Sessions Of Extracorporeal Shock Wave Therapy Research Articles

Is Shock Wave Application Effective on Various Chronic Wounds in the Geriatric Population? Preliminary Clinical Study.

Extracorporeal shock wave therapy (ESWT) is a beneficial adjunct modality for chronic wounds. Limited research has been conducted on pressure ulcers (PUs), while the majority of studies have focused on diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). This study aimed to evaluate the short-term effects of radial ESWT in older adults with chronic wounds. This study involved a total of 31 wounds: PUs (n=22), VLUs (n=7), and DFUs (n=2). A single radial ESWT was performed with 300 + 100 shocks per cm2, pressure of 2.5 bar, energy of 0.15 mJ/mm2, and frequency of 5 Hz. Assessments using digital planimetry and clinical methods, utilizing the Wound Bed Score (WBS) and the Bates-Jansen Wound Assessment Tool (BWAT) were performed before the radial ESWT application (M0) and one week after (M1). A significant wound decrease in planimetry was noted (pre-ESWT vs post-ESWT), with wound area from 9.4 cm2 to 6.2 cm2, length from 6.4 cm to 3.9 cm, and width from 2.8 cm to 2.1 cm (p<0.001). Additionally, a substantial clinical improvement was noted in both the WBS with a 31.25% increase and the BWAT with a 20.00% increase (p<0.001). It was also found a significant correlation between the planimetric and clinical outcomes for both tools: WBS (r=-0.446, p=0.012) and BWAT (r=0.327, p=0.073). The ESWT application yields substantial immediate clinical effects that support the healing of chronic wounds in older adults. Even a single ESWT session can prove to be clinically effective and beneficial in the management of chronic wounds.

Comparing Myofascial Pain Syndrome Treatment with Dry Needling Versus Extracorporeal Shock Wave Therapy for Plantar Fasciitis on Pain and Function of the Heel

The aim of this study was to compare the effects of dry needling (DN) and extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis (PF). The study included 55 patients with PF. The patients were randomly divided into 2 groups. The DN group applied 3 sessions of DN to the myofascial trigger points in the lower limb muscles. The ESWT group applied 3 sessions of ESWT to the plantar fascia. For clinical evaluation, we used a visual analog scale (VAS) (first step, rest, activity) and Foot Function Index (FFI) (pain, disability, activity). Assessments were done baseline, post-treatment first week, and fourth week. Maximum pain-free standing time (Max PfST) and maximum pain-free walking distance (Max PfWD) were recorded at baseline and post-treatment fourth week. In this study, we found significant improvement in VAS, FFI, Max PfST, and Max PfWD in both groups (p<0.01). VAS-activity baseline-forth week change was significantly superior in the DN group compared to the ESWT group (p=0.023). FFI-disability baseline-fourth week change was significantly superior in the DN group compared to the ESWT group (p=0.048). There was no significant difference in other treatment-related changes between the groups (p>0.05). However, VAS-rest baseline-fourth week change and FFI-pain baseline-fourth week change trended towards statistical significance between groups ((p=0.056), (p=0.052) respectively). This study showed that DN may be a good alternative treatment for patients with PF, with effects similar to or even superior to ESWT.

Single-Dose Radial Extracorporeal Shock Wave Therapy Modulates Inflammation During Meniscal Tear Healing in the Avascular Zone

Background: Extracorporeal shock wave therapy (ESWT) promotes tissue healing by modulating inflammation, which has implications for meniscal tear healing in the avascular zone. Purpose: To evaluate the effects of a single dose of radial ESWT on the healing process and inflammation of the meniscus and knee joints after meniscal tears in the avascular zone. Study Design: Controlled laboratory study. Methods: Avascular tears were induced in the medial meniscus (MM) of 72 Sprague-Dawley rats. One week postoperatively, the rats received a single session of radial ESWT with a Power+ handpiece (ESWT group; n = 36) or with a fake handpiece (sham-ESWT group; n = 36). The rats were then euthanized at 2, 4, or 8 weeks postoperatively. The MMs were harvested for analysis of healing (hematoxylin-eosin, safranin O–Fast Green, and collagen type 2 staining) and inflammation (interleukin [IL]-1β and IL-6 staining). Lateral menisci and synovia were obtained to evaluate knee joint inflammation (enzyme-linked immunosorbent assay of IL-1β and IL-6). Cartilage degeneration was assessed in the femurs and tibial plateaus using safranin O–Fast Green staining. Results: The ESWT group showed significantly better meniscal healing scores than the sham-ESWT group at 4 (P = .0066) and 8 (P = .0050) weeks postoperatively. The IL-1β level was significantly higher in the sham-ESWT group than in the ESWT group at 2 (MM: P = .0009; knee joint: P = .0160) and 8 (MM: P = .0399; knee joint: P = .0001) weeks. The IL-6 level was significantly lower in the sham-ESWT group than in the ESWT group at 2 (knee joint: P = .0184) and 4 (knee joint: P = .0247) weeks but higher at 8 weeks (MM: P = .0169; knee joint: P = .0038). The sham group had significantly higher osteoarthritis scores than the ESWT group at 4 (tibial plateau: P = .0157) and 8 (femur: P = .0048; tibial plateau: P = .0359) weeks. Conclusion: A single dose of radial ESWT promoted meniscal tear healing in the avascular zone, modulated inflammatory factors in the menisci and knee joints in rats, and alleviated cartilage degeneration. Clinical Relevance: Radial ESWT can be considered a potential option for improving meniscal tear healing in the avascular zone because of its ability to modulate inflammation.

