Extracorporeal Shock Wave Research Articles

Effect of Radial Extracorporeal Shockwave Therapy on Pain Intensity Level in Patient with Calcaneal Spur

Background: Heel pain is a common musculoskeletal issue that significantly impacts patient daily activities and, consequently, their quality of life. This clinical study aims to evaluate the effectiveness of radial extracorporeal shockwave therapy in reducing pain intensity in patients with calcaneal spurs.Objective: To investigate the effects of radial extracorporeal shockwave therapy on pain intensity in patient with calcaneal spur.Methods: A total of 60 patients diagnosed with calcaneal spurs based on clinical examination and lateral radiography between September 2022 and June 2023 were included in this study. Participants were randomly assigned to two groups: Group A (radial extracorporeal shockwave therapy) and Group B (traditional physical therapy). All participants followed an exercise program; however, those in Group A received six sessions of radial extracorporeal shockwave therapy (10 Hz, 2000 pulses, at 2.4 bar). The Visual Analog Scale (VAS) was used to assess pain intensity both before and after treatment in all participants.Results: No significant differences were observed between Group A and Group B regarding gender, affected side, condition distribution, age, weight, height, or BMI (p > 0.05). Both groups experienced significant reductions in VAS scores post-treatment (p < 0.001); however, Group A demonstrated a greater improvement, with a percentage reduction in pain of -50.65%, compared to -28.17% in Group B. Additionally, post-treatment VAS scores were significantly lower in Group A than in Group B (p = 0.003), indicating that shockwave therapy yielded a more substantial reduction in painConclusions: Both radial extracorporeal shockwave therapy and traditional physical therapy programs significantly reduced pain intensity in patients with calcaneal spurs, with a favorable effect observed for radial extracorporeal shockwave therapy. These methods can be considered effective, safe, and conservative treatment options for managing calcaneal spurs.

Clinical evaluation of the efficacy of focused extracorporeal shock-wave therapy in patients with cervical spondylosis: A randomized control trial.

Extracorporeal shock wave therapy (ESWT) has emerged as a contemporary modality in physiotherapy, demonstrating efficacy in addressing musculoskeletal disorders. Despite its potential, the clinical efficacy of ESWT in the context of cervical spondylosis remains understudied, with a dearth of robust empirical evidence. To bridge this gap, the present study was designed to evaluate the therapeutic impact of focused ESWT (fESWT) on pain alleviation and functional improvement in individuals afflicted with cervical spondylosis. A multicenter, randomized controlled clinical study was conducted, collecting data from 5 clinical studies on the treatment of cervical spondylosis with fESWT from June 2021 to March 2024. The inclusion criteria were patients diagnosed with cervical spondylosis, aged 20 to 70, without severe underlying diseases such as heart disease, hypertension, diabetes, etc. The exclusion criteria included pregnant women, nursing women, patients with bleeding tendencies, or those with cardiac pacemakers. The control group underwent a sham fESWT, while the experimental group received fESWT administered via the Duolith SD1 Tower device. The main observation indicators included the Visual Analogue Scale (VAS) for pain scoring, Neck Disability Index (NDI) scoring, cervical range of motion (ROM) scoring, and the Short Form-36 (SF-36) quality of life survey scoring. A total of 320 subjects were included in the study, with 160 in the experimental group and 160 in the control group. Post-treatment, the VAS and NDI scores in the experimental group were significantly lower than those in the control group (P < .05), while the cervical range of motion (ROM) and SF-36 scores were significantly higher than in the control group (P < .05). The overall treatment efficacy rate in the experimental group exceeded 90%, markedly higher than the approximately 70% rate in the control group (P < .05). There was no significant difference in the incidence of adverse reactions between the 2 groups. The fESWT has shown promising therapeutic effects in the treatment of cervical spondylosis. It effectively reduces patient pain, improves cervical function, and enhances the quality of life, making it worthy of clinical promotion and application.

