Efficacy Of Extracorporeal Shock Wave Therapy Research Articles

Efficacy of extracorporeal shockwave therapy, compared to corticosteroid injections, on pain, plantar fascia thickness and foot function in patients with plantar fasciitis: A systematic review and meta-analysis.

To compare the efficacy of extracorporeal shock waves versus corticosteroids injections on pain, thickness of plantar fascia and foot function in patients with plantar fasciitis. Secondarily, to assess the efficacy of radial and focused extracorporeal shock waves and the most appropriated intensity (high, medium or low). PubMed, SCOPUS, CINAHL and PEDro, until April 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials comparing the efficacy of extracorporeal shock waves versus corticosteroids injections on pain intensity and sensitivity, thickness of plantar fascia and foot function in patients with plantar fasciitis. Methodological quality and risk of bias were assessed using PEDro Scale and Cochrane Risk of Bias Tool. Pooled effect was calculated using the standardized mean difference (SMD) and its 95% confidence interval (95%CI). Sixteen studies involving 1121 patients, showing a mean of 6 points in PEDro scale, were included. At three months, extracorporeal shock waves were better than corticosteroids injections in reducing pain (SMD -0.6; 95%CI -1.1 to -0.11) and thickness of the plantar fascia (SMD -0.4; 95%CI -0.8 to -0.01) and increasing foot function (SMD 0.27; 95%CI 0.12-0.44). At six months, extracorporeal shock waves are more effective in reducing pain (SMD -0.81; 95%CI -1.6 to -0.06) and increasing foot function (SMD 0.67; 95%CI 0.45-0.89). Local pain and slight erythema were the most frequent adverse events. Extracorporeal shock waves are a safe therapy, presenting more efficacy than corticosteroids injections in improving pain, thickness of plantar fascia and foot function at mid-term.

The Efficacy of Extracorporeal Shockwave Therapy Compared with Compression Therapy in Healing Venous Leg Ulcers.

Background: Innovative methods of physical therapy delivered via modern medical devices have significantly extended the possibility of applying conservative treatments in healing venous leg ulcers. The primary objective of this study was to compare the therapeutic efficacy of selected mechanical physical therapies (intermittent pneumatic compression vs. radial extracorporeal shockwave vs. focal extracorporeal shockwave) vs. standard care in the treatment of venous leg ulcers over a 4-week period. Materials: This study included 69 patients, comprising 45 females (65%) and 24 males (35%), with a mean age of 67.1 ± 8.6 years (range: from 52.0 to 80.0 years). Methods: The patients were allocated into four groups: the IPC group was treated with intermittent pneumatic compression therapy, the R-ESWT group was treated with radial extracorporeal shockwave therapy, the F-ESWT group was treated with focal extracorporeal shockwave therapy, and the SC group was treated with standard care. Results: After one month of therapy, the median percentage decrease in wound total surface area after treatment was as follows: in the IPC group, there was a 52.9% decrease (range: 3.3-100%); in the R-ESWT group, there was a 31.6% decrease (range: 2.4-95.8%); in the F-ESWT group, there was an 18.0% decrease (range: 1.9-76.1%); and in the SC group, there was a 16.0% decrease (range: 1.5-45.8%). Conclusions: All the studied therapies caused a statistically significant reduction in the surface area of venous leg ulcers. The best results were observed with the intermittent pneumatic compression, while the radial and focal extracorporeal shockwave therapies appeared less effective. The standard care alone turned out to be the least effective. Our results did not show statistically significant changes in the values of RBC deformability at the investigated shear rates.

Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review

ObjectiveTo determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals.DesignSystematic review.Data sourcesWe followed the Preferred Reporting Items...

Effectiveness of extracorporeal shockwave therapy in treatment of upper and lower limb tendinopathies: Asystematic review and meta-analysis.