Combination Therapy of Autologous Protein Solution and Extracorporeal Shock Wave Therapy for Severe Knee Osteoarthritis

Knee osteoarthritis (OA) is a multifaceted metabolic disorder influenced by biomechanical, inflammatory, and immune system factors. Although autologous protein solution (APS) and extracorporeal shock wave therapy (ESWT) have shown promise for treating mild-to-moderate knee OA, their efficacy for severe cases remains limited when administered individually. Thus, we examined the combination effects of APS and ESWT for severe knee OA. Twenty-four cases (33 knees) of Kellgren–Lawrence grade 4 knee OA with bone marrow lesions and synovitis detected via magnetic resonance imaging from December 2019 to November 2022 were included. All patients underwent an ESWT session before the APS injection. The study included 20 knees in the APS + ESWT group, which underwent an average of 4.5 ESWT sessions, and 13 in the APS-alone group. We evaluated both groups’ Knee Injury and Osteoarthritis Outcome Scores (KOOSs) before the APS injection at 3 and 6 months. Additionally, we compared the mean KOOS changes between the APS + ESWT and APS-alone groups at 3 months (Pre-3M) and from 3 to 6 months (3–6M). Pre-3M showed no significant difference in the KOOSs between the two groups; however, there was a significant change in 3–6M (p &lt; 0.05). Combining APS therapy with ESWT in severe knee OA was more effective and durable than APS alone.

The Role of Extra Corporeal Shockwave in Treatment of Trigger Finger

Background Trigger finger, or stenosing tenosynovitis, is a condition where the normal smooth gliding of the flexor tendons through the fibrous tendon sheath of the digit is altered. Inflammation where the flexor tendon enters the sheath leads to either thickening of the fibrous pulley and/or inflammation or nodular enlargement of the tendon. This enlargement of the tendon results in locking and clicking symptoms of the affected finger, Treatments for trigger finger in order of invasiveness include splinting, NSAIDs, physical therapy, corticosteroid injections, and surgical release of the tendon sheath. Ultrasound allows for noninvasive visualization of the soft tissues, and also provides good depiction of annular pulleys and flexor tendons; the extracorporeal shock waves are defined as sound waves that can maximize the pressure of the target tissue over a few nanoseconds.Recently, extracorporeal shock wave therapy (ESWT) has been proposed as an alternative treatment in patients not responding to conservative treatments. Currently, extracorporal shock wave therapy (ESWT) has been widely used in tendinopathies, including trigger fingers with high success rate, while the complications are low and can be neglected. Objective To evaluate the efficiency of shockwave therapy in the treatment of trigger finger. Patients and Methods This prospective single-center study was carried out on 15 patients (aged 53.133± 9.039 years, 66.67% females and 33.33% males) complaining of symptomatic trigger finger. 6 sessions of ESW therapy were given to all patients with one week interval. Before and after treatment with ESWT sessions, scoring was done to all patients using Numerical Pain Rating Scale (NPRS), Quick Disability of Arm, Shoulder and hand score (Quick DASH), Range of motion assessment of fingers: Active and passive. MSUS was done for all patients before starting the sessions for accurate diagnosis and was repeated one month after patients had finished 6 sessions of ESWT as an assessment tool. Results Our patients showed a high statistical significant difference after one month follow up regarding the numeric pain rating score (NPRS), the Quick DASH score, range of motion (Active Flexion MCP of affected finger), Green`s classification, locking and snapping, thickness of A1 pulley &amp; synovial thickness. Before ESWT sessions, we found that duration of pain was correlated positively with thickness of A1 pulley and negatively with ROM “Active Flexion MCP”. Also ROM “Active Flexion MCP” correlated negatively with thickness of A1 Pulley. Thicknesses of synovial membrane was positively correlated with NPRS and Quick DASH score. After ESWT sessions, ROM “Active Flexion MCP” was correlated negatively with and thickness of A1 pulley. Thicknesses of synovial membrane was positively correlated with NPRS, Quick DASH score and thickness of A1 pulley, But it was negatively correlated with ROM “Active Flexion MCP”. Conclusion We concluded that ESWT is an effective method for treatment of trigger finger and is non invasive compared with surgical treatment. It improves pain, finger ROM and thickness of synovial membrane. We also concluded musculoskeletal ultrasonography is helpful for objectively understanding the severity of trigger finger and its response to treatment, by examining the thickness of the flexor tendon and A1 pulley.

