Abstract Background Upper ureteral calculi are calculi located in the ureteral segment between the renal outlet and the iliac vascular level. They can cause severe low back pain, hematuria, nausea, vomiting and other symptoms. In severe cases, they may lead to hydronephrosis or renal function damage. Common treatment methods include Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopic Lithotripsy (URS). However, there are differences between these two methods in terms of therapeutic effect and impact on patients' mental health. Therefore, this study analyzed and compared the therapeutic effects of these two types of lithotripsy and evaluated their impact on patients' mental health, with the aim of providing a certain theoretical basis for mental health guidance in the treatment of ureteral calculi. Methods A total of 100 patients with upper ureteral calculi were randomly selected for the study and divided into two groups, with 50 patients in each group. One group received ESWL treatment, and the other group received URS treatment. All patients underwent mental health assessments before and after treatment, including scores on anxiety and depression scales. The research results were compared through statistical analysis. Results The mental health impact results of each group under different treatment methods are shown in Table 1. As can be seen from Table 1, there are significant differences (p<.01) between the two groups of patients in terms of the stone clearance rate and recurrence rate after treatment. Among them, the stone clearance rate in the ESWL group was 85.7% and the recurrence rate was 10.2%. The stone clearance rate in the URS group was 94.0%, and the recurrence rate was 4.0%. In terms of mental health, the anxiety scores of patients in the ESWL group before and after treatment were 67.21 ± 5.42 and 51.12 ± 4.67 respectively, and the depression scores were 69.13 ± 5.01 and 54.33 ± 5.19 respectively. The anxiety scores of URS patients before and after treatment were 69.5 ± 5.48 and 47.32 ± 4.45 respectively, and the depression scores were 72.29 ± 6.27 and 53.39 ± 4.8 respectively. The above results indicate that the improvement in the URS group is more significant. Discussion The research results show that URS outperforms ESWL in terms of stone clearance rate and recurrence rate, and is more effective in improving patients' mental health. This might be because URS can remove stones more directly, reducing the patient's pain and anxiety. In addition, the rapid recovery of URS may help patients return to normal life more quickly, thereby improving their mental health. Future research can further explore the long-term impact of different lithotripsy procedures on patients' mental health and how to improve patients' quality of life through comprehensive treatment.

This systematic review and meta-analysis of randomized controlled trials evaluated the effects of low-intensity shock wave therapy (LiSWT) on erectile function (EF) and penile vascular parameters in men with erectile dysfunction (ED), compared with controls receiving sham or no treatment. A systematic search of Scopus, PubMed, and Cochrane databases identified studies assessing LiSWT in men with ED. Primary outcomes were changes in the International Index of Erectile Function (IIEF)-5 and the IIEF-EF domain scores. Secondary outcomes included erection hardness score (EHS), sexual encounter profile (SEP) diary Q2 and Q3, global assessment question (GAQ) scores, and penile Doppler ultrasound parameters-peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI). Changes from baseline to the end of follow-up were compared between LiSWT and control groups. Of 527 retrieved articles, 12 met inclusion criteria. Pooled analysis demonstrated significantly greater improvements in the LiSWT group for IIEF-5 (standardized mean difference [SMD], 1.19; 95% confidence interval [CI], 0.47-1.91; p=0.001) and IIEF-EF (SMD, 1.24; 95% CI, 1.02-1.45; p<0.001) scores compared with controls. No significant differences were found for EHS (p=0.698), SEP-Q2 (p=0.934), SEP-Q3 (p=0.985), GAQ (p=0.993), and penile Doppler ultrasound parameters, including PSV (p=0.855), EDV (p=0.995), or RI (p=0.818). LiSWT provides modest improvements in IIEF scores but fails to produce significant changes in other functional or vascular parameters. These findings suggest that while LiSWT may offer some benefit, the clinical relevance is limited for most patients. Current evidence does not support its routine inclusion in ED treatment algorithms. Future research should focus on identifying patient subgroups most likely to experience significant and sustained improvements from this therapy.

