Extracorporeal Shock Wave Therapy In Treatment Research Articles

Is platelet-rich plasma and extracorporeal shock wave therapy a new frontier in treating patients with erectile dysfunction?

Background. Existing methods for treating erectile dysfunction (ED) do not always provide the necessary therapeutic effect and/or may not be recommended for certain patients.Aim. Evaluate the effectiveness of correcting erectile dysfunction using platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT).Material and methods. 100 men were randomly assigned to 3 groups. Group 1 (n=20) received ESWT treatment on the penis twice a week for 6 weeks. Group 2 (n=40) and Group 3 (n=40) had two visits per week for 6 weeks, involving both ESWT and PRP injections into the penis. In Group 2, PRP activation was performed using ESWT, while in Group 3, it was done using a 10% solution of CaCl2. Patients were evaluated at 0 and 60 days of the study, assessing IIEF-5, SEP, EHS, GAQ, blood testosterone levels, and penile Doppler ultrasound with PGE1.Results. In group 1 IIEF-5 improved from 14.5 (10.5-17) to 19.5 (15.5-21) (р<0.05). SEP changed from 2 (1-2) to 3 (2-4) (р<0.05). EHS improved from 1.5 (1-2) to 3 (2.5-3) (р<0.05). Baseline PSV was 16.3 cm/s (12.2-22.7), at 60 days post ESWT was 24 cm/s (19.4-26.8) (р<0.05) and RI changed from 0.7 (0.7-0.9) to 0.9 (0.8-1) according D-PDU (р<0.05). 14 patients (70 %) noted positive dynamics by GAQ at the last exam. In group 2 IIEF-5 was 13 (11-15) at 0 days, 18 (16-20) at 60 day (р<0.05). SEP improved from 2 (1.5-2) to 3 (3-4) (р<0.05). EHS changed from 2 (1-2) to 3 (2-3) (р<0.05). D-PDU results demonstrated increase median PSV 15.6 cm/s (12.1-22.8) to 27 cm/s (20.6-33.5) (р<0.05) and median RI from 0.8 (0.7-1) to 1 (0.8-1) (р=0.02). 34 men declared positive effects according to GAQ (85 %) In group 3 IIEF-5 results improved from 13 (9-15) to 18.5 (15-20.5) (р<0.05). SEP improved from 2 (1-2) to 3 (3-4) (р<0.05). EHS changed from 1 (1-2) to 3 (3-3) (р<0.05). PSV increased from 17 cm/s (10.3-25) to 27.8 cm/s (20-36.6) (р<0.05). RI improved from 0.8 (0.7-0.9) to 0.9 (0.8-1) (р=0.005). 33 patients respond to an improvement of erectile functions (82.5 %) by GAQ.Conclusion. All treatment methods were well-tolerated by all patients. The study results indicate a positive trend in improving erectile function and increasing total testosterone levels in the blood. When comparing groups, combination therapy significantly improves erectile function according to SEP, EHS, and penile Doppler ultrasound assessments. ESWT can be suggested as an activator for PRP.

Extracorporeal Shock Wave Therapy as Regenerative Medicine in Knee Osteoarthritis: Pre-Experiment for Matrix Metalloproteinase-3 Evaluation.

Knee osteoarthritis (KOA) is currently treated by regenerative therapies that aim to inhibit arthritic degeneration. Extracorporeal shock wave therapy (ESWT) is one of the physical regenerative approaches used for KOA management. However, little is known regarding the impact of shock wave treatment on matrix metalloproteinase-3 (MMP-3), which is one of the enzymes mediating cartilage degradation. To evaluate the effect of ESWT on MMP-3 levels and pain intensity in patients with KOA. Fourteen patients diagnosed with Kellgren Lawrence, grades 2 and 3 KOA were recruited for the study. ESWT piezo shockwave was applied once a week for six weeks. MMP-3 levels in the blood were measured pre-test, mid-test (three weeks after therapy) and post-test (one week after the last session) by enzyme-linked immunosorbent assay (ELISA). The perceived pain was recorded at each session by the Wong Becker Face Scale. The median pre-test, mid-test and post-test MMP-3 levels were 19.92 ng/mL, 15.89 ng/mL and 18.82 ng/mL, respectively, and there were significant differences between the pre-test and mid-test, and the pre-test and post-test values (p < 0.05). The pain scores also decreased significantly over the period of intervention. MMP-3 levels decreased significantly in KOA patients after ESWT, and the decline was most obvious after 3 weeks of therapy. Therefore, EWST should be considered as a suitable treatment option for KOA.

