Extracorporeal Shock Wave Group Research Articles

Study on the effect, safety, prognosis quality and application value of extracorporeal shock wave based neural activity in carpal tunnel syndrome patients

BackgroundMild to moderate CTS is the most common median nerve compression disease in middle-aged and elderly women, mainly manifested by hand numbness and pain. This paper analyzes the extracorporeal shock wave of patients with mild to moderate CTS after nerve mobilization.MethodsThe clinical data of 92 patients with CTS from June 2020 to June 2022 are analyzed and randomly divided into extracorporeal shock wave group (n = 47) and routine group (n = 45). The routine group undergoes nerve mobilization, and the extracorporeal shock wave group receives extracorporeal shock wave therapy on the basis of the routine group. The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function scores, and ADL scores before and after treatment are observed. The Spearman correlation coefficient is used to analyze the correlation between upper limb function and ADL score, and the incidence of complications after treatment is analyzed.ResultsThe clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function score, ADL score and the incidence of complications in the extracorporeal shock wave group are significantly better than those in the conventional group (P < 0.05). ADL scores are negatively correlated.ConclusionExtracorporeal shock wave combined with nerve mobilization has a significant effect in the treatment of CTS patients, which can significantly improve the symptoms and pain scores of patients, and enhance the function of patients’ upper limbs. At the same time, the incidence of complications in patients is less, and it has high safety.

Extracorporeal Shock Wave Therapy Provides Limited Therapeutic Effects on Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

Night wrist splinting has been a conservative treatment for carpal tunnel syndrome. The addition of extracorporeal shock wave therapy provides an alternative treatment. However, strong evidence on the clinical effectiveness of extracorporeal shock wave therapy for carpal tunnel syndrome is still lacking. This study aimed to investigate the effectiveness and safety of extracorporeal shock wave therapy compared with treatments of night wrist splints alone for patients with carpal tunnel syndrome. In this systematic review and meta-analysis, no limitation criteria were used for study selection. All available articles that compare the effectiveness between extracorporeal shock wave therapy combined with night wrist splint and night wrist splint alone for treating carpal tunnel syndrome published up to 20 January 2022 were identified from the databases of PubMed, Embase, and Cochrane Central Register of Controlled Trials Central. The primary outcomes were a standard mean difference with a 95% confidence interval on the improvement of symptom severity and functional impairment between the two groups. In an attempt to analyze trends over time in studies that report repeated measurements, an all time-points meta-analysis (ATM) was undertaken. Seven randomized controlled trials with a total of 376 participants were included in this study. Significant improvements in functional impairment and symptom remission were only observed in the extracorporeal shock wave group at four weeks post-treatment. Extracorporeal shock wave therapy did not demonstrate superior efficacy compared to treatment with night wrist splint alone at 8–10 and 12–14 weeks post-treatment, or through the ATM approach. In conclusion, the therapeutic effect of extracorporeal shock wave therapy is transient and mostly nonsignificant compared with using night wrist splint alone. No serious side effects were reported in all included studies. Other conservative treatments to ameliorate carpal tunnel syndrome symptoms are warranted.

Extracorporeal Shock Wave Rebuilt Subchondral Bone In Vivo and Activated Wnt5a/Ca2+ Signaling In Vitro.

Background This study aimed to identify the optimal extracorporeal shock wave (ESW) intensity and to investigate its effect on subchondral bone rebuilt in vivo and Wnt5a/Ca2+ signaling in vitro using an osteoarthritis (OA) rat model and bone marrow mesenchymal stem cells (BMMSCs), respectively. Methods OA rats treated with (OA + ESW group) or without (OA group) ESW (n = 12/group) were compared with healthy controls (control group, n = 12). Gait patterns and subchondral trabecular bone changes were measured. Western blot and quantitative real-time polymerase chain reaction detected protein expression and gene transcription, respectively. Results The gait disturbances of OA + ESW group were significantly improved compared with the OA group at 6th and 8th weeks. The micro-CT analysis indicated that the BMD, BSV/BV, BV/TV, Tr.S, and Tr.Th are significantly different between OA group and OA + ESW group. Expression of Wnt5a was increased rapidly after ESW treatment at 0.6 bar and peaked after 30 min. Conclusions ESW were positive for bone remodeling in joint tibial condyle subchondral bone of OA rat. ESW prevented histological changes in OA and prevented gait disturbance associated with OA progression. Optimal intensity of ESW induced changes in BMMSCs via activation of the Wnt5a/Ca2+ signaling pathway.