Background: Knee osteoarthritis (OA) remains a leading degenerative joint disease and a primary driver of chronic pain and disability among older adults. This condition is clinically defined by progressive cartilage degradation, joint stiffness, and a significant loss of functional mobility. Because standard conservative treatments often fail to provide adequate relief, there has been growing interest in regenerative approaches such as extracorporeal shock wave therapy (ESWT) and dextrose prolotherapy (DP). While their clinical use is increasing, direct comparative evidence regarding their relative effectiveness is still largely missing from some studies. This study aimed to evaluate the differences between ESWT and DP affect patients with knee OA in terms of functional improvement as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and pain reduction as measured by the Visual Analogue Scale (VAS). Methods: This quasi-experimental study employed a pre-test–post-test randomised group design. Twenty patients with grade II–III knee OA who were not improving with traditional therapy were recruited and randomly assigned to two groups: ESWT (n=11) and DP (n=9). The interventions lasted for six weeks. Both before and after the intervention, the WOMAC and the VAS for pain were assessed as outcome measures. A statistical study was conducted to find differences both within and between groups. Results: Both the ESWT and DP groups had statistically significant improvements in all metrics, including pain (VAS), WOMAC pain, stiffness, disability, and total scores (p&lt;0.05). However, there were no significant differences between the two groups for any of the evaluated outcomes (p&gt;0.05). Conclusion: ESWT and DP were equally effective in reducing pain and improving functional outcomes in patients with knee OA. These findings indicate their role as a successful alternative therapy for people who don't receive enough relief from conventional medical therapies. Additional randomized controlled research are required to confirm these conclusions.

Objectives: This study aimed to compare the efficacy of extracorporeal shock wave therapy (ESWT) and dry needling (DN) in treating piriformis syndrome (PS). Patients and methods: This randomized controlled trial included 48 patients with PS between February 3, 2024, and August 23, 2024. The patients were randomized into DN and ESWT groups. The ESWT group received three sessions of ultrasound-guided ESWT, and the DN group received three sessions of ultrasound-guided DN. Static stretching exercises were given to both groups. Clinical evaluations were assessed with the visual analog scale (VAS), Oswestry Disability Index (ODI), and Lower Extremity Functional Scale (LEFS) at baseline and one and three months after treatment. Results: Forty-four patients completed the study, with 23 patients (18 females, 5 males; mean age: 49.6±8.9 years; range, 33 to 70 years) in the ESWT group and 21 patients (16 females, 5 males; mean age: 50.4±9.2 years; range, 33 to 64 years) in the DN group. In both groups, there was a significant improvement in VAS pain, ODI, and LEFS scores at one and three months of follow-up compared to baseline (p&lt;0.001). However, no significant difference was observed in VAS, ODI, and LEFS scores between the groups (p&gt;0.05). Conclusion: In this study, the combination of DN and stretching exercise, as well as ESWT and stretching exercise, was effective in terms of pain relief and functionality in patients with PS during a three-month follow-up period. These two treatment methods can be effectively used in patients with PS. Extracorporeal shock wave therapy can be considered as an alternative treatment method, particularly in patients with needle phobia.

To investigate the efficacy of extracorporeal shock wave therapy (ESWT), high-intensity laser therapy (HILT), and exercise therapy in patients diagnosed with plantar fasciitis. A total of 84 patients diagnosed with plantar fasciitis were randomized into 3 groups: ESWT combined with a home exercise program (n = 28), HILT combined with a home exercise program (n = 30), and a home exercise program alone (control) (n = 26). The ESWT group underwent a total of 3 ESWT sessions, performed once a week, whereas the HILT group underwent a total of 15 HILT sessions over 3 weeks. All 3 groups were evaluated at the beginning of the treatment, at the end of the treatment (week 3), and at the 12th week for pain levels (measured using the visual analog scale [VAS]), plantar fascia thickness, and the Foot Function Index (FFI). Because of the nature of the interventions, participant masking was not possible; however, assessor masking was strictly adhered to. Eighty-four patients completed the study. Significant reductions in plantar fascia thickness, VAS scores, and FFI values were observed in all 3 groups (P < .05). However, baseline-adjusted analyses detected no meaningful between-group differences at 12 weeks (P > .05; small effect sizes). Our study demonstrated that ESWT, HILT, and exercise therapy each effectively reduced pain levels and improved functional capacity in the treatment of plantar fasciitis. Adding ESWT or HILT to a structured home exercise program did not provide an incremental clinical benefit during the follow-up period. The findings support exercise therapy as a practical first-line option.