Tendinopathy is caused by repetitive motion, excessive stress on the tendon, overstretch, and motion past the critical angle of rotation or translation. There are various treatment options available for tendinitis, including those affecting both the upper and lower limbs and those of calcific and non-calcific types. Few reviews have analyzed the efficacy of Extracorporeal Shockwave Therapy (ESWT) in treating upper and lower limb tendinopathies while considering calcific and non-calcific-type tendinitis. This paper provides a review and meta-analysis on Randomized Controlled Trials (RCTs), which compared results from a group undergoing ESWT treatment to another group under different treatments. Systematic review and meta-analysis. A systematic search was conducted on PubMed, Web of Science, Embase, the Cochrane Central Register of Control Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) databases for articles published up to January 2022. The reference lists of identified articles were further scanned. Twenty-two studies were included in the meta-analysis. Meta-analysis showed no difference in pain reduction in ESWT when compared with a comparison group at 4 (p=0.26) and 12weeks (p=0.33). There were no differences in DASH scores at 12months between the two groups (p=0.32). Extracorporeal Shockwave Therapy (ESWT) is effective when used to treat lower limb and calcific tendinitis. It does not yield any better results than other treatment options in managing upper limb tendinopathies and non-calcific tendinopathies.

Efficacy of Extracorporeal Shockwave Therapy on Pain and Function in Myofascial Pain Syndrome: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

The aim of the study is to examine the effectiveness of extracorporeal shockwave therapy in reducing pain, improving functionality, joint range of motion, quality of life, fatigue, and health status self-perception in people with myofascial pain syndrome. PubMed, the Cochrane Library, CINAHL, the Physiotherapy Evidence Database, and SPORTDiscus were systematically searched for only randomized clinical trials published up to June 2, 2022. The main outcome variables were pain, as reported on the visual analog scale and pressure pain threshold, and functionality. A quantitative analysis was conducted using the inverse variance method and the random effects model. Twenty-seven studies were included ( N = 595 participants in the extracorporeal shockwave therapy group). The effectiveness of extracorporeal shockwave therapy for relieving pain was superior for the extracorporeal shockwave therapy group compared with the control group on the visual analog scale (MD = -1.7 cm; 95% confidence interval = -2.2 to -1.1) and pressure pain threshold (mean difference = 1.1 kg/cm 2 ; 95% confidence interval = 0.4 to 1.7) and functionality (standardized mean difference = -0.8; 95% confidence interval = -1.6 to -0.04) with high heterogeneity. However, no differences were found between extracorporeal shockwave therapy and other interventions as dry needling, exercises, infiltrations, and lasers interventions. Extracorporeal shockwave therapy is effective in relieving pain and improving functionality in patients with myofascial pain syndrome compared with control and ultrasound therapy. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Determine the effectiveness of radial and focal extracorporeal shockwaves on pain perception, the pressure pain threshold, and functionality in people with myofascial pain syndrome; (2) Describe the intervention protocol of extracorporeal shockwave therapy to improve pain perception in people with myofascial pain syndrome; and (3) Describe the advantages and disadvantages of extracorporeal shockwave therapy versus other intervention such as dry needling. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

A Comprehensive Review of the Effects of Extracorporeal Shock Wave Therapy on Stroke Patients: Balance, Pain, Spasticity.

Stroke remains a leading cause of disability worldwide, with survivors often experiencing impairments in balance, pain, spasticity, and control that limit their ability to perform daily living activities. Extracorporeal shock wave therapy (ESWT) has emerged as a potential treatment modality to improve these outcomes in stroke patients. This review aims to provide a comprehensive examination of the effects of ESWT on stroke patients, focusing on the theoretical background, balance, pain reduction, muscle spasticity and control, and upper and lower extremities. This study reviewed the use of ESWT in treating balance, pain, and spasticity in stroke patients, focusing on articles published in PubMed between January 2003 and January 2023. Systematic reviews related to stroke were used to provide an overview of stroke, and a total of 33 articles related to balance, pain, and spasticity were selected. ESWT has several shock wave generation methods and application methods, and it has been shown to have positive therapeutic effects on various aspects of rehabilitation for stroke patients, such as improving balance, reducing pain, decreasing muscle spasticity and increasing control, and enhancing functional activities of the upper and lower extremities. The efficacy of ESWT may vary depending on the patient's condition, application method, and treatment area. Therefore, it is important to apply ESWT according to the individual characteristics of each patient in clinical practice to maximize its potential benefits.