Medical ozone therapy reduces shock wave therapy-induced renal injury

Objectives: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. Methods: Twenty-four male Sprague–Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. Results: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). Conclusion: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

Extracorporeal shock wave therapy for treatment of heel pain

To explore the therapeutic efficacy of extracorporeal shock wave (ESW) for persistent heel pain. A total of 98 patients of persistent heel pain were randomly divided into ESW treatment and control groups (n=49 each). Treatment group had ESW while control group received infrared physical therapy. And their visual analogue scale (VAS) scores were assessed. After one course of treatment, VAS heel pain and function scores were (39.6±6.2) and (25.1±4.6) in ESW group versus (32.3±6.5) and (17.4±7.2) in control group. And before treatment, (16.5±4.6) and (14.4±8.6), (16.1±4.7) and (14.6±8.4) respectively. Heel pain significantly decreased with functional improvement (all P<0.05). After one course, the effective rate was 65% (32/49) in treatment group. And the improvement rate of 31% (15/49) was better than control group [27% (13/49) and 63% (31/49)] (all P<0.05). ESW treatment of persistent heel pain was more efficacious than physical therapy and it could be applied clinically. Key words: Shock waves; Heel spur

Therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis

To observe the therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis. A total of 153 plantar with plantar fasciitis were randomly divided into a combined group (n=51), an extracorporeal shock wave group (n=53) and an orthopaedic group (n=49). The combined group received treatment of both extracorporeal shock wave and orthopaedic insole while the extracorporeal shock wave or the orthopaedic group only received the treatment of extracorporeal shock wave or orthopaedic insole. The therapeutic parameters such as visual analogue scale (VAS) scores, continued walking time and thickness of the plantar fascia were monitored before and aft er the treatment for 2 weeks, 1 month and 3 months, respectively. The VAS scores in the 3 groups were all reduced after the treatment compared with the corresponding scores before the therapy (P< 0.05). The VAS score in the extracorporeal shock wave group was greater than that in the orthopedic group after the treatment for 2 weeks. The VAS score in the combined group was smaller than that in the orthopedic group after the treatment for 2 weeks and 3 months (P< 0.05). The VAS scores in the orthopedic group and the combined group were smaller than those in the extracorporeal shock wave group after the treatment for 1 month or 3 months (P< 0.05). The continued walking time and thickness of the plantar fascia was improved after the treatment (P< 0.05). The cure rate and total effective rate in the combination group were obviously greater than those in the two other groups. The cure rate in the orthopedic group was greater than that in the extracorporeal shock wave group (P< 0.05). Extracorporeal shock wave combined with orthopaedic insole therapy is an effective method to treat plantar fasciitis. It is recommended to spread in clinic.

Extracorporeal shockwave enhanced regeneration of fibrocartilage in a delayed tendon‐bone insertion repair model