Rotator cuff injury is one of the most prevalent tendon disorders of the shoulder, with the highest prevalence in patients over 60 years and in occupations or sports requiring sustained overhead load. It arises from chronic tendon degeneration and repetitive microtrauma, often aggravated by acromial morphology, reduced subacromial space, or scapular dyskinesis. Patients typically present with nocturnal shoulder pain, weakness during abduction and external rotation, and in advanced cases, stiffness or secondary arthropathy. Western treatments include analgesic drugs, structured physiotherapy, shockwave therapy, and arthroscopic repair, where the extent of tendon retraction, degree of fatty infiltration, and expected functional demand largely determine therapeutic choice. Despite advances, high retear rates persist in specific subgroups. Traditional Chinese Medicine (TCM) therapies such as acupuncture, manual techniques, and herbal preparations have been shown in pilot trials to decrease pain scores and enhance range of motion, possibly via modulation of local cytokine expression and peripheral nerve excitability. Integrative strategies are designed to accelerate rehabilitation timelines, minimize reliance on corticosteroids or opioids, and optimize restoration of shoulder strength and endurance. This review evaluates the comparative outcomes of conservative, surgical, and traditional modalities, highlights preliminary signals of benefit from integrative care, and identifies methodological priorities including standardized outcome measures and multicenter randomized trials.

Extracorporeal shockwave therapy (ESWT) is used as an adjunctive treatment for canine osteoarthritis (OA), but its effects in dogs with treatment-refractory advanced disease remain unclear. This study compared the efficacy of one versus two sessions of focused ESWT administered approximately 28 days apart in dogs with refractory elbow or stifle OA. In this randomized, double-blinded clinical trial, twenty-four client-owned dogs with treatment-refractory elbow (n = 12) or stifle (n = 12) osteoarthritis received ESWT using an identical per-session protocol (X-Trode, 1000 pulses at 0.14 mJ/mm2; PulseVet-Zomedica, Ann Arbor, MI, USA), once (Group L) or twice (Group E). Orthopedic examination, goniometric and limb circumference measurements, and kinetic gait analysis (peak vertical pressure [PVP], vertical impulse [VI]) were performed on days 0, 28, and 56. Owner questionnaires (Canine Brief Pain Inventory [CBPI], Client Specific Outcome Measures [CSOM]) were collected on days 0, 28, 56, and 84. Data were analyzed using chi-squared tests, t-tests, and mixed effects models in R. Age, weight, BCS, and radiographic osteoarthritis severity did not differ between groups at baseline. Improvement was small and limited to selected parameters. Vertical impulse and limb circumference increased more consistently in Group E, whereas peak vertical pressure increased in both groups, including before ESWT in Group L. No sustained or treatment-associated improvement was detected in symmetry variables or joint range of motion. Owner-reported outcomes showed variable patterns without consistent treatment effects. ESWT was well tolerated, and no major adverse events occurred. ESWT produced modest, inconsistent improvements in dogs with treatment-refractory OA, with slightly more consistent effects following two sessions. Therapeutic efficacy appeared limited in this end-stage population.

