Effects Of Extracorporeal Shock Wave Therapy Research Articles

Effect of extracorporeal shockwave therapy on muscle spasticity in patients with cerebral palsy: meta-analysis and systematic review.

Recently, clinical trials have been performed to evaluate the efficacy of extracorporeal shockwave therapy (ESWT) in patients with cerebral palsy (CP). However, various studies adopted different clinical scales, making it insufficient to draw a definite conclusion about the efficacy of ESWT in reducing spasticity after cerebral palsy. The purpose of this meta-analysis was to assess the effects of ESWT on reducing spasticity after applying ESWT in patients with CP. In accordance with the PRISMA statement, authors searched MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials and Scopus from their inception dates through December 11th 2018. We included randomised controlled trials in any language that using ESWT for the purpose of ameliorating spasticity in patients with CP. We assessed spasticity measured by modified Ashworth Scale (MAS), range of motion (ROM) and baropodometric values as outcomes. Two authors independently extracted and verified data. Meta-analysis was completed where possible, otherwise data were synthesised narratively. From a total of 206 articles, 16 manuscripts were selected and 5 of them were ultimately included in this meta-analysis. MAS grade as primary outcome was significantly improved after ESWT compared to that in the control group (mean difference [MD]: -0.62; 95% CI: -1.52 to -0.18). ROM after ESWT was also significantly improved compared to that in the control groups (MD: 18.01; 95% CI: 6.11 to 29.91). Baropodometric measures showed significantly increases in foot contact area during gait (SMD: 29.00; 95% CI: 11.08 to 46.92), but not significantly in peak pressure under the heel (MD: 15.12; 95% CI: -1.85 to 32.10) immediately after ESWT. No serious side effects were observed in any patient after ESWT. ESWT may be a valid alternative to existing treatment options targeting spasticity diminishment and ROM improvement in CP patients to maintain healthy lifestyles and normalize spastic gait pattern. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow-up studies are needed to verify our results.

Extracorporeal Shockwave Therapy Accelerates the Healing of a Meniscal Tear in the Avascular Region in a Rat Model

Background: The treatment of meniscal tears in the avascular region remains a clinical challenge. Extracorporeal shockwave therapy (ESWT) is a minimally invasive, safe, and effective therapy for various orthopaedic disorders. However, the therapeutic effect of ESWT on meniscal tears has not been reported. Purpose: To evaluate the therapeutic effect of ESWT in the treatment of meniscal tears. Study Design: Controlled laboratory study. Methods: Twelve-week-old male Wistar rats were divided into 3 groups (normal, ESWT–, and ESWT+). The authors made a full-thickness 2-mm longitudinal tear in the avascular region of the anterior horn in the latter 2 groups. At 1 week after surgery, the ESWT+ group received 800 impulses of shockwave at 0.22-mJ/mm2 energy flux density in a single session. The authors performed a histological examination to evaluate meniscal healing (n = 10 for each group) and immunohistochemistry to analyze the expression of bromodeoxyuridine (BrdU; n = 5 for each group) and CCN family member 2/connective tissue growth factor (CCN2/CTGF; n = 5 for each group) at 2, 4, and 8 weeks after ESWT. The mRNA levels of CCN2, SOX 9, VEGF-a, aggrecan, Col1a2, and Col2a1 at the site of the meniscal tear at 4 weeks after ESWT were quantitatively evaluated by a real-time polymerase chain reaction (n = 5 for each group). Results: The meniscus healing scores in the ESWT+ group were significantly higher than those in the ESWT– group at 4 weeks and 8 weeks. The ratio of BrdU-positive cells was the highest in the ESWT+ group at all observation periods. The ratio of CCN2-positive cells was highest in the ESWT+ group at 4 and 8 weeks. In the ESWT+ group, real-time polymerase chain reaction revealed that the levels of CCN2, SOX9, aggrecan, and Col2a1 were upregulated (All significant data were P < .05). Conclusion: ESWT promoted the healing of meniscal tears in the avascular area. ESWT stimulated proliferation of meniscal cells and the upregulation of cartilage-repairing factors such as CCN2, with the upregulation of cartilage-specific extracellular matrix expression. Clinical Relevance: ESWT may be an effective therapeutic option that promotes meniscal healing in the avascular region.