Efficacy and Safety of Extracorporeal Shock Wave Therapy in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Acquired Premature Ejaculation Patients

Introduction: The aim of this study was to evaluate the efficacy and safety of extracorporeal shock wave therapy (ESWT) in patients with acquired premature ejaculation (APE) due to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Method: Patients with APE due to CP/CPPS between January 2020 and June 2022 were included in the study. Demographic data of the patients were recorded, and the degree of their symptoms was evaluated with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), premature ejaculation diagnostic tool (PEDT), and Premature Ejaculation Profile (PEP). The international prostate symptom index (IPSS) was also used for lower urinary tract symptoms (LUTS), and the international erectile function index-erectile function (IIEF-EF) was used to evaluate erectile functions. All patients received treatment with the Medispec Bold Li-ESWT device without using any anesthesia method (12 sessions). The changes in the symptom scores of the patients were evaluated before the treatment and at the 3rd month after the treatment. Results: A total of 42 patients were included in the study. The mean age of the patients was 43.75 ± 12.03 (20–55), and the mean BMI was 23.58 ± 7.61 (18.03–35.98) kg/m². The patients’ estimated mean intravaginal ejaculation latency time (IELT) before ESWT was 37.98 ± 21.87 s. After a total of 12 sessions of ESWT, the IIEF-EF, IPSS, NIH-CPSI, and PEP index scores of the patients showed significant improvements (p < 0.001 for each). The IELT mean increased to 74.81 ± 46.79 s (p < 0.001). Posttreatment IELT fold increase was determined as 3.25 ± 1.72 fold. A highly significant positive correlation (p = 0.032; r = 0.839) was found between the CPSI score difference and the posttreatment PEP index score. Conclusion: Li-ESWT treatment is an effective and safe treatment with positive effects on both LUTS and premature ejaculation in patients with APE symptoms due to CP/CPPS. Patients who benefit from CP treatment also have longer IELT times.

Early application of extracorporeal shock wave therapy improves pain control and functional scores in patients undergoing total knee arthroplasty: a randomized controlled trial.

The use of biophysical stimuli produced by extracorporeal shock wave therapy (ESWT) can improve the rehabilitation treatment of patients undergoing total knee arthroplasty (TKA). The aim of our study is to evaluate the short-term efficacy of early postoperative ESWT in combination with physiotherapy in terms of pain reduction and motor function recovery of patients undergoing TKA and compare it with conventional physiotherapy treatment. Fifty-six patients undergoing TKA were enrolled in the study from January 2019 to February 2020. Patients received two sessions of physiotherapy daily, with (experimental group) or without (control group) four sessions of ESWT within sevendays after surgery. Patients were prospectively evaluated at baseline and at post-operative day two and seven. Assessment included active knee range of motion (aROM), timed up and go (TUG)test, visual analogue scale (VAS) for pain, and Borg scale. Fifty patients completed the study. Both treatments proved to be effective in reducing pain and improving the knee range of motion and functional scores at sevendays after surgery: the aROM in the ESWT group was 36.8 ± 11.0 grades (p < 0.001), while in control group was 19.8 ± 7.8 grades (p < 0.001). TUG, VAS, and BORG scores showed a similar trend. Comparative analysis revealed superior clinical results for the experimental group in all the outcomes, in particular aROM (96.0 ± 5.40 vs. 81.20 ± 11.01, p < 0.001) and TUG test (17.4 ± 5.61 vs. 21.24 ± 5.88, p < 0.001), at day seven after surgery. Early application of ESWT in addition to physiotherapy can positively influence the rehabilitation process after TKA. The treatment proved to be well tolerated and safe. Preliminary results demonstrated better pain control and functional scores compared to physiotherapy alone.