To compare the effectiveness and safety of selective arterial perfusion (SAP) combined with core decompression (CD) versus CD alone for treating osteonecrosis of the femoral head (ONFH) at association research circulation osseous (ARCO) stages 1-2. Overall, 102 individuals (involving 130 hips) diagnosed with nontraumatic ONFH at ARCO stages 1-2 and admitted into Beijing Jishuitan Hospital Guizhou Hospital (Guizhou Orthopedic Hospital) between January 2021 and December 2023 were enrolled in this retrospective study. They were assigned to two groups based on the treatment protocol: the experimental group (56 patients, 72 hips) treated with SAP combined with CD, and the control group (46 patients, 58 hips) receiving CD only. Both groups were supplemented with conventional treatment: oral aescuven forte (1 tablet/time, 2 times/day for 12 weeks), extracorporeal shock wave therapy (once per week for 4 weeks), nerve block (lateral femoral cutaneous nerve block for visual analogue scale (VAS) >5 points), and rehabilitation training (30 minutes/day, 5 days/week for 12 weeks). All participants were followed up for 12 months, with key outcomes such as effective rate, femoral head collapse rate, lesion size, bone marrow edema grading, VAS score, harris hip score (HHS) score, and complication rate recorded. No statistically significant differences in baseline data (age, gender, disease duration, ARCO staging, etiology, etc.) were identified between the two groups (p > 0.05), indicating their comparability. Twelve months after treatment, the effective rate of the experimental group (91.7%) proved higher than that of the control group (63.8%), whereas the femoral head collapse rate in the experimental group (5.6%) was lower in comparison to that of the control group (19.0%). After treatment, the experimental group also showed more significant improvements in lesion size, bone marrow edema (BME) grading improvement rate, VAS score, and HHS score. The complication rates of the two groups were similar (7.1% vs. 6.5%, p > 0.05). At 12 months of follow-up, compared with CD alone, SAP combined with CD demonstrated better clinical performance in nontraumatic ONFH patients at ARCO stages 1-2, accompanied by a higher effective rate, lower femoral head collapse rate, more significant reductions in lesion size and improved hip joint function, while maintaining a comparable safety profile. This combined regimen provides a valuable option for hip-preservation treatment in early-stage ONFH, with potential clinical implications for optimizing minimally invasive intervention strategies.

The traditional A1-centric paradigm for trigger finger (TF) management does not fully capture heterogeneous pathology spanning isolated pulley stenosis, tendon degeneration, and impaired tendon-sheath gliding. A comprehensive literature synthesis (2010-2025) integrating anatomy, biomechanics, and ultrasound-guided interventions was performed to develop a testable, phenotype-driven framework. A continuum model is proposed emphasizing (i) origin-to-insertion assessment of the flexor apparatus, (ii) pragmatic ultrasound phenotyping into pulley-dominant, tendon-dominant, and mixed patterns, and (iii) a stepwise, phenotype-matched management pathway incorporating conservative care, ultrasound-guided injection, selected adjuncts (e.g., hydrodissection, prolotherapy, ESWT) for tendon-dominant or mixed presentations, and percutaneous or open release when an A1 bottleneck is confirmed. This framework is presented as a hypothesis to guide standardized reporting, reliability testing, and phenotype-stratified comparative trials, rather than as a validated clinical guideline. This article proposes a novel, phenotype-driven clinical framework to address this limitation. Contemporary evidence is integrated to construct a model emphasizing (i) a whole-length, origin-to-insertion assessment of the flexor apparatus, (ii) sonographic phenotyping into pulley-dominant, tendon-dominant, and mixed patterns, and (iii) a stepwise treatment algorithm integrating conservative care, ultrasound-guided injections, ultrasound-guided percutaneous release, and selected adjunctive approaches such as hydrodissection (HD), prolotherapy (Prolo), and extracorporeal shockwave therapy (ESWT). While evidence supports individual modalities, the framework's primary innovation lies in matching interventions to phenotype. This sonographic phenotyping system is presented not as a validated tool, but as a testable hypothesis designed to guide future validation studies. The proposed framework establishes research priorities, including standardized criteria, reliability testing, and comparative effectiveness research for phenotype-stratified management.