Extracorporeal shockwave therapy raises mechanical nociceptive threshold in horses with thoracolumbar pain

Although extracorporeal shockwave therapy (ESWT) is a common treatment for horses with back pain, effects on mechanical nociceptive threshold (MNT) and multifidus muscle cross sectional area (CSA) in the spine are unknown. To evaluate effects of ESWT on spinal MNT and multifidus muscle CSA in horses with thoracolumbar pain. Non-randomised trial. Thoracolumbar spines of 12 horses with thoracolumbar pain were radiographed to document existing pathology. Each horse received three ESWT treatments, 2weeks apart (days 0, 14, 28). Palpation scores were documented (days 0, 45 and 65). Ultrasonographic CSA of left and right multifidus muscles was recorded at T12, T14, T16, T18, L3 and L5 (days 0, 45 and 65). MNT was measured at the same spinal sites every 7days (day 0-56). Mechanical nociceptive threshold in 10/12 horses (83%) was greater at each time point compared with day 0 (P<0.05). Mechanical nociceptive threshold increased at all time points at six sites in 2/12 (16%), at five sites in 3/12 (25%), at four sites in 4/12 (33%) and at one site in 1/12 (8%; P<0.05). Mechanical nociceptive threshold average per cent increase from day 0 to 56 was 64% for the thoracic region (T12-T18) and 29% for the lumbar region (L3-L5). There was no statistical difference in MNT from day 35 to 56 (P=0.25). A bimodal analgesic trend was observed following ESWT. Degree of radiographic change was not associated with response to treatment. No significant change in multifidus muscle CSA was observed. Small study size and lack of control group. Three treatments of ESWT 2weeks apart raised MNT over a 56-day period in horses with back pain, but did not influence change in CSA of the multifidus muscle. While ESWT appears justifiable for analgesia, physiotherapeutic techniques may be necessary in conjunction for concurrent muscle rehabilitation.

Effects of Extracorporeal Shock Wave Therapy in The Maxillofacial Surgery Practice – A Systematic Review

This review intends to provide researchers with a brief summary of extracorporeal Shock Wave Therapy (ESWT), and to bring new perspectives by systematic reviewing of the available data on the results of the various effects of ESWT regarding dentistry and the maxillofacial area. Literature search was conducted on December 2017 using the PubmedMedline, Google Scholar, Scopus and Web of Science databases.Articles between 1989 and 2018 were included.Search was performed using the keywords ‘alveolar, dentoalveolar, maxilla, mandibular, oral and sialolthiasis’ words in combination with ‘shock wave or shockwave’. The studies that were decided to include to this systematic review (n: 35) mostly consist of experimental and clinical studies. The current systematic review stated that ESWT has a success rate of up to 50% in the treatment of sialolithiasis. Shock wave therapy has also different dose-dependent effects on each tissue in the intraoral region. Shock wave parameters that will bring optimal biological effect to any treatment indication are yet to be clarified.International Journal of Human and Health Sciences Vol. 03 No. 04 October’19 Page : 186-195

Effect of extracorporeal shockwave therapy on carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials.

Although several trials have reported the use of extracorporeal shock wave therapy (ESWT) for mild to moderate carpal tunnel syndrome (CTS), little is known about the efficacy of ESWT. Thus, we performed a meta-analysis to evaluate whether ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in CTS. Six randomized controlled trials investigating the effect of ESWT on CTS were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- or random-effects models. ESWT showed significant overall effect size compared to the control (overall Hedge g pooled standardized mean difference (SMD) = 1.447; 95% confidence interval [CI], 0.439-2.456; P = .005). Symptoms, functional outcomes, and electrophysiologic parameters all improved with ESWT treatment. However, there was no obvious difference between the efficacy of ESWT and local corticosteroid injection (pooled SMD = 0.418; 95% CI, -0.131 to 0.968; P = .135). A publication bias was not evident in this study. Our meta-analysis revealed that ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in patients with CTS. Further research is needed to confirm the long-term effects and the optimal ESWT protocol for CTS.

