE, AMED, CINAHL, PEDro and Cochrane databases and bibliographic searches from inception until April 2013 to identify randomised control trials comparing ESWT with other treatment methods. Primary outcome measures like Victorian Institute of Sports Assessment score (VISA) which assesses

Extracorporeal shockwave therapy in osteoporotic osteoarthritis of the knee in rats: An experiment in animals

This study investigated the effectiveness of extracorporeal shockwave therapy (ESWT) in osteoporotic (OP) osteoarthritis (OA) of rat knee. Fifty-six rats were divided into seven groups including sham, OA, OP, OA + OP, OA + ESWT, OP + ESWT, and OA + OP + ESWT groups. The evaluations included gross pathology, bone mineral density (BMD), micro-computed tomography (micro-CT) scan, bone-strength test, histopathologic examination, and immunohistochemical analysis. On gross pathology, group OA + OP showed larger areas of osteoarthritic changes than did groups OA and OP, as compared with the sham group. BMD and bone strength significantly decreased in groups OA, OP, and OA + OP relative to the sham group, and ESWT significantly improved BMD and bone-strength changes. On micro-CT scan, the subchondral plate thickness significantly decreased, and the bone porosity increased in groups OA, OP, and OA + OP, and ESWT significantly improved the changes in subchondral-plate thickness and bone porosity. In histopathologic examination, Mankin score and safranin O score significantly increased in groups OA and group OA + OP, but not in group OP relative to the sham group, and ESWT significantly improved the changes. In immunohistochemical analysis, Dickkopf-1 (DKK-1) significantly increased, but vessel endothelial growth factor (VEGF), proliferating cell nuclear antigen (PCNA), and bone morphogenetic protein 2 (BMP-2) decreased in groups OA, OP, and OA + OP relative to the sham group, and ESWT significantly reversed the changes. Osteoporosis increased the severity of cartilage damage in osteoarthritis of the knee. ESWT showed effectiveness in the reduction of osteoporotic osteoarthritis of the knee in rats.

In Vitro Effects of Extracorporeal Shockwave Therapy (ESWT) on Proliferation and Metabolic Activity of Adult Human Keratinocytes

Background: The objective of the presented study is to investigate in vitro effects of low energy extracorporeal shockwave therapy (ESWT) on the keratinocytes and their metabolic and proliferative properties for their therapeutic applications. Materials: Primary culture of keratinocytes was isolated from clinical samples and after passaging into 12 flasks exposed to the various number of ESWT impulses (n=25, 50 and100impulses) in combination with several frequencies (1, 3 or 5Hz) and distances from the applicator head (5, 6 or 7cm with corresponding energy flux densities (EFD)=0.04, 0.025 and 0.015 mJ/mm2, respectively) using modified water bath at constant temperature 37°C. Flasks were assigned to receive one combination of treatment parameters. The individually tested distances/EFD with the various impulse numbers and frequencies were summarised to experimental series. Cell viability was measured using trypan blue, cell cytotoxicity was measured using lactate dehydrogenase assay, and cell metabolic activity was measured by level of glucose metabolism. Results: Our results indicate that low energy ESWT has both cytotoxic and stimulating effects on the keratinocytes. These effects depend on number of impulses, distance from the applicator head, and frequency. A proliferationstimulating effect and a higher viable cell count could be observed for a distance of 5 cm with 100 impulses at 1 Hz and EFD=0.04 mJ/mm2. Conclusion: Our results indicate that ESWT (EFD=0.04 mJ/mm2, 100 impulses, 1Hz at 5 cm) augmented proliferative capacity of keratinocytes in vitro. These promising results grant further investigation and have practical potential in keratinocyte research and production.

Therapeutic Effect of Extracorporeal Shock Wave Therapy According to Treatment Session on Gastrocnemius Muscle Spasticity in Children With Spastic Cerebral Palsy: A Pilot Study.

ObjectiveTo investigate the therapeutic effect of extracorporeal shockwave therapy (ESWT) according to treatment session on gastrocnemius muscle spasticity in children with spastic cerebral palsy (CP).MethodsTwelve children with spastic CP underwent 1 ESWT and 2 sham ESWT sessions for gastrocnemius (group 1) or 3 ESWT sessions (group 2) once per week for 3 weeks. Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle plantar-flexor muscles with knee extension, and median red pixel intensity (RPI) of color histogram of medial gastrocnemius on real-time sonoelastography (RTS) were measured before ESWT, immediately after the first and third ESWT, and at 4 weeks after the third ESWT.ResultsMean ankle PROM was significantly increased whereas as mean ankle MAS and median gastrocnemius RPI were significantly decreased in both groups after the first ESWT. Clinical and RTS parameters before ESWT were not significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 1. However, they were significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 2. Mean ankle PROM, mean ankle MAS, and median gastrocnemius RPI in group 2 were significantly different from that in group 1 at 4 weeks or immediately after the third ESWT.ConclusionThe therapeutic effect of ESWT on spastic medial gastrocnemius in children with spastic CP is dependent on the number of ESWT sessions.