Tendinopathy is a common musculoskeletal condition that impairs body function and quality of life. Extracorporeal shockwave therapy is a widely used non-invasive treatment method. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of radial shockwave therapy (RSWT) and focused shockwave therapy (FSWT) in the treatment of upper and lower limb tendinopathies, based on randomized controlled trials (RCTs) assessing pain intensity, physical function, muscle strength, and adverse effects. The review protocol was registered in the PROSPERO database under the registration number CRD420251011209. A comprehensive search of PubMed, EBSCOhost, Ovid MEDLINE, and Embase was conducted to identify RCTs. Databases were searched from their inception until the last update-26 March 2025 for PubMed, EBSCOhost and Ovid MEDLINE, and 27 March 2025 for Embase. Review methods: Risk ratios and mean differences (MD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I2 statistic. The risk of bias and methodological quality of the included studies were evaluated using the Cochrane Risk of Bias tool and the Physiotherapy Evidence Database scale. The overall quality of the body of evidence was assessed using the GRADE approach. Of the 102 records identified, 9 articles met the inclusion criteria, comprising a total of 530 patients with upper or lower limb tendinopathy. No clear superiority of RSWT or FSWT was observed for pain or functional outcomes, owing to low or very low certainty of evidence. Moderate-quality evidence indicated that RSWT significantly improved wrist extensor strength in patients with tennis elbow compared to FSWT (MD: 1.81; 95% CI 0.97 to 2.64; p < 0.001; I2 = 0%), while grip strength did not differ significantly between the modalities (MD: 0.57; 95% CI -1.68 to 2.82; p = 0.62; I2 = 0%). Both treatments were similarly safe, but conclusions are limited by low-quality evidence.

What are the benefits and harms of low-intensity shockwave therapy for treating erectile dysfunction?

Stenosing tenosynovitis is a common chronic tendon disease that seriously affects daily life and working ability. However, its treatment is very challenging and requires more effective treatment methods. A large number of clinical studies have shown that extracorporeal shock wave therapy (ESWT) may relieve the symptoms of stenosing tenosynovitis, but there are no published reviews or meta-analyses specifically and comprehensively evaluating its efficacy for this disease. Therefore, through conducting a meta-analysis, this study systematically evaluated the therapeutic effect of ESWT on stenosing tenosynovitis, aiming to provide evidence-based medical evidence for clinical decision-making. A literature search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Wanfang, CNKI, and VIP databases. Randomized controlled trials (RCTS) on shock wave therapy for stenosing tenosynovitis from database establishment to June 2025. The limited languages are Chinese and English. The search terms include: "Extracorporeal shockwave therapy," shock wave therapy, "HIFU therapy, "De quervain stenosing tenosynovitis," Trigger Digits, "finger Snapping". The extracted inclusion indicators included the pain score VAS or NRS, the QDASH Disability questionnaire (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire), and the cooney wrist joint function score. After extracting the data, meta-analysis was conducted through Review Manager5.3 software and Stata17.0 software. Twelve studies were included, all of which were randomized controlled studies. The results showed that the experimental group was significantly superior to the control group in terms of pain relief, with a total effect size of -1.32 (95% CI: -1.85, -0.79), which was highly statistically significant (Z = 4.89, P < 0.00001). The QDASH score of the shock wave group was superior to that of the control group, and there was no statistically significant difference (MD = -6.14, 95% CI [-14.00, 1.72], P = 0.13, I2 = 78%). The Cooney score showed that there was a significant difference between the shock wave group and the control group (MD = 13.84, 95% CI [5.04, 22.64], P = 0.002, I2 = 95%); The evaluation of clinical efficacy showed that there were significant differences between the shock wave group and the control group (RR = 5.44, 95% CI [2.99, 9.90], P < 0.00001, I2 = 49%). The results of this meta-analysis show that ESWT has a positive effect on symptom improvement in patients with stenosing tenosynovitis, but there is currently a lack of sufficient and high-quality systematic data to support it. In the future, more rigorous and well-designed clinical studies with adequate sample sizes are needed to comprehensively verify the safety and efficacy of ESWT in treating stenotic tenosynovitis.