Efficacy of Extracorporeal Shockwave Therapy in the Treatment of Patients with Trigger Finger

Efficacy of Extracorporeal Shockwave Therapy in the Treatment of Patients with Trigger Finger

Evaluation of the Effects of Extracorporeal Shockwave Therapy in Patients With Peripheral Arterial Disease: A Meta-Analysis of Randomized Control Trials.

The aim of this meta-analysis is to assess the efficacyof extracorporeal shockwave therapy (ESWT) in patients with peripheral arterial disease (PAD).This meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted independently by two authors using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to January 15, 2023. Primary clinical outcomes assessed in this meta-analysis were changes in maximum waking distance (MWD) and pain-free walking distance (PFWD) from baseline. Other outcomes assessed included change in ankle brachial pressure index (ABI) and degree of arterial stenosis. Four RCTs involving a total of 228 patients were included. Change ofPFWD and MWD from baseline was significantly higher in patients randomized in the ESWT group as compared to the control group. No significant differences were reported between the two groups in terms of change in ABI from baseline. In conclusion, this meta-analysis of four randomized controlled trials found evidence that ESWTis an effective treatment for patients with PAD in terms ofimproving PFWD and MWD and reducing stenosis. However, there was no significant difference in the improvement of the ankle-brachial index between the study groups.

Efficacy of Extracorporeal Shockwave Therapy versus Corticosteroid Injection in Patients with Myofascial Pain Syndrome: A Prospective Study

Efficacy of Extracorporeal Shockwave Therapy versus Corticosteroid Injection in Patients with Myofascial Pain Syndrome: A Prospective Study

Dosing and efficacy of extracorporeal shockwave therapy for diabetic foot ulcer healing: a systematic review protocol

Background: Effective interventions to improve diabetic foot ulcer (DFU) healing are urgently required. Extracorporeal shockwave therapy (ESWT) has the potential to transform DFU care, but is limited by uncertainties around clinical effectiveness and optimal dosing regimen. This protocol outlines the methodology of a systematic review that will address these unknowns. Methods: Databases and the grey literature will be searched for randomised controlled trials (RCTs) comparing ESWT plus standard ulcer care to standard ulcer care ± sham ESWT in patients with a DFU. The primary outcome of the review is time to ulcer healing. Two independent reviewers will screen search results against pre-determined eligibility criteria and extract data onto a pre-piloted spreadsheet. A meta-analysis is planned to compare time to healing for ESWT versus standard care and different doses of ESWT. The Risk of Bias 2 and GRADE tool will be used to assess the quality of the evidence. Outputs, dissemination, impact: The review will provide an estimate of the effect of ESWT on DFU healing and the impact of the ESWT dose on DFU healing. The systematic review will be submitted for publication in a peer-reviewed journal. A plain English summary will be produced. Outputs from the review will guide patient care and research.

Impact of soft tissue around the knee on the efficacy of extracorporeal shockwave therapy in knee osteoarthritis