Fibrous tissue is often formed in delayed healing of tendon bone insertion (TBI) instead of fibrocartilage. Extracorporeal shockwave (ESW) provides mechanical cues and upregulates expression of fibrocartilage-related makers and cytokines. We hypothesized that ESW would accelerate fibrocartilage regeneration at the healing interface in a delayed TBI healing model. Partial patellectomy with shielding at the TBI interface was performed on 32 female New Zealand White Rabbits for establishing this delayed TBI healing model. The rabbits were separated into the control and ESW group for evaluations at postoperative week 8 and 12. Shielding was removed at week 4 and a single ESW treatment was applied at week 6. Fibrocartilage regeneration was evaluated histomorphologically and immunohistochemically. Vickers hardness of the TBI matrix was measured by micro-indentation. ESW group showed higher fibrocartilage area, thickness, and proteoglycan deposition than the control in week 8 and 12. ESW increased expression of SOX9 and collagen II significantly in week 8 and 12, respectively. ESW group showed a gradual transition of hardness from bone to fibrocartilage to tendon, and had a higher Vickers hardness than the control group at week 12. In conclusion, ESW enhanced fibrocartilage regeneration at the healing interface in a delayed TBI healing model.

COMPARING EXTRACORPOREAL SHOCK WAVE AND HYALURONIC ACID ON RABBIT CARTILAGE DEFECT MODEL

To compare the efficiency of extracorporeal shock wave (ESW) treatment with hyaluronic acid (HA) viscosupplementation in an experimental rabbit cartilage defect model. Materials and methods: A total of 24 New Zealand rabbits were randomly divided into 4 groups: HA, ESW, ESW + HA, and control. Chondral defects were created in the left knees of the rabbits. HA viscosupplementation was performed on the HA and ESW + HA groups, and after 24 h, 0.16 mJ/mm2 ESW was performed on the ESW and ESW + HA groups. After an 8-week follow-up, the rabbits were sacrificed and histopathological examination of the defects was carried out. In addition, immunohistochemistry was performed by the avidin-biotin peroxidase method using vascular endothelial growth factor (VEGF), transforming growth factor beta 1 (TGF-beta 1), and type II collagen antibodies, and the results were evaluated semiquantitatively. Results: There was a significant difference between the control group and the ESW group in terms of Pineda score and type II collagen expression; between the control group and the HA group in terms of Pineda score, VEGF expression, type II collagen expression, and TGF-beta 1 expression; and between the control group and the ESW + HA group in terms of Pineda score, VEGF expression, type II collagen expression, and TGF-beta 1 expression. Conclusion: The results show that both treatment methods have positive therapeutic effects on the articular cartilage defect model in terms of the parameters studied.

Impact of low-energy extracorporeal shock wave on collagen deposition and transforming growth factor-β1 expression in excisional wound of diabetic rats

Objective To investigate the effect of low-energy extracorporeal shock wave (ESW)treatment on collagen deposition and transforming growth factor-β1 (TGF-β1) expression in excisional wound of diabetic rats,and the possible mechanism of ESW promoting wound healing.Methods Chronic diabetic wound models were made in 64 6-8-week-old male SD rats weighing (220 ±20) g,and randomly divided into the ESW treatment group and the diabetic control group.Normal wound models were made in 32 SD rats and were used as the normal control group.In ESW treatment group,wound was treated by ESW with 0.11 mJ/mm2,1.5 Hz and 500 pulses one day post-wounding.In diabetic control group and normal control group,wound was only given coupling fluid and received no ESW treatment.Wound closing rate was calculated at 3rd,7th,14th and 21st day after treatment.Wound specimens were harvested to observe histological changes,hydroxyproline contents,density of collagen fibers and TGF-β1 expression.Resuits At different time points after treatment,collagen deposition,the relative density of collagen and hydroxyproline content were decreased in the diabetic control group as compared with those in the normal control group (P ＜ 0.05).At the same time,TGF-β1 expression was significantly decreased in the diabetic control group (P ＜ 0.05).After ESW treatment,fibroblasts and granulation tissue formation were increased,and collagen fibers density and hydroxyproline content in the wound were also increased simultaneously (P ＜ 0.05),and there was no significant difference in collagen fibers density and hydroxyproline content between the ESW group and normal control group (P ＞0.05).In addition,TGF-β1 expression at different time points was increased (P ＜ 0.05) and began to decline at 14th day in the ESW treatment group as compared with that in the diabetic control group.Conclusion The reduced collagen deposition is a major contributor of impaired diabetic wound healing and ESW treatment may increase the expression of TGF-β1,fibroblast migration or proliferation,collagen formation and hydroxyproline content within the wound tissue,and thus accelerate granulation tissue formation and wound healing process. Key words: Diabetes ; Wound; Collagen ; Transforming growth factor-β1