Background/Objectives: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a multifactorial condition often refractory to standard medical therapy. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a mechanism-oriented option; however, prior reviews reported substantial heterogeneity, potentially due to pooling different wave-generator modalities despite their distinct physical properties. This study synthesized randomized evidence on Li-ESWT for CP/CPPS and explored a wave-generator modality as a prespecified effect modifier. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 2015 to 31 October 2025 (date of last search) for randomized controlled trials (INPLASY: 2025120064). Eligible studies compared Li-ESWT (focused, radial, or multifocal) with sham or standard medical therapy (SMT). The primary outcome was total NIH-CPSI at the follow-up closest to 12 weeks. Pooled effects were calculated as weighted mean differences (WMDs) with 95% confidence intervals (CIs). Prespecified subgroup analyses were performed by wave-generator modality and therapy strategy (monotherapy vs add-on to SMT). Results: Eight RCTs (n = 455) were included. Li-ESWT significantly improved total NIH-CPSI versus the control (WMD -8.46; 95% CI -12.12 to -4.79; I2 = 94.8%). Benefits were observed in both monotherapy and the add-on to SMT trials. By modality, focused devices showed consistent effects (WMD -6.59; I2 = 0.0%), whereas radial devices showed an imprecise estimate with extreme heterogeneity (WMD -10.38; 95% CI -21.33 to +0.57; I2 = 98.2%). Multifocal devices showed a significant benefit (WMD -10.84; I2 = 81.0%). Improvements were mainly driven by pain-domain reduction. Conclusions: Li-ESWT provides clinically meaningful symptom relief in CP/CPPS, predominantly through pain reduction. Modality- and strategy-based subgroup findings are exploratory given substantial heterogeneity, limited trials, and no head-to-head comparisons; focused devices showed consistent effects, whereas estimates for radial and multifocal devices warrant cautious interpretation.

Foot and ankle diseases are highly prevalent in both the general and athletic populations, frequently resulting in pain, impaired physical function, and a decreased quality of life. Pulsed Electromagnetic Field (PEMF) therapy has shown beneficial effects on pain by reducing inflammation and improving circulation, yet its efficacy in treating foot and ankle soft-tissue pathologies remains unclear. This systematic review aimed to evaluate the impact of PEMF therapy on pain and physical function among individuals with foot and ankle soft-tissue pathologies. A systematic literature search was conducted across Medline, Embase, Emcare (Ovid Nursing & Allied Health), Allied and Complementary Medicine Database (AMED), and Web of Science from database inception to May 15, 2025. Additional searches were performed using Google Scholar and clinical trial registries. Two reviewers independently screened studies and extracted data on pain and physical function outcomes. Four randomised controlled trials (RCTs), comprising a total of 243 participants with a mean age of 48.79 years, were included in the review. In three of the four trials, PEMF therapy was administered alongside another conservative intervention, such as shockwave therapy, heel pads, or eccentric exercise, and compared to the conservative treatment alone. Only one study investigated the isolated effects of PEMF therapy vs. sham stimulation. Among the included studies, three reported statistically significant reductions in pain in the intervention groups compared to controls (p < 0.05). However, only one of three studies demonstrated a significant improvement in physical function following PEMF therapy (p < 0.05). Large heterogeneity in terms of treatment protocols and intervention parameters was observed across the studies which may limit the comparability of outcomes. No serious adverse events were reported; only minor skin redness was documented as a side effect. PEMF therapy appears safe and effective for reducing pain in individuals with various foot and ankle soft-tissue pathologies. However, the findings on the PEMF therapy in improving physical function remain inconclusive. Future research should focus on a large-scale, standardised setting, including the PEMF therapy protocol, to evaluate the efficacy of PEMF therapy on both pain and functional outcomes in this specific population. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251076499, PROSPERO CRD420251076499.

The aim of this study was to evaluate the effects of extracorporeal shock wave therapy and low-level laser therapy on pain, functional status, and quality of life in shoulder adhesive capsulitis. This single-center, prospective, single-blind randomized controlled trial included patients with shoulder adhesive capsulitis randomly assigned to extracorporeal shock wave therapy, low-level laser therapy, or control groups. The extracorporeal shock wave therapy group received three extracorporeal shock wave therapy sessions plus 15 sessions of hot pack and exercise; the low-level laser therapy group received 15 low-level laser therapy sessions with hot pack and exercise. Outcomes (Constant-Murley Score, visual analog scale, Short Form 36) were assessed at baseline, 3, and 12 wks. Sixty shoulder adhesive capsulitis patients were randomized equally into extracorporeal shock wave therapy ( n = 20), low-level laser therapy ( n = 20), and control ( n = 20) groups. By week 3, both extracorporeal shock wave therapy and low-level laser therapy showed significant improvements in visual analog scale-pain and Constant-Murley Score-pain versus control ( P < 0.05), while only low-level laser therapy improved Short Form 36 physical limitation scores ( P < 0.05). At week 12, the low-level laser therapy group showed greater improvements in Constant-Murley Score-range of motion, Constant-Murley Score-total, and Short Form 36 subdomains related to physical and emotional role limitations ( P < 0.05). In patients with shoulder adhesive capsulitis, both extracorporeal shock wave therapy and low-level laser therapy added to exercises therapy positively affected pain and range of motion.