Protective effects of extracorporeal shockwave on rat chondrocytes and temporomandibular joint osteoarthritis; preclinical evaluation with in vivo99mTc-HDP SPECT and ex vivo micro-CT

Extracorporeal shockwave therapy (ESWT) has been shown to have chondroprotective effects on arthritic diseases. We investigated the effects of ESWT on temporomandibular joint osteoarthritis (TMJOA) using rat chondrocytes and TMJOA rat models. Cell viability and expression of pro-inflammatory cytokines, cartilage degradation, and apoptosis markers were measured in control, monosodium iodoacetate (MIA)-treated and ESWT plus MIA-treated chondrocytes invitro, and intra-articular MIA injection (TMJOA) and ESWT on TMJOA rats invivo. Invivo99mTc-hydroxymethylene diphosphonate (HDP) single-photon emission computerized tomography/computerized tomography (SPECT/CT) and ex-vivo micro-CT and histologic examinations were performed in rat models. ESWT plus MIA-treated chondrocytes showed increased cell viability significantly (P=0.007), while decreased genetic expression of pro-inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6); P<0.001 for each] and cartilage degradation markers [matrix metalloproteinase-3 (MMP3), matrix metalloproteinase-13 (MMP13), and bone morphogenetic protein 7 (BMP7); P<0.001 for each], and number of apoptotic cells (P<0.001) compared to MIA-treated chondrocytes. Changes in cytochrome c and cleaved caspase-3 levels relative to procaspase-3 were decreased over MIA-treated chondrocytes. ESWT on TMJOA rat models was associated with a significant decrease in pro-inflammatory and cartilage degradation markers, as demonstrated by real-time PCR and immunohistochemistry stains (P<0.001 for each). On 99mTc-HDP SPECT/CT, the ESWT group showed a significantly lower uptake ratio compared to the TMJOA group (P=0.008). Micro-CT analysis revealed that the ESWT group showed improved structure and bone quality compared to the TMJOA control group. ESWT was associated with a protective effect on cartilage and subchondral bone structures of TMJOA by reducing inflammation, cartilage degradation, and chondrocyte apoptosis.

Clinical and functional outcomes of extracorporeal shock wave therapy in isolated medial epicondylitis

Objective: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for the patients with isolated medial epicondylitis refractory to other conservative methods. Methods: A retrospective analysis of 57 patients with the diagnosis of isolated medial epicondylitis refractory to conservative measures was done. 36 of them who met our eligibility criteria were included. Patients were subjected to three sessions of extracorporeal shock wave therapy with 2000 pulses per a session in a dose of 0.06-0.12 mJ/mm2. Pain and clinical/functional scores were measured by visual analogue scale (VAS) and Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) respectively before the treatment and at 1st week and 12th week of the last session. Results: Mean age of the patients was 47.3 (25-67) years and there was a higher female presentation (24 female and 12 male patients). The VAS scores were improved from a mean of 7.8 before the treatment to 5.3 at 1st week (p &amp;lt; 0.001) and to 2.9 at 12th week (p &amp;lt; 0.001). Also the results of the Q-DASH showed a mean improvement from 50.4 before the treatment to 27.1 at 1st week (p &amp;lt; 0.001) and 9.6 at 12th week (p &amp;lt; 0.001). There were no significant differences in the improvements of VAS and Q-DASH scores by the time between the male and female patients. Conclusion: According to the results of this study which will be one of the limited studies about isolated medial epicondylitis; ESWT is a good conservative treatment option for medial epicondylitis in refractory cases like in lateral epicondylitis. 