Chronic Plantar Fasciitis Treatment: A Randomized Trial Comparing Corticosteroid Injections Followed by Therapeutic Ultrasound with Extracorporeal Shock Wave Therapy

This study aims to compare the effect of corticosteroid injection (CSI) followed by therapeutic ultrasound (TUS) with that of extracorporeal shock wave therapy (ESWT) in patients with chronic plantar fasciitis (PF) and to explore the impact of a sedentary lifestyle and obesity on treatment outcomes. Female patients with PF were randomly allocated to receive ESWT (group A, n = 25) or CSI + TUS (group B, n = 25). Interventions: Group A received four once-weekly sessions of ESWT (2000 shocks, 2.5 bar pressure, 10.0 Hz frequency). Group B received a local injection of 40 mg triamcinolone acetonide with 2 mL 1% xylocaine, followed by three sessions of TUS per week for two weeks. Pain visual analog scale (VAS pain), plantar fasciitis pain and disability scale (PFPDS), and fascia thickness using musculoskeletal ultrasound were all measured at baseline, 4 weeks, and 12 weeks after the end of treatment. VAS pain and PFPDS improved significantly in both groups after 4 and 12 weeks. In the ESWT group, the pain improved significantly more at 12 weeks (p = 0.004). In obese patients (BMI &gt; 29.9 kg/m2), ESWT gave more long-term pain relief at 12 weeks follow-up. In both the ESWT and CSI + TUS groups, after 12 weeks, the VAS pain improved more in patients with a sedentary daily life than in those with active life (p = 0.021 and p = 0.014, resp.), as well as the PFPDS (p = 0.014 and p = 0.019, resp.). Plantar fascia thickness decreased in both groups at 12 weeks. In both groups, improvements in function (PFPDS) correlated significantly with decreased plantar fascia thickness at 4 and 12 weeks. In the CSI + TUS group only, the decrease in plantar fascia thickness was correlated with pain improvement at both follow-up visits. Echogenicity changed from hypoechoic to iso- or hyperechoic and improved significantly in both groups at 12 weeks follow-up, but changes were not different between the groups (p = 0.208). Both CSI + TUS and ESWT are effective treatments for female patients with chronic plantar fasciitis resulting in pain relief and improved function and fascia thickness. ESWT gave more pain relief at 12 weeks follow-up. CSI + TUS is effective as a rapid and short-term modality for relieving PF pain. According to previous studies, the addition of TUS does not appear to make CSI much more effective.

Efficacy of kinesio taping versus extracorporeal shock wave therapy in the short term for the calcaneal spur

The calcaneal spur is a common cause of heel pain, and there are various approaches to its treatment. Our aim in this study is to investigate the effectiveness of kinesio taping against Extracorporeal Shock Wave Therapy (ESWT) in the treatment of calcaneal spur. This study was designed as a randomized controlled, prospective and single-center clinical trial. A total of 93 patients with calcaneal spur (18 men, 75 women) were included. Patients were divided into two groups (based on gender, age, BMI, and pain duration) by stratified randomization (kinesio tape group=46, ESWT group=47 patients). 3 sessions of ESWT were applied to the heels of the patients in the 1st group with an interval of 1 week. Kinesio taping was applied to the 2nd group. It was applied once a week, for 3 weeks. Visual Analogue Scale (VAS) and Foot Function Index (FFI) scores of the patients in both groups before the treatment and 1 week after the end of the treatment were recorded. When we evaluated the pre-treatment and post-treatment parameters, we found a significant decrease in VAS, FFI-pain, FFI-disability and FFI-activity restriction scores in both groups (p=0.0001). We also found that kinesio taping was more effective than ESWT in reducing FFI-pain (for after treatment FFI-pain inter group p=0.005, for FFI-pain difference inter group p=0.002) and FFI-disability (for after treatment FFI-disability inter group p=0.023, for FFI-disability difference inter group p=0.0001) scores. To conclude, although both kinesio taping and ESWT treatments reduced patients' pain, disability and activity limitation, kinesio taping was found to be more effective in reducing pain and disability. Studies with longer follow-up are needed to clarify our results.

Double screw versus angular stable plate fixation of scaphoid waist nonunions in combination with intraoperativeextracorporeal shockwave therapy (ESWT).