Post-stroke spasticity (PSS) is a common complication affecting motor function and quality of life in stroke patients. Extracorporeal shockwave therapy (ESWT) has been proposed as a non-invasive treatment for PSS, though variations in protocols raise questions about its efficacy and optimal dosage. This review aims to evaluate the efficacy of ESWT in reducing PSS and analyze its dose-response relationship. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Adults with spasticity following ischemic or hemorrhagic stroke in rehabilitation or hospital-based clinical settings were included. RCTs assessing ESWT versus sham or no intervention were selected, with spasticity reduction measured by the Modified Ashworth Scale (MAS) as the primary outcome. Secondary outcomes included range-of-motion (ROM), functionality, and the Modified Tardieu Scale, assessed in both the short and long term. Risk of bias was evaluated using the revised Cochrane Risk of Bias Tool. Meta-analyses and meta-regression were performed using R software. Thirteen RCTs with 533 participants were included. Meta-analyses demonstrated that ESWT significantly reduced MAS scores in the short term [mean difference (MD)=-0.85; 95% confidence interval (CI): -1.17 to -0.53, P<0.01] and long term (MD=-0.84; 95% CI: -1.31 to -0.38, P<0.01). Secondary outcomes also improved in both short-term (P<0.01) and long-term analyses (P=0.04). Meta-regression revealed a dose-response relationship for the primary outcome, showing that higher ESWT doses were associated with greater MAS improvement. ESWT effectively reduces PSS with short- and long-term benefits. A dose-response relationship suggests higher doses provide better outcomes. However, further research is needed to optimize treatment protocols due to the observed heterogeneity.

BackgroundPost-stroke spasticity (PSS) arises from central neural hyperexcitability and maladaptive muscle architectural changes that impair motor function. Interventions targeting both mechanisms is essential to support adaptive neural reorganization.ObjectiveTo investigate the combined effects of extracorporeal shockwave therapy (ESWT) and a neuroplasticity-based training protocol (NBTP) on lower limb spasticity, muscle architecture, and motor function in stroke patients.MethodsThis was a sham-controlled, double-blind, randomized controlled trial. Fifty-four patients with post-stroke spasticity (PSS) were randomly assigned to receive either ESWT combined with a NBTP, or to sham ESWT with NBTP . Participants received six weekly sessions of ESWT (1,500 shocks at 5 Hz, 0.10 mJ/mm2) targeting the gastrocnemius muscle, alongside a 12-week NBTP comprising mirror therapy, resistance and aerobic training, motor imagery, and task-specific activities. Outcome assessments were conducted at baseline, 6th week, and 12th week using the Modified Ashworth Scale (MAS), passive range of motion (PROM), and the Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Ultrasonographic evaluations included measurements of muscle thickness (MT), muscle fascicle length (MFL), and pennation angle (PA).ResultsAt the 12th week, the experimental group showed significantly greater improvements than controls in MAS (MD = 0.88; p < 0.001), PROM (MD = -6.72; p < 0.001), and FMA-LE (MD = -1.55; p < 0.001). RMI also improved moderatly (MD = -1.04; p = 0.03). Ultrasonographic parameters improved in both groups, with a significant difference observed only in PA and MT (p < 0.05).ConclusionESWT combined with NBTP yielded superior functional and structural outcomes compared with NBTP, supporting this integrative approach as a clinically relevant post-stroke intervention.Trial registration numberTrial was submitted on http://clinicaltrials.gov (registration no. NCT05405140).