Abstract 4143239: Extracorporeal Shockwave Therapy Improves Physical Outcomes and Quality of Life In Patients With Symptomatic Peripheral Arterial Disease: Results from a Meta-analysis of Randomized Controlled Trials

Introduction: Extracorporeal shockwave therapy (ESWT) is a non-invasive procedure that may be useful to treat symptomatic peripheral arterial disease (PAD). Trials comparing ESWT with control groups have shown promising results. Methods: PubMed, Cochrane, EMBASE, and Google Scholar were searched for randomized controlled trials reporting the efficacy of extracorporeal shockwave therapy versus control in patients with symptomatic PAD. Data from eligible studies was analyzed using the Review Manager 5.4 software. Mean difference (MD) and 95% Confidence intervals (CI) were calculated for continuous outcomes. Inverse variance method and a random effects model were used for pooled estimates. A p-value &lt; 0.05 (Z-test) was considered significant. Results: 5 randomized controlled trials with 264 patients were included in our analysis. A significant increase in the mean walking distance (MD: 54.13, 95% CI 9.34 to 98.92, p=0.02), pain-free walking distance (MD: 54.13, 95% CI 14.19, 57.88, p= 0.001), SF-36 physical component summary (MD: 11.97, 95% CI 0.26 to 23.69, p=0.05), EQ-5D-3L index score (MD; 0.08, 95% CI: 0.00 to 0.15, p=0.05) and VascuQoL index ((MD: 0.48, 95% CI 0.03 to 0.92, p= 0.04) was seen with ESWT. A slightly higher ankle brachial pressure index was seen in the control group (MD: -0.01, 95% CI: -0.02 to -0.00, p=0.04). There was no difference in SF-36 physical functioning domain score (MD: 18.58, 95% CI: -0.29 to 37.45, p=0.05) and SF-36 bodily pain score (MD: 9.17, 95% CI: -2.885 to 21.19, p=0.13). Conclusions: There was significant improvement in walking distances, exertional symptoms, and quality of life with ESWT. However, ESWT did not translate to an increase in post-treatment ankle-brachial index which was slightly higher in the control group. There is a need for larger randomized controlled trials to substantiate the efficacy of ESWT in treating symptomatic PAD.

Using Extracorporeal Shockwave Therapy in Patients with Orthopedic Conditions

Background: Among other non-invasive procedures, Extracorporeal Shockwave Treatment (ESWT) has been used to resolve many musculoskeletal ailments. The authors completed a systematic review to study articles that reported the effectiveness of focused shockwave therapy in patients with orthopedic conditions. Methods: A comprehensive search was conducted across reputable databases including Pub Med, The Cochrane Library, Science Direct, PEDro, Clinicaltrials.gov, and Google Scholar, ensuring a thorough review of the literature until October 10, 2022. Original articles of any design reporting on the use of ESWT in orthopedic patients were meticulously selected. Information related to study design, sample size, participants, intervention, and key findings of the study were extracted. The PEDro classification scale, a recognized tool, was used to evaluate the quality of the studies, further enhancing the credibility of findings. Results: Nineteen research articles (including 1157 participants) were retrieved and included for qualitative analysis. The sample size ranged from twenty-one to one hundred fifteen subjects, and the articles were published between 2001 and 2022. Out of 19 studies published, five were conducted in China, three in Germany, two in Iran and Turkey, and one in the United States, Canada, Italy, Denmark, Spain, Taiwan, and Saudi Arabia. The risk of bias was either moderate or low among the included studies. In patients with various orthopedic conditions, considerable moderate evidence of ESWT’s effectiveness and success in lowering pain levels, increasing treatment success rates, promoting patient-reported functional recovery, and raising performance-based functional outcomes was seen in the results. Conclusion: The systematic literature review provided compelling evidence of the successful application of ESWT in treating a wide range of musculoskeletal problems. These positive outcomes were achieved without severe complications and morbidities, offering a promising outlook for the future of orthopedic treatment.

Advanced Non-Operative Interventions for Anterior Knee Pain.