Effectiveness of Extracorporeal Shock Wave Therapy after Botulinum Toxin Injection for Post-Stroke Upper Extremity Spasticity: A Randomized Controlled Study.

Post-stroke spasticity is a common complication that limits the functional performance of patients. Botulinum toxin (BTx) is an effective treatment for spasticity. Numerous researchers have applied extracorporeal shock wave therapy (ESWT) to address post-stroke spasticity, yielding positive clinical outcomes. We aimed to clarify the add-on effects of ESWT on BTx therapy for spasticity in patients with post-stroke. Sixteen eligible patients with upper extremity spasticity after stroke were recruited for this study. They were randomized to either a BTx with focused ESWT treatment group or a BTx alone group. Spasticity, measured using the modified Ashworth score (MAS) and modified Tardieu scale (MTS), showed statistically significant improvements in the elbow and wrist flexor muscles in both BTx + ESWT group and BTx alone groups. However, no significant differences were observed between the two groups with time flow. The BTx + ESWT group showed significantly decreased MAS of the finger flexors at follow-up and increased R1 (MTS) of the finger flexors at 3 weeks after treatment, which was not observed in the BTx alone group. This is the first study to identify the add-on effect of ESWT on BTx injections to improve post-stroke upper limb spasticity.

Effects of extracorporeal shockwave therapy for mild knee osteoarthritis: A pilot study.

Extracorporeal shockwave therapy (ESWT) has been widely used for various musculoskeletal disorders, including knee osteoarthritis (OA), and has been shown in several studies to be a safe treatment. Although some studies have confirmed the pain-relieving effect of ESWT for knee OA, research on objectivity for structural changes in knee OA is lacking. The aim of this study was to evaluate the ESWT treatment mechanisms in patients with knee OA by means of clinical symptoms and ultrasound techniques as objective measures. Eighteen patients with mild knee OA were enrolled and randomized to 1 of 2 treatment groups: active or sham. Patients in the experimental group received 0.05 mJ/mm² total energy with 1000 pulses weekly for 3 weeks. We then assessed them before, immediately after, and 1-month after the last treatment using the following measurements: pain on a visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne index, knee joint range of motion, and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height). All 18 patients completed the 3 treatment sessions without any complication. Both the experimental and control groups improved in terms of OA symptoms, as measured by the visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index score, and Lequesne index (P < .05). The height of the suprapatellar effusion decreased with time course in the experimental group (P < .05) and showed significant differences with control group at 1-month follow-up (P < .05). The experimental group showed an increase in knee flexion range of motion and Doppler activity immediately following the last treatment session (P < .05), but the effect was not sustained at the 1-month follow-up. Although the therapeutic activity itself could improve OA symptoms, objective improvements were only observed after ESWT. Suprapatellar effusion height was reduced after ESWT and the effect was maintained after 1-month. Our results suggest that ESWT may be effective in reducing suprapatellar effusion and improving symptoms in mild knee OA. However, studies with a larger sample size are required.

Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up.

Chronic prostatitis (CP) is one of the diseases that reduce the quality of life (QoL) of young men. To date, there is no consensus on the management of these patients. It is essential to continue research into the treatment of CP, despite the use of various therapies, including low-energy extracorporeal shockwave therapy (ESWT). The main objective of this study is to observe and record the clinical symptomatology of patients during a 48-week follow-up period after ESWT treatment. Between 2019 and 2021, 28 patients with type IIIB CP/chronic pelvic pain syndrome were enrolled. Patients underwent ESWT once weekly for 4 weeks (3,000 individual sessions, maximum total energy flux density 0.25 mJ/mm2, frequency 3 Hz). Participants were assessed at 0, 4, 12, 24, 36 and 48 weeks post-treatment using the visual analogue scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function (IIEF)-5. The mean age of patients was 47.1 ± 13.7 years (range 28-4 years). The positive effect of LI-ESWT was reflected in improvements in VAS, NIH-CPSI, and IIEF-5 scores. Regression of patients' symptoms was observed as early as 4 weeks after treatment. The greatest progress was achieved at week 24. In addition, a slight worsening was observed at week 36 and 48, with stable progress. The treatment significantly improved the QoL of the patients, with the most significant improvement in the VAS score. In conclusion, this treatment approach is safe, most effective in the first 6 months. Thereafter, the efficacy of the treatment diminishes, but is sustained over a longer period.