Substantial Biomechanical Improvement by Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears

Background: Characteristics of chronic rotator cuff tears include continuous loss of tendon structure as well as tendon elasticity, followed by a high failure rate after surgical reconstruction. Several studies have already shown the beneficial effect of extracorporeal shockwave therapy (ESWT) on tissue regeneration in tendon pathologies. Hypothesis: ESWT improves biomechanical tendon properties as well as functional shoulder outcomes in chronic rotator cuff reconstruction in rodents. Study Design: Controlled laboratory study. Methods: After tendon detachment and 3 weeks of degeneration, a subsequent transosseous reattachment of the supraspinatus tendon was performed in 48 adult male Sprague-Dawley rats (n = 16 per group). Rodents were randomly assigned to 3 study groups: no ESWT/control group, intraoperative ESWT (IntraESWT), and intra- and postoperative ESWT (IntraPostESWT). Shoulder joint function, as determined by gait analysis, was assessed repeatedly during the observation period. Eight weeks after tendon reconstruction, the rats were euthanized, and biomechanical and gene expression analyses were performed. Results: Macroscopically, all repairs were intact at the time of euthanasia, with no ruptures detectable. Biomechanical analyses showed significantly improved load-to-failure testing results in both ESWT groups in comparison with the control group (control, 0.629; IntraESWT, 1.102; IntraPostESWT, 0.924; IntraESWT vs control, P≤ .001; IntraPostESWT vs control, P≤ .05). Furthermore, functional gait analyses showed a significant enhancement in intensity measurements for the IntraPostESWT group in comparison with the control group (P≤ .05). Gene expression analysis revealed no significant differences among the 3 groups. Conclusion: Clearly improved biomechanical results were shown in the single-application and repetitive ESWT groups. Furthermore, functional evaluation showed significantly improved intensity measurements for the repetitive ESWT group. Clinical Relevance: This study underpins a new additional treatment possibility to prevent healing failure. Improved biomechanical stability and functionality may enable faster remobilization as well as an accelerated return to work and sports activities. Furthermore, as shockwave therapy is a noninvasive, easy-to-perform, cost-effective treatment tool with no undesired side effects, this study is of high clinical relevance in orthopaedic surgery. Based on these study results, a clinical study has already been initiated to clinically confirm the improved functionality by ESWT.

Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-Analysis

ObjectiveTo investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application.MethodsPubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria.ResultsThe estimate of effect size showed statistically significant MAS grade reduction immediately after treatment (standardized mean difference [SMD]=-0.57; 95% confidence interval [CI], -1.00 to -0.13; p=0.012), 1 week after (SMD=-1.81; 95% CI, -3.07 to -0.55; p=0.005), 4 weeks after (SMD=-2.35; 95% CI, -3.66 to -1.05; p<0.001), and 12 weeks after (SMD=-1.07; 95% CI, -2.04 to -0.10; p=0.03). Meta-regression and subgroup analysis were performed for the ‘immediately after ESWT application’ group. The prediction equation obtained from metaregression was -1.0824+0.0002* (number of shocks), which was not statistically significant. Difference in MAS grade reduction depending on site of application was not statistically significant either in subgroup analysis (knee and ankle joints vs. elbow, wrist, and finger joints).ConclusionESWT effectively reduced spasticity levels measured with MAS regardless of patient group. Its effect maintained for 12 weeks. The number of shocks or site of application had no significant influence on the therapeutic effect of ESWT in reducing spasticity. Ongoing trials with ESWT are needed to address optimal parameters of shock wave to reduce spasticity regarding intensity, frequency, and numbers.

PO-01-010 Synergistic effects of extracorporeal shockwave therapy and Korean herbal formulation on erectile dysfunction in diabetic animal model

Studies on low-intensity extracorporeal shockwave therapy (ESWT) for the treatment of refractory erectile dysfunction (ED) have been reported to date, but inconclusive evidence has been obtained. KH-204, a Korean herbal formula has been reported to have anti-oxidative effects many times. We investigated the synergy effect of ESWT with KH-204 in an animal model of diabetes mellitus (DM) - induced ED. Streptozotocin-induced DM rats were divided into 5 groups: group 1, control; group 2, DM; group 3, DM + ESWT; group 4 DM + KH-204; and group 4 DM + ESWT + KH-204. In ESWT groups rats were treated with ESWT 3 times a week for 2 weeks. The KH-204 groups were treated with a daily oral dose of KH-204 for 12 weeks. After all treatments, intracavernous pressure (ICP) was measured, and the cavernous tissues were evaluated. ICP was evaluated as a measurement of erectile function. The DM + ESWT, DM + KH-204, and DM + ESWT + KH-204 groups showed significantly restored erectile function compared with the DM group (p<0.05). Among these groups, the DM+ ESWT + KH-204 group showed the highest ICP. Moreover, ESWT and KH-204 treatment restored smooth muscle contents and many parameters related to potency including vascular endothelial growth factor, eNOS, platelet endothelial cell adhesion molecule, cGMP and nNOS expression levels compared with the DM group (p<0.05).