Over the past years, different fixation techniques focused on rotational stability in order to increase stability and stimulate union rates. Additionally, extracorporeal shockwave therapy (ESWT) has gained importance in the treatment of delayed and nonunions. Purpose of this study was to compare the radiological and clinical outcome of two headless compression screws (HCS) and plate fixation in scaphoid nonunions, in combination with intraoperative high energy ESWT. Thirty-eight patients with scaphoid nonunions were treated by using a nonvascularized bone graft from the iliac crest and stabilization with either two HCS or a volar angular stable scaphoid plate. All patients received one ESWT session with 3000 impulses and energy flux per pulse of 0.41mJ/mm2 intraoperatively. Clinical assessment included range of motion (ROM), pain according to the Visual Analog Scale (VAS), grip strength, disability of the Arm Shoulder and Hand Score, Patient-Rated Wrist Evaluation Score, Michigan Hand Outcomes Questionnaire and modified Green O'Brien (Mayo) Wrist Score. To confirm union, a CT scan of the wrist was performed. Thirty-two patients returned for clinical and radiological examination. Out of these, 29 (91%) showed bony union. All patients treated with two HCS compared to 16 out of 19 (84%) patients treated by plate showed bony union on the CT scans. The difference was not statistically significant.However, at a mean follow-up interval of 34months, no significant differences could be found in ROM, pain, grip strength and patient-reported outcome measurements between the two HCS and plate group. Height-to-length ratio and capitolunate angle improved significantly in both groups compared to preoperative. Scaphoid nonunion stabilization by using two HCS or angular stable volar plate fixation and intraoperative ESWT results in comparable high union rates and good functional outcome. Due to the higher rate for a secondary intervention (plate removal), HCS might be preferable as first choice, whereas the scaphoid plate fixation should be reserved for recalcitrant (substantial bone loss, humpback deformity or failed prior surgical intervention) scaphoid nonunions.

Management of first metatarsophalangeal joint pain in runners with extracorporeal shockwave therapy and physical therapy

Problem: The first metatarsophalangeal (MTP) joint can become painful in runners and limit ability to remain active. Extracorporeal shockwave therapy (ESWT) is a conservative treatment option for musculoskeletal disorders due to its proposed effect on tissue remodeling and pain modulation and is best combined with physical therapy (PT). We hypothesized that a portion of runners with first MTP pain treated with ESWT and PT would achieve functional improvements. Methods: Chart review identified 21 runners who received ESWT and PT for first MTP joint pain. Functional outcomes were quantified using the Foot and Ankle Ability Measure (FAAM) prior to and following treatment, and patients meeting minimally clinically important differences (MCID) was the primary outcome of interest. Each runner received a minimum of three sessions of ESWT over the MTP joint, and PT focused on intrinsic foot strengthening and joint mobilization. Results: MCID was achievable in either FAAM ADL and/or FAAM Sports subscales for 15 of 21 runners, of whom 9 of 15 (60%) met MCID in one or both subscales. FAAM Sports subscale improved from pre-treatment median of 12 to best post-treatment median of 23 (p=0.0049) after a median time of 3 weeks. Discussion: ESWT combined with PT may be an effective and well-tolerated treatment for runners with first MTP joint pain in whom other conservative management has failed. Most included runners treated with ESWT and PT had improved function.

Novel triple therapy in osteoarthritis of knee joint

Background: Regenerative medicine may be defined as the process of replacing or regenerating human tissues or cells of humans to restore or to get very near to normal function of human life. Biological tissues found in humans such as blood, fat, bone marrow are the main resources of regenerative medicine which help in natural process of healing of soft tissue. Extracorporeal shock wave therapy (ESWT) is a physical modality that helps in enhancing healing process of soft tissues. Osteoarthritis of the knee joint is a gradually progressive degenerative condition with the loss of articular cartilage. The early stages of disease are managed conservatively with the aim of retarding the rate of cartilage destruction. Methods: A total of 80 patients underwent the novel triple therapy. The objective is to find out the potential of combination therapy in early degenerative disease of knee with the aim of reduction of inflammation. A protocol was developed which involved three injections of platelet rich plasma (PRP), six sessions of combined ESWT and physiotherapy. Results: Evaluation was mainly based on WOMAC/KSS/VAS scores. Patients in stage 1 and 2 (55+15=70) had excellent results for 36 months, patients in stage 3 (10 cases) had satisfactory outcome at 24 months. Conclusions: Triple therapy is an alternative treatment or in few cases a definitive treatment in degenerative disease of knee joint where medical and surgical management has minimal or no role. Triple therapy in mild to moderate osteoarthritis of knee joint has better outcome.

Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis?