Dose related effects of extracorporeal shockwave therapy in patients with plantar fasciitis

Dose related effects of extracorporeal shockwave therapy in patients with plantar fasciitis

Extracorporeal shock wave therapy for painful chronic neurogenic heterotopic ossification after traumatic brain injury: a case report.

Neurogenic heterotopic ossification (NHO) is a process of benign bone formation and growth in soft tissues surrounding major synovial joints and is associated with central nervous system (CNS) injuries. It is a common complication in major CNS injuries, such as traumatic brain injury, spinal cord injury, and stroke. Here, we report the case of a 72-year-old male, who experienced a traumatic brain injury and painful chronic NHO around the left hip joint. Three applications of extracorporeal shock wave therapy (ESWT) were administered to the area of NHO, which resulted in pain relief and an improvement in the loss of motion in the left hip joint. Improvements were also noted in walking performance and activities of daily living, although the size of NHO remained unchanged. Therapeutic effects of ESWT lasted for 12 weeks.

COMPARISON OF SHORT-TERM ANALGESIC EFFECTS OF EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT) AND CONSERVATIVE TREATMENT (CT) IN MEN WITH CHRONIC HEEL SPUR (HS).

<p><strong>Background.</strong> The surgical removal of heel spur (HS) provokes many controversial opinions, but clinical studies show the risk of complication after operation. An alternative to the surgical removal of HS is Extracorporeal Shock Wave Therapy (ESWT), because it is non-invasive method.<br /><strong>Objective.</strong> The aim of the study is to compare the short-term analgesic effects of ESWT and conservative treatment (CT) in males with chronic HS.<br /><strong>Methods.</strong> Sixty patients (mean age 54.9±4.3 years; range 42 to 59 years) were examined who had pain associated with HS. In the shockwave group (group 1) patients received 1000–2000 impulses of shocks to the affected heel in a single session. The patients in this group took a series of 5 ESWT in 1 week intervals. Patients in the control group (group 2) at the same time received CT consisting of nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics and a local cortisone injection. The basic method of research was to evaluate pain according to Visual Analogue Scale (VAS) 0–10. The patients of the two groups were tested before the treatment, after the last treatment and 3 months and 6 months after the treatment.<br /><strong>Results.</strong> A significant decrease of VAS (p=0.000) was seen in the shockwave group. In the control group no significant decrease of VAS was seen.<br /><strong>Conclusions.</strong> ESWT reduces pain more effectively than CT in men with chronic HS.</p><p><br /><strong>KEY WORDS:</strong> extracorporeal shock wave therapy, conservative treatment, visual analogue scale, heel spur, pain.</p>

Effect of extracorporeal shock wave treatment on deep partial-thickness burn injury in rats: a pilot study.

Extracorporeal shock wave therapy (ESWT) enhances tissue vascularization and neoangiogenesis. Recent animal studies showed improved soft tissue regeneration using ESWT. In most cases, deep partial-thickness burns require skin grafting; the outcome is often unsatisfactory in function and aesthetic appearance. The aim of this study was to demonstrate the effect of ESWT on skin regeneration after deep partial-thickness burns. Under general anesthesia, two standardized deep partial-thickness burns were induced on the back of 30 male Wistar rats. Immediately after the burn, ESWT was given to rats of group 1 (N = 15), but not to group 2 (N = 15). On days 5, 10, and 15, five rats of each group were analyzed. Reepithelialization rate was defined, perfusion units were measured, and histological analysis was performed. Digital photography was used for visual documentation. A wound score system was used. ESWT enhanced the percentage of wound closure in group 1 as compared to group 2 (P < 0.05). The reepithelialization rate was improved significantly on day 15 (P < 0.05). The wound score showed a significant increase in the ESWT group. ESWT improves skin regeneration of deep partial-thickness burns in rats. It may be a suitable and cost effective treatment alternative in this type of burn wounds in the future.

Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis

The treatment of adhesive capsulitis is a dilemma for orthopaedic rehabilitation specialists. In this study, we assessed whether extracorporeal shockwave therapy (ESWT) improves the functional outcome of primary shoulder adhesive capsulitis. In this prospective, randomized, controlled, single-blind clinical trial, we enrolled 40 patients with primary adhesive capsulitis to assess whether ESWT can improve the functional outcome of primary adhesive capsulitis better than oral steroid therapy. Patients were allocated to the oral steroid group or ESWT group with randomization. Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Oxford Shoulder Score. Both groups showed significant improvement in the Oxford Shoulder Score evaluation throughout the study period. In the ESWT group, the total CSS and range of motion (ROM) parameter of the CSS in the ESWT group showed significant improvement from the fourth week that was better than that in the steroid group; the activities–of–daily living (ADL) parameter of the CSS achieved significance and was better than that in the steroid group at the sixth week. For the steroid group, pain was significantly reduced from baseline to the fourth week of the study; ADL and ROM improved at the fourth to 12th week. For the ESWT group, ADL and ROM improvements were significant from baseline to the sixth week. Our results showed that ESWT can be an alternative treatment, at least in the short-term, for primary adhesive capsulitis of the shoulder. In addition, all of the side effects of ESWT were transient and tolerable.

Effects of Extracorporeal Shock Wave Therapy on Functional and Strength Recovery of Handgrip in Patients Affected by Epicondylitis

Extracorporeal shock wave therapy (ESWT) is effective in the treatment of tendinopathy. We designed a prospective observational clinical study to assess the correlation between clinical and functional measures and recovery of strength after ESWT for epicondylitis. We analyzed 26 patients. We measured progressive improvement in visual analogue scale values (p < 0.0005) and Mayo Elbow Performance Index scores (p = 0.004) for the pathologic limb. Monitoring of handgrip failed to reveal changes in values at any follow-up (p > 0.05). We found no correlation between degree of clinical function and muscle deficit during follow-up. After ESWT, there was a tendency toward a decrease in grip strength, especially in the dominant limb. This could be related to the effects of ESWT, which reduces spasticity in painful hypertonic muscles. These data may be useful in defining the expectations for function during ESWT for epicondylitis, particularly for elite athletes.

Assessment of the Effectiveness of Extracorporeal Shock Wave Therapy (ESWT) For Soft Tissue Injuries (ASSERT): An Online Database Protocol.

Soft tissue injuries and tendinopathies account for large numbers of chronic musculoskeletal disorders. Extracorporeal shockwave therapy (ESWT) is popular, and effective in the management of chronic tendon conditions in the elbow, shoulder, and pain at and around the heel. Ethical approval was granted from the South East London Research Ethics Committee to implement a database for the Assessment of Effectiveness of Extracorporeal Shock Wave Therapy for Soft Tissue Injuries (ASSERT) to prospectively collect information on the effectiveness of ESWT across the UK. All participants will give informed consent. All clinicians follow a standardised method of administration of the ESWT. The primary outcome measures are validated outcome measures specific to the condition being treated. A Visual Analogue Score for pain and the EuroQol will be completed alongside the condition specific outcome tool at baseline, 3, 6, 12 and 24 months post treatment. The development of the ASSERT database will enable the evaluation of the effectiveness of ESWT for patients suffering from chronic conditions (plantar fasciopathy, tennis elbow, Achilles tendinopathy, greater trochanter pain syndrome and patellar tendinopathy). The results will aid the clinicians in the decision making process when managing these patients.

The Effects of Extracorporeal Shockwave Therapy (ESWT) in Treating Lateral Epicondylitis in People between 40 and 50 Years Old

The extracorporeal shockwave therapy (ESWT) was used for the first time in 1980, for fragmenting kidney stones. Since 1981, it also began to be used in Orthopedics, due to the contribution of German scientists - its use was to be developed more after 1990. Ten years later, ESWT was introduced in the treatment of several musculoskeletal disorders.This paper aims at highlighting the effects of ESWT on lateral epicondylitis in people between 40 and 50 years old, who unsuccessfully followed a conventional treatment. Lateral epicondylitis can be encountered in tennis players (5% of the cases), violinists, surgeons, dentists, persons who type (secretaries), people who use the computer mouse very often, housewives. The largest incidence can be found in the age groups between 40 and 50, especially in amateur tennis players.The treatment for this condition is very diverse and complex. Nevertheless, the recurrences are quite frequent, a large number of patients being unresponsive even after 3 months of treatment.The experiment was conducted on a group of 43 patients, men and women, with various backgrounds, diagnosed with lateral epicondylitis, and who had previously been subjected to classical treatments, without any result. The study was conducted over a period of 5 weeks. The ESWT treatment was performed twice a week. The assessment of the subjects was done by observing and recording their pain intensity during palpation, and during the performance of their daily activities, at the beginning and at the end of treatment. This was done using the Visual Analogue Scale (VAS) for Pain. The final results presented a significant decrease and disappearance of the patients’ pain.Thus, one can say that positive results were obtained, and the ESWT treatment had an effect on the athletes with lateral epicondylitis who did not respond to a conventional treatment.