Extracorporeal Shock Wave Therapy Immediately Affects Achilles Tendon Structure and Widespread Pressure Pain Thresholds in Healthy People: A Repeated-Measures Observational Study.

Extracorporeal shockwave therapy is a common clinical treatment for tendinopathy, yet negative effects on tendon structure have been shown in animal studies. This study aimed to investigate the effect of extracorporeal shockwave therapy in healthy participants (i.e., no Achilles tendon pain or pathology). This study examined the effect of three bouts of weekly extracorporeal shockwave therapy for 3 wks in 13 healthy participants. Outcomes measures assessed were as follows: (a) Achilles tendon structure, quantified using ultrasound tissue characterization (before and 3 hrs after extracorporeal shockwave therapy), (b) pressure pain thresholds, over the Achilles tendon and common extensor tendon origin (before, immediately after, and 3 hrs after extracorporeal shockwave therapy), and (c) hop pain (before and immediately after extracorporeal shockwave therapy). There was a significant reduction in echo type I (P < 0.05) and increase in echo type II (P < 0.05) at 3 hrs after the first extracorporeal shockwave therapy session that recovered to baseline levels before week 2. There were no significant changes in ultrasound tissue characterization echo pattern observed in subsequent sessions. There were increased pressure pain thresholds immediately after extracorporeal shockwave therapy at the common extensor tendon origin but no significant change at the Achilles tendon. Pressure pain thresholds returned to baseline at 3 hrs after extracorporeal shockwave therapy. There were no significant changes in pressure pain threshold in subsequent sessions. Extracorporeal shockwave therapy resulted in transient changes to tendon structure and widespread hyperalgesia.

Effects of Extracorporeal Shockwave Therapy and Hand Massage on Body Composition and Serum Lipids According to Serum Cholesterol Level in Korean Women

Obesity, particularly abdominal obesity, increases the risk of cardiovascular disease (CVD). This study investigates the effects of six-week (twice a week, 12 sessions total) extracorporeal shockwave therapy (SWT) and hand massage therapy (HT) on body composition and serum lipids in overweight and obese Korean women aged between 35 and 59, according to their serum cholesterol level (≥200 mg/dL versus <200 mg/dL). After the program, weights decreased significantly in both the HT Group and SWT Group (p < 0.05); weights of those with cholesterol < 200 mg/dL significantly decreased in the HT Group (p = 0.038), while weights of those with cholesterol ≥ 200 mg/dL significantly decreased in the SWT Group (p = 0.001). BMIs decreased significantly in both the HT Group and the SWT Group (p < 0.05); BMIs of those with cholesterol < 200 mg/dL significantly decreased in the HT Group (p = 0.018), while BMIs of those with cholesterol ≥ 200 mg/dL significantly decreased in the SWT Group (p = 0.001). The body fat percentage of subjects significantly decreased only in the SWT Group (p = 0.027); the waist-hip ratio significantly decreased only in HT Group (p = 0.034). Serum cholesterol levels significantly decreased in those with cholesterol < 200 mg/dL in the HT Group (p < 0.05) and those with cholesterol ≥ 200 mg/dL in SWT Group (p = 0.055). Triglyceride significantly decreased in both those with cholesterol < 200 mg/dL and those with cholesterol ≥ 200 mg/dL, but did not significantly decrease in either subgroup of the HT Group. The study results suggest that SWT is effective in improving body measurements and serum lipids in those with cholesterol ≥ 200 mg/dL, while HT therapy is effective in those with cholesterol < 200 mg/dL. In conclusion, SWT and HT improved abdominal obesity by reducing body weight and waist circumference and helped improving serum lip index, suggesting the benefit for managing body measurements and serum lipids of overweight and obese individuals.

Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke.