Knee osteoarthritis (KOA) is the leading cause of knee pain in middle-aged and older individuals. Extracorporeal shockwave therapy (ESWT) has been applied to treat patients with KOA to reduce pain and improve function. Patients (n = 123) diagnosed with KOA who received ESWT were selected to participate in this study, and were grouped according to their body mass index (BMI). The treatment parameters were as follows: 8000 pulses, 2.0 bar, 0.25 mJ/mm2, and 6 Hz/s once per week for 8 weeks. The visual analog scale (VAS), Lequesne index, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were measured to assess knee pain and functional recovery according to BMI groups. Radiographs were used to measure the richness of the soft tissue around the knee joint. The correlation between the distribution of tissue, pain, and functional improvement was analyzed using the receiver operator characteristic curve. All the patients showed a reduction in pain after treatment compared to that before treatment (P < .01). As measured by the VAS, the Lequesne and WOMAC indexes, after the intervention, the pain and functional index of the overweight and above BMI group improved to a greater extent than that of the normal or below normal BMI group (P < .01). The area under the curve showed, with VAS as the demarcation criterion, when the tibial plateau soft tissue ratio, femoral intercondylar apex soft tissue ratio, and medial tibial soft tissue ratio exceeded 1.538, 1.534, and 1.296, respectively, the patient's pain relief was more pronounced the ESWT treatment was better. With pain in WOMAC as the demarcation criterion, the tibial plateau soft tissue ratio, femoral intercondylar apex soft tissue ratio, and medial tibial soft tissue ratio also are positively correlated with pain relief in patients. When the Lequesne and WOMAC scores were the demarcation criteria, the patients' function improved significantly when the patella apical soft tissue ratio exceeded 2.401 and 2.635, respectively. ESWT can effectively alleviate pain and improve knee function in patients with KOA, and the soft tissue around the knee joint should also be an important reference factor in KOA treatment.

Treatment of Jumper's Knee with Extracorporeal Shockwave Therapy: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to determine the therapeutic efficacy of extracorporeal shockwave therapy (ESWT) for athletes with patellar tendinopathy. We searched PubMed, EBSCOHost and Ovid for randomized controlled trials (RCTs) which evaluated the therapeutic efficacy of ESWT in athletes with jumper's knee. The methodological quality of RCTs was rated with the Physiotherapy Evidence Database scale. Data in the meta-analysis were expressed as standardized mean difference (SMDs) and 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Of 192 records identified, a total of seven articles met the inclusion criteria. The ESWT and control groups with any other conservative treatment did not differ significantly with respect to the Visual Analogue Scale (VAS) long-term scores obtained at ≥ 6 months of therapy completion (SMD: -0.33; 95% CI: -4.64 to 3.98; p = 0.87; I2= 98%). Furthermore, no significant differences were found between the ESWT and control groups regarding the pooled Victorian Institute of Sports Assessment for Patella (VISA-P) scores for long-term outcomes (SMD: 8.21; 95% CI: -39.3 to 55.73; p = 0.73; I2= 99%). The ESWT and control groups did not differ significantly on the VAS and VISA-P scores for long-term outcomes. In both cases, heterogeneity was considered to be high. Hence, no clear and generalized conclusions can be drawn regarding ESWT effectiveness in athletes with patellar tendinopathy.

Diagnosis and treatment of frozen shoulder with shock-wave therapy

Introduction: Adhesive capsulitis is pathology of the gleno-humeral joint that causes joint pain and immobility. The cause in most cases is unknown. Conservative treatment is good but still unclear, ESWT is an adjunctive and effective therapy for treatment. Objectives: To analyze the effectiveness of Shock-Wave therapy (ESWT) in the treatment of pain and ROM in frozen shoulder. Method: We based on 7 studies, taken from medical websites (PubMed,Medline, WebMD, MedScope). Patients diagnosed with adhesive capsulitis in all studies taken in reference were randomly divided into two groups. In studies [1], Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis and [3], Extracorporeal Shockwave Therapy Improves Functional Outcomes of Adhesive Capsulitis of the Shoulder in Patients With Diabetes one group was treated with ESWT, the other with oral AINS In studies [2]. The efficacy of radial extracorporeal shockwave therapy in shoulder adhesive capsulitis: a prospective, randomised, double-blind, placebo-controlled, clinical study one group was treated with ESWT, and the other with placebo treatment. In study [4], the effects of extracorporeal shock wave therapy on frozen shoulder patients’ pain and functions. All patients received NSAIDs once a day. The subjects of this study were divided into the conservative physical therapy group one group was treated with ESWT, All subjects were treated 2 times a week for 6 weeks. In within-group comparisons of VAS and PSFS, both ESWT and CPT groups showed significant decreases in VAS and PSFS. In comparisons between VAS and PSFS groups, ESWTG showed much lower results compared to CPTG. In studies [6], Efficacy of Extracorporeal Shockwave Therapy in Frozen Shoulder and [7] Shock Wave Therapy and Ultrasound Therapy plus Exercises for Frozen Shoulder Joint Clients, one group was treated with ESWT, the other with conservative physical therapy Results: For the studies considered it was observed that: patients treated with ESWT have an earlier and more noticeable improvement in pain and functionality, articular ROM compared to the effect from other treatments such as: (placebo, AINS, conservative treatment, ultrasound) applied to patients. Conclusions: Based on the above studies, it is concluded that ESWT is more effective in treating pain and functionality, articular ROM, compared to other treatments applied to the groups of patients diagnosed with adhesive capsulitis.