The therapeutic effect and safety profile of extracorporeal shockwave therapy in treatment of chronic prostatitis/chronic pelvic pain syndrome: a systematic review

Background: Extracorporeal Shockwave Therapy (ESWT) has been indicated to relieve local perineal symptoms caused by Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). Current research has examined the efficacy of ESWT in CPPS patients. Different types of energy generators for ESWT lead to development of different clinical protocols for treatment of CP/CPPS. Therefore in this review, we aimed to compare the clinical protocol, efficacy and safety profile of all these different ESWT machines in CP/CPPS treatment. Methods: A systematic literature search of 3 search engines (PubMed, Scielo, and Science Directs) was undertaken using the following keywords: Chronic Prostatitis, Chronic Pelvic Pain Syndrome, and Extracorporeal Shockwave Therapy. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. This review included original studies that evaluated the efficacy and clinical protocol of Extracorporeal Shockwave Therapy and Chronic prostatitis or Chronic Pelvic Pain Syndrome that are fully written in English with full-text articles readily available. This article excluded letters to the editor, reviews, and editorials about prostatitis other than CPPS. Results: The search strategy yielded 8 journals that meet the inclusion and exclusion criteria from all 3 search engines. These 8 studies included 3 different types of energy generators (Piezoelectric, Electropneumatic, and Electromagnetic) with different protocols applied. All 3 types of energy generators of ESWT can effectively decrease all domains of CPSI score within 12 months of follow-up (P-value 0,05). The limitations of this systematic review include the restricted variety of energy generators with the lack of openly registered protocols. Conclusions: In Conclusion, ESWT provides significant improvement in clinical symptoms as compared to oral medications alone. These therapeutic effects are also observed in all different types of energy generators with different clinical protocols with similar safety profiles.

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Median age at surgery was 9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required a median of 1.3 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: median increase of 6.8% (range 1.3%-35.7%) between 106.5 days (17.5% of ideal visualized, range 5%-42%) and 245.5 days (27.9% of ideal, range 8%-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.

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

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

Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners.

Bone stress injury (BSI) is a common overuse injury that can result in prolonged time away from sport. Limited studies have characterized the use of extracorporeal shockwave therapy (ESWT) for the treatment of BSI. The purpose of this study was to describe the use of ESWT for the management of BSI in runners. A retrospective chart review was performed to identify eligible patients in a single physician's clinic from 1 August 2018 to 30 September 2022. BSI was identified in 40 runners with 41 injuries (28 females; average age and standard deviation: 30 ± 13 years; average pre-injury training 72 ± 40 km per week). Overall, 63% (n = 26) met the criteria for moderate- or high-risk Female or Male Athlete Triad categories. Runners started ESWT at a median of 36 days (IQR 11 to 95 days; range 3 days to 8 years) from BSI diagnosis. On average, each received 5 ± 2 total focused ESWT treatments. Those with acute BSI (ESWT started <3 months from BSI diagnosis) had an average return to run at 12.0 ± 7.5 weeks, while patients with delayed union (>3 months, n = 3) or non-union (>6 months, n = 9) had longer time for return to running (19.8 ± 14.8 weeks, p = 0.032). All runners returned to pain-free running after ESWT except one runner with non-union of grade 4 navicular BSI who opted for surgery. No complications were observed with ESWT. These findings suggest that focused ESWT may be a safe treatment for the management of BSI in runners.

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.

Perspective of application of еру extracorporeal shock-wave therapy in treatment of chronic ostheomyelitis.

Perspective of application of еру extracorporeal shock-wave therapy in treatment of chronic ostheomyelitis.

Use of combined shockwave therapy and platelet-rich plasma injection for management of chronic plantar fasciitis in runners: two case reports

Plantar fasciitis is one of the most common causes of foot and heel pain in adults. Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) have each been described as effective treatments for plantar fasciitis; however, the combined use has not been adequately described. This report characterizes successful return to sport in two runners with plantar fasciitis who were treated with ESWT combined with PRP. Patient-reported outcomes were measured using the Foot and Ankle Ability Measure (FAAM). A 69-year-old female had 8 months of pain refractory to physical therapy (PT). A 73-year-old male presented with recent onset of 3 weeks of symptoms. Both runners had exam findings of plantar fasciitis and MRI confirmation. Each elected to complete ESWT along with PT using a foot core program and met functional improvements for both sport and ADL subscales of FAAM after initial ESWT treatment. However, each runner had worsening pain when attempting to run and both elected to proceed with a single leukocyte-poor PRP injection combined with ESWT. This allowed for successful return to running. Both cases highlight how combined ESWT and PRP with a foot core PT progression may be effective in managing plantar fasciitis in running athletes.