Extracorporeal shock wave therapy (ESWT) has been suggested as a useful treatment for spasticity in patients with stroke. To date, most studies have used clinical or biomechanical assessments to determine the effects of treatment. To assess the effect of a single session of ESWT through ultrasonographic assessment on spasticity in patients with chronic stroke. Randomized controlled trial. Rehabilitation center. Eighteen patients with chronic stroke. Participants were randomly assigned to an ESWT group (n = 9) or control group (n = 9). In the ESWT group, a single session of ESWT was given in the medial head of the gastrocnemius muscle of the spastic side at 4 Hz, 2000 shots with intensity of stimulation using energy of 0.1 mJ/mm2 . Sham stimulation was provided by only making sound without putting the device into contact with the skin in the control group. The clinical trial registration number of this study is KCT0002582. Participants were evaluated prior to the treatment, 30 minutes, 1 week, and 4 weeks after treatment. Clinical measures included Modified Ashworth Scale (MAS), passive range of motion (PROM), and Fugl-Meyer Assessment (FMA). As the primary outcome measure, the ultrasonographic measures were Achilles tendon length (ATL), muscle fascicle length (MFL), muscle thickness (MT), and pennation angle (PA). There were no significant differences between the 2 groups for any demographic or baseline measures. At all follow-up evaluations, improvement was shown in MAS as well as changes from baseline of ultrasonographic measures in the ESWT group compared to the control group. In the case of ultrasonographic measures, the difference between the group was greatest at 4 weeks. At follow-up of 4 weeks, between-group difference was 0.66 points (P = .04) on MAS scores, 5.45 points (P = .004) on ATL scores, 4.95 points (P = .002) on MFL scores, 1.83 points (P < .001) on MT scores, and 3.73 points (P < .001) on PA scores. Some ultrasonographic measures of spasticity as well as MAS were improved after a single session of ESWT. Future studies with larger numbers of subjects compared with other spasticity metrics are necessary to further evaluate the treatment effect of ESWT. II.

The Effects of Abdominal Therapy on Quality of Life and Body Image: Focusing on extracorporeal shockwave therapy (ESWT) and manipulative therapy

This study attempted to investigate the effects of extracorporeal shockwave therapy (ESWT) and manipulative therapy on aesthetic factors &#8211; obesity-related quality of life and body image. For this, the therapies were given a total of 12 times to 45 middle-aged women with abdominal obesity (BMI: 23kg/ ㎡ or higher, WHR: 0.80 or higher, waist circumference: 80cm or greater) aged 35-59 living in Busan and Gyeongnam. According to analysis using SPSS 20.0, compared to manipulative therapy, the ESWT improved the obesity-related quality of life (F=79.828, p<0.001) and had a positive influence on appearance evaluation (F=136.554, p<0.001), health evaluation (F=19.912, p<0.001), appearance orientation (F=57.377, p<0.001), fitness orientation F=5.527, p=0.023), health orientation (F=31.061, p<0.001), preoccupation with being overweight (F=68.407, p<0.001) and body area satisfaction (F=133.102, p<0.001). In fitness evaluation and self-classification weight, there were no differences between the two groups. In addition, test subjects were satisfied with the abdominal care and realized its necessity regardless of how high or low the obesity-related quality of life/body image was. It’s anticipated that the study results would be available as evidence-based effective data that has considered an aesthetic aspect referring to the pursuit of feminine beauty.

Power Doppler Ultrasound Findings before and after Focused Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Pilot Study on Pain Reduction and Neovascularization Effect