Efficacy of Extracorporeal Shockwave Therapy on Knee Osteoarthritis Related Pain and Activities of Daily Living: A Systematic Literature Review

PurposeExtracorporeal Shockwave Therapy (ESWT) is currently being marketed and advertised as a safe treatment alternative for various musculoskeletal conditions including osteoarthritis. There has been an increased interest in the use of ESWT as a noninvasive passive modality by physical therapists as an adjunct to holistic care. This literature review aims to look at the state of evidence among previous systematic reviews and randomized controlled trials examining the application of ESWT for pain and activities of daily living (ADL) outcomes for individuals with knee osteoarthritis (OA).MethodologySystematic literature searches for randomized controlled trials between 2010‐2021 were performed in the databases of PubMed, PEDro Database, Google Scholar, Cochrane Library, EBSCO between November 18 to December 8, 2021. A total of six randomized controlled trials (full text available, PEDro score &gt; 6, and conducted in the past 11 years) with a total of 459 subjects met quality guidelines using the PEDro scale. There were 5 systematic reviews (full text available, inclusion criteria, pain and ADL outcome measures, and conducted in the past 11 years) with a total of 6922 subjects that met methodological guidelines.ResultsA total of 2682 articles were screened, and 6 studies with a total population of n = 459 were included in this review. With heterogeneity in frequency, dosage, and volume no meta‐analysis was conducted. There were statistically significant improvements reported in the use of ESWT in terms of pain and ADL outcomes associated with knee OA in 5 of the studies (n= 370). No clinically significant differences were found in the use of ESWT for knee OA related pain and ADL outcomes in 1 of the studies (n=89), and no studies found nil effects. The results suggest that in the management of symptoms related to knee OA, the use of ESWT has some effect on pain and activities of daily living outcomes.ConclusionsA review of current randomized controlled trials and systematic reviews presented some evidence for the use of ESWT in knee OA. While the use of ESWT may improve pain and ADL outcomes, further studies towards dosing and prescription is suggested.

Is Li-ESWT effective in diabetic patients with severe erectile dysfunction?

Noninvasive low-intensity extracorporeal shockwave treatment (Li-ESWT) has been widely used to treat erection disorders. There is no clear information regarding either the selection of patients for the treatment or the treatment protocol. In this study, we aimed to investigate the efficacy of extracorporeal shockwave therapy in diabetic patients with severe erectile dysfunction (International Index of Erectile Function-5 [IIEF-5] scores of 5 to 7). Sixty-three diabetes mellitus patients with erectile dysfunction having IIEF-5 scores of 5 to 7 and not showing a recovery of potency despite phosphodiesterase type 5 inhibitor therapy for the past 6 months were included in the study. The patients were evaluated based on their IIEF-5 scores and Erection Hardness Scale scores. The IIEF-5 score (mean ± standard deviation [s.d.]) increased from 5.29 ± 1.67 to 5.56 ± 1.85, with a difference of 0.27 ± 0.18 (P > 0.05). The Erection Hardness Scale scores (mean ± s.d.), on the other hand, increased from 1.46 ± 0.50 to 1.48 ± 0.50, with a difference of 0.02 ± 0 (P > 0.05). In conclusion, the response to phosphodiesterase type 5 inhibitors did not change after extracorporeal shockwave treatment in diabetes mellitus patients with severe erectile dysfunction (IIEF-5 scores of 5 to 7).