Improving Cadence and Walking Speed after Extracorporeal Shockwave Therapy: Preexperimental Study in Knee Osteoarthritis Patients

Introduction: Current treatment for knee osteoarthritis (KOA) has aimed at inhibiting the degenerative processes of osteoarthritis by regenerative medicine. One of the physical modalities that have a regenerative effect is extracorporeal shockwave therapy (ESWT). There was limited evidence based for evaluating the improvement function of KOA, especially after ESWT management. This study aimed to investigate the effect of ESWT by serial evaluation of cadence and gait speed for patients with KOA. Methods: Preexperimental with one group design was conducted in this study. We recruited 14 participants diagnosed with KOA with scoring Kellgren–Lawrence Grades 2 and 3. ESWT piezo shockwave was applied once a week for 6 weeks. Evaluations of cadence and walking speed were conducted three times (pretest, mid-test at 3 weeks after therapy, and posttest at 1 week after the last session). Results: There was a significant improvement of cadence and gait speed pretest compared to mid-test (P = 0.004; P = 0.003) and posttest (P = 0.001; P = 0.001). However, there was no significant difference between mid-test and posttest results. Conclusions: Cadence and gait speed were improved significantly after ESWT treatment for KOA, especially after 3 weeks.

Lateral Epikondilitli Hastalarda Farklı Tedavi Yöntemlerinin Klinik Sonuçlarının Karşılaştırılması

Aim: In our study, the effectiveness of steroid injection therapy, extracorporeal shock wave therapy (ESWT) and splint use in the treatment of lateral epicondylitis, were compared.Methods: A total of 97 patients (28 males, 57 females, mean age: 47 years) with a clinical diagnosis of lateral epicondylitis were included in the study. The patients were divided into three treatment groups. Steroid injection was applied to 30 patients, ESWT treatment to 28 patients, and bandage treatment to 29 patients. Patients were evaluated with Visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores before and after treatment.Results: A decrease in VAS and DASH scores and clinical improvement compared to pre-treatment were observed in all three groups. Although positive results were obtained with all three treatment methods, we found that the most statistically significant treatment method was steroid injection. Better results were obtained in the group that received steroid injection with the peppering technique. (p&amp;lt;0.05).Conclusion: The results of this study showed that local steroid injection, ESWT application and bandage treatment may be beneficial in the short term in the treatment of patients with lateral epicondylitis. However, it was evaluated that the best improvement in scores was obtained with local steroid injection with the peppering technique, whereas the least improvement was obtained with bandage treatment.

Myogenous Temporomandibular Disorders: Diagnostic Concepts and Prospective Pilot Study on Extracorporeal Shockwave Therapy

The aims of this article are to discuss the current, and potential future directions, in the diagnosis of myogenous temporomandibular disorders (M-TMD), as well as to report a pilot study to investigate the feasibility and clinical outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of M-TMD. Forty-one adult patients presented with M-TMD were recruited into the study and randomized into two groups: Group 1 received ESWT treatment, whereas Group 2 received placebo treatment. The variables investigated were pain, measured by a numerical rating scale (NRS) and mouth opening. Twenty-six patients (Group 1: n = 14, mean age = 45.3 (16.7) years; Group 2: n = 12, mean age = 46.8 (19.7) years) completed 1-year follow up and were included into the final analysis. In both groups, reduction in pain and increase in MO (unassisted maximum, assisted maximum, and pain-free) were seen at post-treatment 1 year. There were more reduction in pain and increase in all MO in Group 1 than Group 2, but statistical significance was not detected. No major complications were encountered in this study. Although significant differences were not seen between groups, this prospective pilot study provided preliminary evidence that ESWT is safe and potentially beneficial in the treatment of M-TMD.

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

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

Extracorporeal shock wave therapy in association with bromelain and escin for the management of patients affected by chronic prostatitis/chronic pelvic pain syndrome.