: The purpose of this study was to determine the effect of the presence, size, or type of calcaneal spurs on pain or the outcomes of extracorporeal shock wave therapy (ESWT) therapy in patients with plantar fasciitis. Seventy-four patients with unilateral plantar fasciitis who had no pain in the contralateral foot, either currently or in the past, were included in the study. The length, base width, type, and presence of plantar calcaneal spurs in both heels of the patients were determined using radiography. A total of five sessions of ESWT (3 bar, 2000 shocks/session, 12 Hz frequency) with an interval of 3 days were performed on the painful sides of the patients. Symptom duration and numerical rating scale (NRS) scores were recorded pretreatment and 1 week and 12 weeks after treatment. : Spurs were detected in 85.1% of painful feet and 71.6% of painless feet, this difference was statistically significant (p = 0.046). There was no significant correlation between the type of the spurs and whether the foot was painful. Patients with spur sizes of >5 mm or with horizontal and hooked spurs had a higher NRS decrease than patients with spur sizes of ≤5 mm or with a vertical spur. Symptom duration, spur length, and base width were found to be correlated with pretreatment NRS scores. The presence and size of calcaneal spurs are associated with pain. However, it should be kept in mind that a high rate of spurs can also be found in painless feet, so spur is not the only factor that causes pain. Patients with a spur size of ≤5 mm or a vertical spur have less pain relief with ESWT.

The effects of extracorporeal shock wave therapy on hemineglect following a stroke. A case report study

Extracorporeal shock wave therapy (ESWT) is a non-invasive repetitive peripheral mechanical stimulation and might promote neuroplasticity in hemineglect syndrome. Two out of 15 patients with hemi spatial neglect following chronic stroke were completed the inclusion criterions and underwent one session of sham (placebo) and then one session of real ESWT. Both of the cases responded successfully to the ESWT by diminishing the neglect symptoms in comparison to their baseline evaluation, which maintained during one week of follow up evaluation session, but we did not observe changes in hemineglect syndrome in sham group. Our data showed that ESWT could be considered a promising tool in the treatment of neglect syndrome, however further studies are needed to confirm the effectiveness of ESWT.

Patient Outcomes on Treatment of Insertional Achilles Tendinopathy with Extracorporeal Shockwave Therapy: A Retrospective Study

Category: Ankle; Other Introduction/Purpose: Insertional achilles tendinopathy (IAT) affects approximately one-third of patients who report achilles tendon pain during their lifetime. It is characterized by stiffness and pain that are aggravated by prolonged rest and physical activity, respectively. Known treatments for IAT include eccentric exercises, night splints, pharmacologic or biologic injections, and extracorporeal shockwave therapy (ESWT). However, pain and functional outcomes following ESWT treatment for IAT vary throughout the literature. In addition, ESWT protocols have varied across studies. This retrospective study aimed to collect information on patient outcomes following ESWT treatment for IAT at a single institution to better characterize patient-reported pain and functional outcomes and to determine if patient-reported outcomes differ according to varying ESWT protocols. Methods: 44 patients who presented with IAT and received ESWT from 2/1/2016 to 10/1/2021 were included. Confirmation of IAT was determined by a review of each patient's chart. Patient-reported outcomes included NRS or VAS scores and PROMIS-10 were collected prior to ESWT sessions and at follow-up time points. Additionally, demographic information for each patient was collected including age, gender, race, ethnicity. Information regarding their achilles tendinopathy included symptom duration, laterality, prior interventions before ESWT, concurrent foot or ankle injuries on the same side, pain (baseline and follow-ups), PROMIS-10 (baseline and follow-ups) was also collected. Finally, ESWT information was reviewed including focused vs radial, number of sessions, number of pulses, energy intensity, frequency, any adverse outcomes after ESWT (e.g., tendon rupture, increase in pain; immediate or delayed), and if any interventions were needed during or after ESWT (physical therapy, cortisone injection, PRP, surgery, medications, orthotics). Results: Out of the 44 patients who were included in the study, 27 were female and 17 male. Mean symptom duration was 23.3 months (SD 26.7 months). 34 patients had unilateral pain while 5 had bilateral pain. Every patient had undergone previous treatment with a majority having tried physical therapy (n=33) and bracing (n=21). Mean number of ESWT sessions between patients was 3.3 (SD 1.5 sessions). 30 patients received focused shockwave therapy, 3 received radial shockwave therapy and 1 received both. The remaining 10 patient charts were inconclusive as to which type of shockwave was performed. 13 patients reported no improvement whereas the remaining 31 patients reported improvement, with a majority (n=18) reporting at least 50% improvement or greater. Conclusion: Insertional achilles tendinopathy can be treated with a wide variety of modalities, therapies and adjuncts. When considering treatment for cases that do not respond to the traditional methods including physical therapy, bracing and injections, ESWT shows promising data to be an effective treatment option, regardless of type or intensity. Most patients require more than 1 ESWT to be effective.