Extracorporeal shock wave therapy (ESWT) has been found to have a positive effect in the treatment of pain in Achilles tendinopathy, although the exact mechanism is not yet completely understood. Among the mechanisms suggested to underlie ESWT effects are direct stimulation of healing, neovascularization and direct suppressive effects on nociceptors and hyperstimulation, which would block the gate-control system. The neovascularization observed in flogistic tissue is associated with stimulated nerve fibers around tendons and induces a painful condition. The objectives of the present study were to evaluate the effect of ESWT on pain and function in patients with non-insertional Achilles tendinopathy (NIAT) and to assess the neovascularization phenomenon using power Doppler ultrasound (PDU). Twelve patients with NIAT underwent five sessions of focused ESWT over 5 wk. Outcome measures were the visual analogue scale, the Victorian Institute of Sport Assessment–Achilles questionnaire and active dorsiflexion and plantar flexion ankle articular range of motion. Moreover, the patients’ clinical impressions of treatment results after ESWT were investigated using the Roles and Maudsley score. Patients were assessed at baseline and 1 and 3 mo after treatment. They had a significant reduction in pain with improvement of arthrokinematic motion and functionality and a positive clinical impression of treatment outcome (50% of patients considered their clinical picture as good/excellent after 3 mo). However, the pulse Doppler ultrasound exam did not reveal neovascularization in 91.7% of the patients 1 and 2 mo after focused ESWT, and in some patients there was a reduction in blood vessels related to flogistic processes. The present observational study confirmed the efficacy of ESWT in pain reduction in NIAT, with a higher degree of patient satisfaction, although doubt persists over the neovascularization effect on the Achilles tendons treated.

Effectiveness of extracorporeal shock-wave therapy for frozen shoulder: A protocol for a systematic review of randomized controlled trial.

Background:This systematic review aims to explore the effectiveness and safety of extracorporeal shock-wave therapy (ESWT) for patients with frozen shoulder.Methods:The sources of Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and Websites of Clinical Trials Registry will be searched. All databases and other sources will be searched from inception to the date of the search will be run. Only randomized controlled trials of ESWT for frozen shoulder will be considered for inclusion in this systematic review. Two authors independently screen the studies, extract the data, and evaluate the methodology quality for included trials. If sufficient trials will be included with fair heterogeneity, the data will be pooled, and the meta-analysis will be performed by using RevMan 5.3 software.Results:This systematic review will assess the effectiveness and safety of ESWT for frozen shoulder. The primary outcome includes pain intensity. The secondary outcomes consist of shoulder function, quality of life, and also the adverse events.Conclusion:Its findings may provide latest evidence of ESWT for the treatment of frozen shoulder.Ethics and dissemination:No research ethics approval is required in this study, because it is a systematic review and will not use individual data. The results of this study are expected to publish at peer-reviewed journals.

The effectiveness of extracorporeal shockwave therapy for frozen shoulder in patients with diabetes: randomized control trial.

[Purpose] This study examined the effectiveness of extracorporeal shock wave therapy versus ultrasound therapy, combined with the mobilization and therapeutic exercise in both groups, in participants with diabetic frozen shoulder. [Participants and Methods] Twenty participants with diabetic frozen shoulder were divided into an experimental group who received extracorporeal shock wave therapy, mobilization and exercises (n=10, Mean: 43.70) and the control group who received ultrasound, mobilization and exercises (n=10 Mean: 45.50). The clinical outcomes, i.e., a) pain b) active range of motions of the shoulder, c) disability scores by Disabilities of the Arm, Shoulder and Hand scale and d) global rating of change was measured weekly for four weeks. [Results] Significant improvements in pain, all active range of motions and disability scores were observed at the end of the 4th week in both groups. Additionally, the experimental group benefitted significant pain reduction (median difference: 7 in experimental versus 6 in control group), reduced number of therapy sessions and thus the costs of treatment compared to the control group. [Conclusion] Extracorporeal shock wave therapy significantly reduced pain in people with diabetic frozen shoulder with a reduction of treatment cost compared to the control group.

Extracorporeal Shockwave Therapy in Pillar Pain after Carpal Tunnel Release: A Prospective Randomized Controlled Trial.

Background:The aim of this study was to evaluate the effect of extracorporeal shockwave therapy (ESWT) on pillar pain after carpal tunnel release.Materials and Methods:In this prospective randomized controlled trial, forty patients with pillar pain for at least 1 month after carpal tunnel release surgery were randomly assigned in two groups. ESWT group received four sessions of ESWT at weekly intervals, and patients in the control group received sham ESWT treatment at the same intervals, involved sound but no energy. At baseline, 1st month, and 3rd month, hand function (using Brief-Michigan Hand Outcome Questionnaire) and pain score were assessed and compared between groups.Results:At baseline, pain score and hand function score were similar in both groups. After 1st month, pain score in ESWT and control groups was 3.7 versus 4.7, respectively (P = 0.066), and hand function score was 60.7 versus 52.2, respectively (P = 0.032). After 3 months, pain score in ESWT group was significantly lower than the control group (1.6 versus 3.6, respectively, P < 0.0001), hand function score in ESWT group was significantly better than the control group (75.4 vs. 63.7, respectively, P < 0.0001). Trend of decrease in pain score between groups was significantly different, but trend of increase in hand function score was not significantly different.Conclusion:After ESWT, hand function and pain score in patients with pillar pain improved faster compared to control patients. Hence, ESWT can be used as a safe and effective noninvasive technique in patients with pillar pain after carpal tunnel release.