Extracorporeal shock wave therapy (ESWT) has been purposed for the management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with encouraging results. Phytotherapeutic compounds have been used in everyday clinical practice for patients with CP/CPSS due to their anti-inflammatory properties. The present study aimed to investigate the effects of ESWT in association with the use of bromelain and escin extracts in patients with CP/CPSS. For this purpose, 95 patients with a clinical diagnosis of CP/CPSS were enrolled in the study. The patients were randomly allocated to either the ESWT plus bromelain and escin group (group A; n=48) or the ESWT only group (group B; n=47). A total of five weekly ESWT treatment sessions were administered alone or in combination with bromelain and escin. Each session consisted of 3,000 focused shock waves. Doses of 160 and 500 mg/day bromelain and escin were administered respectively for 5 weeks. The changes in urinary symptoms, pain and quality of life were considered the main outcome measures and were assessed at baseline, and at 4, 12 and 24 weeks of follow-up. Urinary symptoms, pain and quality of life were evaluated using the international prostatic symptoms score (IPSS), visual analog scale (VAS) and the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). After 4 weeks, the mean VAS score, mean IPSS and mean satisfaction rate score had significantly improved in patients receiving ESWT plus bromelain and escin. After 12 weeks, the mean IPSS and mean satisfaction rate score were stable in the ESWT plus bromelain and escin group, while the mean VAS score was significantly lower when compared with the baseline values in both groups. On the whole, the present study demonstrates that in patients affected by CP/CPPS, treatment with ESWT plus bromelain and escin leads to pain resolution, and both treatments improve the IPSS, VAS and NIH-CPSI results.

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.

O080 A double-blind, placebo-controlled, randomised trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication.

Abstract Introduction Intermittent claudication (IC) is a prevalent manifestation of peripheral arterial disease and affects about 3% of the UK population. Current guidance for the management of nonlife limiting IC is supervised exercise and best medical therapy. Supervised exercise however is not readily available across the nation and has poor recruitment and retention rates. Pilot data has demonstrated that Extracorporeal ShockWave Therapy (ESWT) is effective for improving walking distance in patients with IC. This study aims to consider its effectiveness for improving quality of life (QoL). Methods In a double-blind, sham-controlled, randomised trial, patients with IC were randomised in a 1:1 ratio to ESWT or sham treatment. The primary endpoint was change in physical functioning at 12-week follow-up, as measured by the SF-36. Secondary endpoints included changes in walking distances and ABPI. Results 138 patients were randomised. The ESWT group had a significantly higher physical functioning score at 12 weeks (Mdn 41 vs 34, z=-2.1, p=0.033). They also had significantly longer claudication (Mdn 125 vs 88, z=-2.9, p=0.004) and maximum (Mdn 179 vs 129, z=-2.4, p=0.013) walking distances. The change from baseline to 12-weeks was also significantly greater in the ESWT group for claudication (Mdn 51 vs 24, z=-2.8, p&amp;lt;0.01) and maximum (Mdn 63 vs 17, z=-4 p&amp;lt;0.01) walking distance. No difference observed in ABPI. Conclusion This study demonstrates that ESWT is safe, well tolerated and clinically effective for improving QoL and walking distances in patients with IC. Take-home message Extracorporeal shockwave therapy improves quality of life and walking distances, and could potentially be used as a non-invasive adjunct to supervised exercise or in institutions were supervised exercise is not available.

The Effectiveness of Extracorporeal Shockwave Therapy for Midportion Achilles Tendinopathy: A Systematic Review.

Achilles tendinopathy is one of the most common lower limb injuries in both athletes and the general population. Despite the plethora of conservative treatment options available for the management of Achilles tendinopathy, as many as one in four patients will go on to require surgery. Extracorporeal shockwave therapy (ESWT) has emerged as a promising treatment option and has been successful in the management of other common musculoskeletal injuries such as plantar fasciitis. However, the evidence for ESWT in the management of Achilles tendinopathy remains inconclusive. Therefore, the aim of this systematic review was to evaluate the current evidence for the use of ESWT in the management of midportion Achilles tendinopathy.A comprehensive literature search was conducted using the databases MEDLINE (Pubmed), AMED, EMBASE, CINAHL, and CENTRAL. The databases were searched from their inception to December 2021. This was conducted to identify randomised control trials (RCTs) evaluating the effectiveness of ESWT versus control treatment in the management of midportion Achilles tendinopathy.Following a comprehensive search of the literature, a total of 283 articles were identified. Following the screening of titles and abstracts, 236 articles were excluded. The main reasons for exclusion were the identification of duplicates, non-randomised studies, and the use of ESWT on other pathology. Following the exclusion of 236 articles, 47 articles were retrieved for full-text review. Of these 47 articles, 40 were excluded leaving a total of 7 RCTs eligible for inclusion in this review. There was consistent evidence from 4 RCTs that ESWT is effective in the management of midportion Achilles tendinopathy.This review suggests that ESWT is a safe and effective modality for treating midportion Achilles tendinopathy as it reduces pain and improves function. The best available evidence suggests that a combination of ESWT with eccentric exercises and stretching may be even more effective than ESWT alone. Further research is required to confirm this and to determine the optimum ESWT treatment protocol.