A Systematic Review of Extracorporeal Shock Wave Therapy (ESWT) for Insertional and Non- Insertional Achilles Tendinopathy

Category: Sports; Other Introduction/Purpose: Depending upon the site of injury, Achilles tendinopathy (AT) can be either Insertional (IAT) or Non- Insertional (nIAT). AT has long been managed by conservative measures such as eccentric exercises, but now extracorporeal shock wave therapy (ESWT) has emerged as a non-invasive treatment to stimulate self-repair. However, the native biology at the insertion of the Achilles tendon and mid-substance are intrinsically different, with the mid-substance (2 to 6 cm above the insertion) being significantly less perfused. Thus, we performed a systematic review of the literature on shockwave therapy to determine if there was a difference in efficacy for patients who have undergone ESWT for IAT and nIAT. Methods: In January 2022, the MEDLINE and EMBASE databases were systematically reviewed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included randomized controlled trials, prospective and retrospective studies, published in English, with pre- and post-operative scores for at least either Visual Analogue Scale (VAS) or Victorian Institute of Sport Assessment - Achilles (VISA-A). We excluded basic science studies, systematic reviews and meta- analyses, retrospective studies, case reports, studies without pre-operative scores, studies that don't differentiate IAT and nIAT. The LoE and QoE of the included studies were evaluated using the Journal of Bone and Joint Surgery Criteria and the Modified Coleman Methodology Score, respectively. We calculated weighted mean values for age, body mass index (BMI), the number of ESWT sessions and their frequency, duration of symptoms prior to ESWT, follow-up time, as well as for each outcome score. Results: 16 studies were included in this review, six with Level I evidence, four with Level II, five with Level III, and one with Level IV. There were 505 cases of AT: 325 patients with IAT and 180 with nIAT. For the IAT cohort, the weighted mean (WM) duration of symptoms prior to treatment was 18.1 months, and WM follow-up was 8.1 months. For the nIAT cohort, the WM duration of symptoms prior to treatment was 15.0 months, and WM follow-up was 11.6 months. In terms of outcome scores, for VAS, the WM pre-operative scores were 6.89 for IAT and 7.76 for nIAT and the WM post-operative scores were 2.76 for IAT and 2.49 for nIAT. For VISA-A, the WM pre-operative scores were 49.3 for IAT and 42.8 for nIAT, and the WM post-operative scores were 75.4 for IAT and 75.7 for nIAT. Conclusion: As the mid-substance portion of the Achilles tendon has diminished blood supply compared to the insertional portion, we expected outcomes after ESWT to be inferior for the nIAT cohort. Interestingly, the VAS pain scores and VISA-A functional scores displayed similar positive results for both cohorts. We see that the virtually equivalent functional and pain outcomes mean that ESWT is stimulating cellular components of the tendon to promote healing regardless of injury location.

Comparison of extracorporeal shock wave therapy and high-intensity laser therapy on pain, grip strength, and function in patients with lateral epicondylalgia: a randomized controlled study.

This study aimed to compare the effects of extracorporeal shockwave therapy (ESWT) and high-intensity laser therapy (HILT) on pain, grip strength, and function in patients with lateral epicondylalgia. This prospective randomized controlled study included 42 patients (22 women and 20 men, mean age: 37) divided into 3 groups. The first group received physiotherapy (n = 14), the second received physiotherapy combined with ESWT (n = 14), and the third received physiotherapy combined with HILT (n = 14). All participants underwent 10 physiotherapy sessions for 2weeks, 5 sessions per week. In addition to physiotherapy, the ESWT group received 4 ESWT sessions, 2 sessions per week, and the HILT group received 4 HILT sessions, 2 sessions per week. The outcomes were pain intensity as assessed by Visual Analog Scale, grip strength by hand dynamometer, and function by the Duruoz Hand Index and Patient-Rated Tennis Elbow Evaluation-Turkish version questionnaire. The participants were assessed at the beginning of the study (T1/week 0), at the end of treatment (T2/2nd week), and at follow-up (T3/6th week). At follow-up (T3), a significant improvement was observed in all outcomes compared to baseline (T1) in all groups (P < 0.05). Inter-group comparison of the mean differences between baseline and end values showed that the HILT group was superior in all outcomes (P < 0.05). This study showed that physiotherapy alone combined with ESWT and HILT positively affected the treatment of lateral epicondylalgia. Physiotherapy combined with HILT was found to be the most effective for improving pain, grip strength, and function. Clinical trial number: NCT674325.