Evaluating the efficacy of High-energy Extracorporeal Shockwave Therapy Aimed at Treating Calcified Shoulder (ESWT-CS): a study protocol for a randomized controlled trial

Shockwave therapy is a solid scientifically based medical tool used to manage calcified shoulder. This therapy, along with its pros and cons, is paving its way among armamentarium of interventions for musculoskeletal disorders. Objective: To determine efficacy of extracorporeal shockwave therapy on subjective and objective measures in patients with calcified shoulder. Methods: Single-blinded, parallel-group, randomized trial will be conducted on sample of 48 participants recruited through convenient sampling. Patients with calcified shoulder tendinopathy, aged between 30-55 years and both gender will be included. Outcome measures will be numeric pain rating scale, Constant and Murley score, Western Ontario rotator cuff index, shoulder ROM and radiological outcomes. Current study has been initiated in June 2020 till enrollment in December 2020.The quantitative data would present in the form of mean and standard deviation. After fulfilling the parametric assumptions, data will be analyzed using independent sample t-test/Mann Whitney test. Repeated measure ANOVA/Friedman test for pair-wise comparisons for follow-ups will be used to determine the effects of treatment within the groups at baseline, in 6th week and 12th week after commencement of treatment. Discussion: Evidence reported related to shockwave therapy for tendinopathy shows less quality and less number of randomized trials done, with no comparable groups and methodological deficiencies of studies. Trial registration: Approval was obtained from Institutional Review Board Committee (ref: IRB-UOL-FAHS/693/2020). The study was registered on 28th March 2020 in Iranian Registry of Clinical trials (IRCT), its registration reference number is IRCT20200204046373N1 https://irct.ir/trial/45657.

Evaluation of plantar fasciitis improvement after shock wave therapy in calcaneal spur patients by musculoskeletal ultrasonography

BackgroundPlantar fasciitis due to calcaneal spur is a common cause of heel pain and functional disability, and its management presents a huge challenge for clinicians which results sometimes in unpleasant clinical outcomes. The efficacy of extracorporeal shock wave therapy (ESWT) as an alternative therapeutic option to surgical management after failure of conservative treatment has been addressed. Our aim was to evaluate the efficacy of ESWT in the treatment of plantar fasciitis in calcaneal spur patients using ultrasonography.ResultsThe mean plantar fascia (PF) thickness was statistically significantly higher in the calcaneal spur patient group (5.66 ± 1.14 mm) than in the healthy control group (2.40 ± 0.35 mm), (P = 0.001). Significant PF thickness reduction, visual analog scale (VAS), and Roles and Maudsley score (RMS) improvement were observed (P < 0.001) after 4 sessions of ESWT.ConclusionPF thickness increases significantly in calcaneal spur patients and responds to treatment. ESWT decreases the thickness of the PF and improves pain and function significantly.

Extracorporeal shockwave therapy in spinal cord injury, early to advance to clinical trials? A systematic review and meta-analysis on animal studies.