The Effectiveness of Extracorporeal Shock Wave Therapy in Lower Limb Tendinopathy

Background: There is accumulating evidence for the effectiveness of extracorporeal shock wave therapy (ESWT) when treating lower limb tendinopathies including greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT), and Achilles tendinopathy (AT). Purpose: To evaluate the effectiveness of ESWT for lower limb tendinopathies. Study Design: Systematic review and meta-analysis. Methods: PubMed (Medline), Embase, Web of Knowledge, Cochrane, and CINAHL were searched from inception to February 2013 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non–English language studies were excluded. A quality assessment was performed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided. Results: A total of 20 studies were identified, with 13 providing sufficient data to compute effect size calculations. The energy level, number of impulses, number of sessions, and use of a local anesthetic varied between studies. Additionally, current evidence is limited by low participant numbers and a number of methodological weaknesses including inadequate randomization. Moderate evidence indicates that ESWT is more effective than home training and corticosteroid injection in the short (<12 months) and long (>12 months) term for GTPS. Limited evidence indicates that ESWT is more effective than alternative nonoperative treatments including nonsteroidal anti-inflammatory drugs, physical therapy, and an exercise program and equal to patellar tenotomy surgery in the long term for PT. Moderate evidence indicates that ESWT is more effective than eccentric loading for insertional AT and equal to eccentric loading for midportion AT in the short term. Additionally, there is moderate evidence that combining ESWT and eccentric loading in midportion AT may produce superior outcomes to eccentric loading alone. Conclusion: Extracorporeal shock wave therapy is an effective intervention and should be considered for GTPS, PT, and AT particularly when other nonoperative treatments have failed.

The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella

This randomized, controlled study was performed to compare the effects of extracorporeal shockwave therapy (ESWT) and ultrasound on the rehabilitation of knee osteoarthritis with popliteal cyamella. One hundred and twenty patients with bilateral moderate knee osteoarthritis (Altman III) and popliteal cyamella were selected and randomly assigned to four groups (GI–GIV). Patients in Groups I–III received isokinetic muscular strengthening exercises three times weekly for 8 weeks. Group II received pulse ultrasound treatment for popliteal cyamella three times weekly for 8 weeks, Group III received weekly shock wave therapy for popliteal cyamella for the first 6 weeks, and Group IV acted as controls. The therapeutic effects were evaluated by changes in the arthritic knees range of motion (ROM), visual analogue scale, Lequesne's index, and muscle peak torques after treatment and at follow-up 6 months later. Each treated group exhibited increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-ups. However, only patients in Groups II and III showed significant improvements in ROM after treatment, and only participants in Group III showed immediate improvement in ROM after each treatment. Patients in Group III also showed the greatest increase in muscular strength and the greatest decrease in disability after treatment and at the follow-ups. ESWT is better than pulse ultrasound in rehabilitation of patients with knee osteoarthritis and popliteal cyamella results in more functional improvements.

The effects of extracorporeal shockwave therapy on matrix metalloprotease activity in tendinopathy (1046.8)

INTRODUCTION Extracorporeal shockwave therapy (ESWT) is an effective, non‐invasive treatment for degenerative tendinopathies, however, the biological mechanisms underpinning its therapeutic effects are largely unknown.METHODS The local tissue response of matrix metalloproteinase (MMP) ‐2 and ‐9 (gelatinases involved in extracellular matrix remodelling) to ESWT was examined in 18 healthy (18 Achilles) and 10 degenerative (4 Achilles, 6 patellar) tendons using microdialysis. Dialysate samples were collected from the peritendinous space before and after a single ESWT session. Analysis of MMP‐2 and ‐9 activities were completed using gelatin zymography.RESULTS Active MMP‐9 increased ~350% after ESWT, whereas pro‐MMP‐9 was not detected in our samples. There was a ~200% increase in a heavy MMP‐2 complex (~135 kDa; likely an MMP‐2 dimer) after ESWT when compared to baseline, however, levels of pro‐ and active MMP‐2 monomers did not change significantly. There were no response differences between healthy and degenerative tendons.CONCLUSION These findings provide evidence of the biological mechanisms underpinning ESWT in humans in vivo. Our findings are consistent with studies examining MMP activity after exercise and suggest that the mechanical stimulus provided by ESWT might initiate tendon remodeling in tendinopathy by promoting the catabolic processes required to remove damaged matrix constituents.Grant Funding Source: Engineering and Physical Sciences Reserach Council Knowledge Transfer Partnership