Ultrasound-guided tibial nerve block vs. local corticosteroid injection in recalcitrant plantar fasciitis treatment: A single blind randomized controlled study.

Chronic musculoskeletal pain disorders account for 70% to 80% of chronic pain diagnoses in the United States. T he most common conditions are low back pain, neck pain, headache disorders, and knee and hip osteoarthritis. Most evidence suggests that treatments for chronic pain are best used in combination, such as in multidisciplinary rehabilitation programs. Evaluation of individual treatments in isolation is limited by small sample sizes, high risk of bias, lack of standardization in clinician delivery and treatment dosage or intensity, and inconsistent categorization of treatment techniques. Moderate-certainty evidence supports the effectiveness of exercise-based therapies, whereas low- to moderate-certainty evidence supports the use of osteopathic manipulative treatment for pain management across multiple body regions. Additional available therapies include other types of manual therapy (eg, spinal manipulative therapy, chiropractic care), massage therapy, Rolfing, traction, transcutaneous electrical nerve stimulation, therapeutic ultrasound, laser therapy, dry needling, shockwave therapy, and kinesio taping.

Extracorporeal cardiac shock wave (ECSW) therapy enhances the function of endothelial colony-forming cells (ECFCs), but whether it can serve as a preconditioning strategy to enhance myocardial infarction (MI) therapy remains unclear. This study investigated the efficacy and mechanism of intravenously delivered ECSW-preconditioned ECFCs (SW-ECFCs) in a rat MI model. ECFCs were isolated from the bone marrow of ApoE-/- rats and fully characterized. RNA sequencing of control ECFCs versus SW-ECFCs revealed significant enrichment of the PI3K/AKT pathway. We therefore performed a series of in vitro functional assays on these cells, including Transwell migration, Matrigel tube formation, CCK-8 proliferation, flow cytometric apoptosis analysis, and VEGF-A ELISA. . The role of the PI3K/AKT pathway was interrogated using the inhibitor LY294002. Subsequently, an acute MI model was established in ApoE-/- rats via left anterior descending coronary artery ligation. Rats were randomized into four groups: MI + PBS, MI + ECFCs, MI + SW-ECFCs, and MI + LY294002-pretreated SW-ECFCs (LY-SW-ECFCs), with sham-operated rats as controls. Comprehensive evaluations included echocardiography, serum injury biomarkers, TTC, and histopathological (H&E, Masson) staining, immunohistochemical detection of cardiomyocyte apoptosis and p-eNOS, immunofluorescence assessment of ECFC homing and vascular markers (CD31, α-SMA, VEGF-A), tissue/plasma nitric oxide measurement, and Western blot analysis of PI3K/AKT signaling proteins. Transcriptomic analysis revealed significant enrichment of the PI3K/AKT pathway in SW-ECFCs. Functionally, ECSW enhanced ECFCs migration, tube formation, proliferation, and VEGF-A secretion, while reducing apoptosis; these effects were largely abolished by PI3K inhibition. In vivo, serum levels of CK, CK-MB, and LDH were significantly elevated in all MI groups compared to the Sham group (P < 0.01), indicating comparable initial injury. However, no significant differences were observed among treatment groups (P > 0.05). SW-ECFCs transplantation significantly improved cardiac function, reduced infarct size, fibrosis, and apoptosis, and enhanced angiogenesis (P < 0.05). These benefits were associated with increased levels of p-AKT, p-eNOS, and BCL-2 protein as well as nitric oxide content, while suppressing the expression of cleaved caspase-3 (P < 0.05). Crucially, all these therapeutic benefits were largely abolished by PI3K inhibition. In conclusion, this study demonstrates that preconditioning ECFCs with ECSW significantly enhances their therapeutic efficacy for myocardial infarction, improving both cardiac function and structural repair. These benefits are mediated primarily through activation of the PI3K/AKT signaling pathway, which augments cell homing, paracrine activity, and survival, thereby providing a novel and promising strategy for cardiac regeneration.