As there is no consensus over the efficacy of extracorporeal shockwave therapy in the management of spinal cord injury complications, the current meta-analysis aims to investigate preclinical evidence on the matter. The search strategy was developed based on keywords related to 'spinal cord injury' and 'extracorporeal shockwave therapy'. A primary search was conducted in Medline, Embase, Scopus and Web of Science until the end of 2020. Studies which administered extracorporeal shockwave therapy on spinal cord injury animal models and evaluated motor function and/or histological findings were included. The standardised mean difference with a 95% confidence interval (CI) were calculated. Seven articles were included. Locomotion was significantly improved in the extracorporeal shockwave therapy treated group (standardised mean difference 1.68, 95% CI 1.05-2.31, P=0.032). It seems that the efficacy of extracorporeal shockwave therapy with an energy flux density of 0.1 mJ/mm2 is higher than 0.04 mJ/mm2 (P=0.044). Shockwave therapy was found to increase axonal sprouting (standardised mean difference 1.31, 95% CI 0.65, 1.96), vascular endothelial growth factor tissue levels (standardised mean difference 1.36, 95% CI 0.54, 2.18) and cell survival (standardised mean difference 2.49, 95% CI 0.93, 4.04). It also significantly prevents axonal degeneration (standardised mean difference 2.25, 95% CI 1.47, 3.02). Extracorporeal shockwave therapy significantly improves locomotor recovery in spinal cord injury animal models through neural tissue regeneration. Nonetheless, in spite of the promising results and clinical application of extracorporeal shockwave therapy in various conditions, current evidence implies that designing clinical trials on extracorporeal shockwave therapy in the management of spinal cord injury may not be soon. Hence, further preclinical studies with the effort to reach the safest and the most efficient treatment protocol are needed.

Extracorporeal Shockwave Therapy in the Treatment of Trigger Finger: A Randomized Controlled Study

ObjectivesTo determine the efficacy of extracorporeal shockwave therapy (ESWT) and to determine the ideal energy flux density of wide-focused ESWT in the treatment of trigger finger (TF). DesignDouble-blind randomized controlled trial. SettingA university hospital. ParticipantsA total of 60 patients (N=60) with grade II TF according to the Quinnell classification were randomly and evenly allocated to 3 treatment groups. InterventionsThree treatment groups included a high-energy ESWT (HS) group (energy flux density of 0.01 mJ/mm2, 5.8 bar, 1500 impulses, once per week for 4wk), a low-energy ESWT (LS) group (energy flux density of 0.006 mJ/mm2, 3 bar, 1500 impulses, once per week for 4wk), and a sham intervention group (sham group). All participants received 6 months of follow-up after intervention when only painkillers were allowed as concomitant treatment. Main Outcome MeasuresClinical outcomes were followed at baseline and 1, 3, and 6 months after intervention, including pain score, frequency of triggering, severity of triggering, functional impact of triggering, and quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH). ResultsAll groups showed significant improvements from baseline in all clinical parameters, except for functional impact of triggering, 6 months after the interventions. However, the HS group demonstrated a higher magnitude of improvement than the LS and sham groups. In addition, the HS group reported significantly lower pain (P=.01) and lower qDASH (P=.008) than the sham group 6 months after the interventions. No adverse effects were reported in the HS and LS groups within 6 months of follow-up. ConclusionsWide-focused ESWT is a safe and effective but dose-dependent alternative facilitating pain relief and functional improvement in the treatment of grade II TF according to the Quinnell classification.

Role of extracorporeal shockwave therapy in patients with rotator cuff tendinopathy: synthetic analysis of last two decades.

To explore current evidence on the effectiveness of shockwave therapy in patients with rotator cuff tendinopathy. The meta-analysis study was conducted at University of Lahore from May 2019 to December 2019 and comprised search on Cochrane, Medline, Embase, Physiotherapy Evidence Databasedatabases and other sources as well as unpublished grey literature related to shockwave therapy in patients with rotator cuff tendinopathy published between 2000 and 2019. Methodological quality assessment was performed using Cochrane risk of bias tool and the included studies were critically appraised using the Physiotherapy Evidence Databasescale. Of the 11 studies shortlisted, data was not extractable from 2(18%). Of the 9(82%) studies analysed, 8(89%) were randomised trials and 1(11%) was randomised pilot study. Overall, 4(44.4%) studies had high quality and 5(55.6%) fell in the fair category. There was no consensus found on the efficacy of extracorporeal shockwave therapy compared to traditional rehabilitation among patients with rotator cuff tendinopathy.