A comparison between the efficacy of eccentric exercise and extracorporeal shock wave therapy on tendon thickness, vascularity, and elasticity in Achilles tendinopathy: A randomized controlled trial.

This study aims to compare the efficacy of the eccentric exercise (EE) and extracorporeal shock wave therapy (ESWT) on chronic midportion Achilles tendinopathy and evaluate the efficacy of these treatment modalities on tendon thickness, vascularity, and elasticity. In this randomized controlled trial, a total of 63 patients (40 females, 23 males; mean age: 37.3±12.2; range, 18 to 55 years) with chronic midportion Achilles tendinopathy were enrolled between April 2017 and December 2019. The patients were allocated randomly to two groups: the first group was treated with EE every day for three months with the Alfredson protocol, and the second group received four sessions of ESWT at weekly intervals. The study was terminated at the end of three months. Visual Analog Scales (VAS), Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaires, and ultrasonography measurements were assessed before and after treatment. Patient pain was evaluated at the two-year follow-up. At the three-month follow up, VAS scores decreased, and VISA-A scores increased in both groups (p<0.001). At the two-year-follow-up, VAS scores significantly decreased in the EE group (p<0.001), but the difference was statistically insignificant in the ESWT group (p=0.095). Tendon thickness and stiffness increased in the EE group (p=0.003 and p=0.03, respectively) while the difference was statistically insignificant in the ESWT group after treatment (p=0.173 and p=0.702, respectively). Eccentric exercise and ESWT are efficient in the short term, whereas EE is efficient on tendon pain in the long term. While EE increases tendon thickness and stiffness, ESWT has no effect on these measures.

Comparison of Plantar Pressure Distribution and Ultrasonographic and Clinical Features After Application of Different Energy Levels of Extracorporeal Shockwave Therapy in Patients with Plantar Fasciitis: A Randomized, Prospective, Double-Blind Clinical Trial.

The effectiveness of different energy levels used in extracorporeal shockwave therapy (ESWT) has been investigated in previous studies, but controversy remains regarding which energy levels should be used in the treatment of plantar fasciitis. We compared the efficacy of different energy levels used in ESWT in the treatment of plantar fasciitis using plantar fascia thickness and pressure distribution. Between July 2021 and September 2021, a total of 51 patients (71 feet) with plantar fasciitis were randomized into three treatment groups using the sealed envelope method. Group 1 (n = 25) received low energy density (0.09 mJ/mm2), group 2 (n = 25) received medium energy density (0.18 mJ/mm2), and group 3 (n = 21) received high energy density (0.38 mJ/mm2). Each group received three sessions of ESWT at a frequency of 2,000 shocks per minute at 1-week intervals. Patients were evaluated before and after treatment using a visual analog scale (VAS) for pain, the Foot Function Index (FFI), plantar fascia thickness measured by ultrasonography, and plantar pressure distribution. Posttreatment VAS and FFI scores were determined to be significantly lower than the values before treatment in the three groups (P < .001). There were no significant differences among groups in pretreatment and posttreatment values of VAS, FFI, plantar fascia thickness, and pressure distribution (P > .05). No significant differences were found among groups in percentage changes in all of the outcome parameters (P > .05). There was no superiority among low, medium, or high levels of ESWT in terms of pain, foot functions, fascia thickness, and pressure distribution in the treatment of plantar fasciitis.

Analgesic Effect of Extracorporeal Shock-Wave Therapy in Individuals with Lateral Epicondylitis: A Randomized Controlled Trial.

This study was conducted to investigate the effect of extracorporeal shock-wave therapy (ESWT) on pain, grip strength, and upper-extremity function in lateral epicondylitis. A sample of 40 patients with LE (21 males) was randomly allocated to either the ESWT experimental (n = 20) or the conventional-physiotherapy control group (n = 20). All patients received five sessions during the treatment program. The outcome measures used were the Visual Analog Scale (VAS), the Taiwan version of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and a dynamometer (maximal grip strength). Forty participants completed the study. Participants in both groups improved significantly after treatment in terms of VAS (pain reduced), maximal grip strength, and DASH scores. However, the pain was reduced and upper-extremity function and maximal grip strength were more significantly improved after ESWT in the experimental group. ESWT has a superior effect in reducing pain and improving upper-extremity function and grip strength in people with lateral epicondylitis. It seems that five sessions of ESWT are optimal to produce a significant difference. Further studies are strongly needed to verify our findings.