Shockwave Targeting on Subchondral Bone Is More Suitable than Articular Cartilage for Knee Osteoarthritis.

Our study compared the effects of extracorporeal shockwave therapy (ESWT) on the subchondral bone and the articular cartilage in the treatment of early osteoarthritis (OA) of rat knee. The rats were divided into 5 groups which included Sham group, Meniscus group (ESWT applied on medial meniscus), OA group (arthrotomy and medial menisectomy (MMx) and anterior cruciate ligament transection (ACLT), T(M) group (arthrotomy and MMx and ACLT followed by ESWT on medial tibial subchondral bone) and Articular cartilage group (arthrotomy and MMx and ACLT followed by ESWT on medial articular cartilage). Evaluations included the pathological changes of the synovium, articular cartilage and subchondral bone, and compared with ESWT on the meniscus, medial tibial subchondral bone and articular cartilage. The ESWT (0.25 mJ/mm² and 800 impulses) did not cause any damages on the cartilage of the meniscus and the tissue of the joint when compared with Sham group. Among the treatment of osteoarthritic groups (OA, T(M) and Articular cartilage groups), T(M) group showed significant in pathological examination, micro-CT analysis, cartilage grading score and grading of synovium changes by compared with OA and Articular cartilage groups (P < 0.05) in the treatment of early OA knee. In immunohistochemical analysis, T(M) group significantly increased the expression of TGF-β1 but reduced DMP-1, MMP-13 and ADAMTS-5 in the cartilage by compared with OA group and Articular cartilage group (P < 0.05). Our results showed that subchondral bone was an excellent target than articular cartilage for ESWT on early knee osteoarthritis.

Synergistic effects of extracorporeal shockwave therapy and modified Ojayeonjonghwan on erectile dysfunction in an animal model of diabetes.

PurposeWe investigated the synergy effect of extracorporeal shock wave therapy (ESWT) with modified Ojayeonjonghwan (Korean herbal formula, KH-204) in an animal model of diabetes mellitus (DM)-induced erectile dysfunction (ED).Materials and MethodsEight-week-old male Sprague-Dawley rats were used in this study. DM was induced by an intraperitoneal injection of streptozotocin. DM rats were divided into 5 groups (n=10 per group): group 1, control; group 2, DM; group 3, DM+ESWT; group 4, DM+KH-204; and group 5, DM+ESWT+KH-204. In ESWT groups, rats were treated with ESWT at the penis 3 times a week for 2 weeks under anesthesia. The KH-204 groups were treated with a daily oral dose of KH-204 for 12 weeks. After all treatments, intracavernosal pressure (ICP) was measured, and the cavernous tissues were evaluated by Masson's trichrome, immunohistochemistry and western blot analysis.ResultsICP was evaluated as a measurement of erectile function. The DM+ESWT, DM+KH-204, and DM+ESWT+KH-204 groups showed significantly restored erectile function compared with the DM group (p<0.05). Among these groups, the DM+ESWT+KH-204 group showed the highest ICP. Moreover, ESWT and KH-204 treatment restored smooth muscle contents and many parameters related to potency (vascular endothelial growth factor, neuronal nitric oxide synthase (NOS), endothelial [NOS] and platelet endothelial cell adhesion molecule-1) compared with the DM group (p<0.05).ConclusionsWe confirmed the potential efficacy of ESWT and KH-204 in the treatment of ED patients using an animal model. The combination treatment of KH-204 and ESWT is expected to have good potential clinical results in the future treatment of refractory ED.