Osteogenesis induced by extracorporeal shockwave in treatment of delayed osteotendinous junction healing

Healing at the osteotendinous junction (OTJ) is challenging in orthopedic surgery. The present study aimed to test extracorporeal shockwave (ESW) in treatment of a delayed OTJ healing. Twenty-eight rabbits were used for establishing a delayed healing (DH) model at patella-patellar-tendon (PPT) complex after partial patellectomy for 4 weeks and then were divided into DH and ESW groups. In the ESW group, a single ESW treatment was given at postoperative week 6 to the PPT healing complex. The samples were harvested at week 8 and 12 for radiographic and histological evaluations with seven samples for each group at each time point. Micro-CT results showed that new bone volume was 1.18 +/- 0.61 mm(3) in the ESW group with no measurable new bone in the DH group at postoperative week 8. Scar tissue formed at the OTJ healing interface of the DH group, whereas ESW triggered high expression of VEGF in hypertrophic chondrocytes at week 8 and regeneration of the fibrocartilage zone at week 12 postoperatively. The accelerated osteogenesis could be explained by acceleration of endochondral ossification. In conclusion, ESW was able to induce osteogenesis at OTJ with delayed healing with enhanced endochondral ossification process and regeneration of fibrocartilage zone. These findings formed a scientific basis to potential clinical application of ESW for treatment of delayed OTJ healing.

Effect of high-energy extracorporeal shock waves on the immature epiphysis in a rabbit model

We investigated the effect of high-energy extracorporeal shock wave (ESW) on immature tibial epiphysis in a rabbit model. Twenty New Zealand white immature rabbit were used in this study. Animals were divided into two groups and they received 14 kW, 0.6 mJ/mm(2), 1,500 or 3,000 shots for three times with an interval of 7 days. After 6 weeks all rabbits were killed. The all tibia epiphysis were assessed by histology. The epiphyseal plaque thickness of right tibiae of the 3,000-shot ESW group was significantly higher than those of the 1,500-shot ESW group and the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). The epiphyseal plaque thickness of right tibiae of the 1,500-shot ESW group was significantly higher than that of the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). We demonstrated that high-energy ESW stimulated the growth of immature rabbit epiphysis. The long-term effect of shock wave on the immature rabbit epiphysis deserves further study.

Early effect of extracorporeal shockwave treatment on distraction osteogenesis of long bone in rabbits

目的 观察体外冲击波对兔长骨牵伸骨痂形成的早期作用,探讨其作用机制.方法30只成年新西兰大白兔胫骨中段截断,5 d后开始延长,每天延长1 mm,10 d后停止延长,待骨痂形成10 d;随机分成实验组和对照组,实验组于牵伸骨痂中心区进行体外冲击波(ESW)处理,冲击波能量密度0.54 mJ/mm2,脉冲1 000次;对照组不予任何处理.两组于截骨后45、60、75 d取材,采用X线片、骨密度检测对牵伸骨痂形成进行观察,并行统计学分析,组织学观察比较.结果术后45 d和60 d,X线片及骨密度检测显示实验组牵伸骨痂形成量及骨密度值明显高于对照组(P＜0.05),75 d两组比较差异无显著意义;组织学观察发现45 d实验组成熟软骨和类骨组织形成量均较对照组多,实验组新生骨痂内毛细血管数量较多,60 d实验组可见大量新生骨组织,有丰富的骨髓腔和原始骨髓,对照组以类骨组织为主,原始骨髓少,75 d两组间组织学形态趋于一致.结论在兔胫骨牵伸骨形成过程中,ESW可加速骨痂的早期形成、矿化和改建。