This review presents evidence for advanced non-operative interventions, including extracorporeal shockwave therapy (ESWT), prolotherapy, platelet-rich plasma (PRP), adipose tissue-derived cells, bone marrow aspirate concentrate, various additional non-corticosteroid injectates, and needle-based interventions for common causes of anterior knee pain in the adult population. These etiologies include osteoarthritis of the knee, patellofemoral pain syndrome, chondromalacia patella, Hoffa fat pad impingement syndrome, patellar/quadriceps tendinopathy, and prepatellar bursitis. This review discusses patient care options using a case-based understanding of interventions by condition while recognizing strength of evidence. ESWT and PRP are the most robustly studied and have greatest evidence for treating tibiofemoral osteoarthritis and for long-term benefit in treating patellar tendinopathy. PRP may have evidence for treatment of chondromalacia and prolotherapy for management of tibiofemoral arthritis; both have limited evidence. Botulinum neurotoxin type A has strong evidence to support use in treating patellofemoral pain syndrome. There is limited evidence to support the use of viscosupplementation, percutaneous needle tenotomy, and medicinal signaling cell-based therapies beyond platelet-rich plasma for anterior knee pain. There is limited research on the management of quadriceps tendinopathy, prepatellar bursitis, patellofemoral osteoarthritis, and Hoffa's fat pad impingement syndrome. Further research and standardization of protocols are necessary to fully assess these treatments' efficacy. ESWT, cell-based, and needle-based interventions, may serve as effective treatment options for patients with anterior knee pain. Selection of each intervention requires understanding the evidence, level of risk, and appropriate application based on a patient's level of activity to enable clinicians to enhance patient outcomes and quality of life.

Comparison of high intensity laser therapy and extracorporeal shock wave in treatment of lateral epicondylitis: a randomized controlled study.

This study aims to evaluate and compare the short-term efficacies of high-intensity laser therapy (HILT) and ESWT(focused) on pain, sensitivity, handgrip strength and functions, in the treatment of lateral epicondylitis (LE). Fourty seven patients (age range, 18 to 65 years) with unilateral elbow pain were randomized into two groups. HILT group (n = 24) and ESWT group(n = 23). The HILT and ESWT were administered three times a week for three weeks, and each treatment was combined with exercises. All paticipant in both of two groups were evaluated with ultrasonography for common extansor tendon thickness. A visual analog scale (VAS), quick Disabilities of the Arm, Shoulder, and Hand (QDASH), hand grip strength test were used to evaluate the patients before, one and six weeks after treatment. There were significant improvement in VAS, hand grip strength, QuickDASH scores and CET thickness before and after treatment in both group(p < 0,05). But there were no significant differences between the groups pre-treatment, at the 1st week, and 6th week after treatment (p > 0.05). Only hand grip strength was smilar to the pretreatment outcomes in HILT group. Both treatment methods were found to be effective and safe in the short-term treatment of LE. Consequently, these non-invasive, effective and safe techniques can be successfully used in the treatment of common pathology of the elbow.

Application of extracorporeal shockwave to regulate subchondral bone homeostasis through tumor necrosis factor-α/hypoxia-inducible factor-1α/vascular endothelial growth factor signaling pathway in treatment of talus bone marrow edema.

To investigate the effect of extracorporeal shock wave on the treatment of talus bone marrow edema by regulating subchondral bone homeostasis through tumor necrosis factor-α (TNF-α)/hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway. A total of 81 patients with talus bone marrow edema admitted to our hospital from May 2019 to May 2021 were studied and divided into control group (n = 40) and extracorporeal shock group (n = 41) according to random number table method. The control group was given conventional treatment, and the extracorporeal shock group was combined with extracorporeal shock wave therapy on the basis of the control group. The expression of TNF-α, HIF-1α, and VEGF in the 2 groups were compared, pain degree, and the area of talus bone marrow edema was evaluated by magnetic resonance imaging. The visual analogue scale scores of 1 month, 2 months and 5 months after treatment were decreased in both groups, and the extracorporeal shock group was lower than the control group (P < .05). After 5 months of treatment, the expressions of TNF-α and HIF-1α were decreased in both groups, and the extracorporeal shock group was lower than the control group, VEGF was increased, and the extracorporeal shock group was higher than the control group (P < .05), and the western blot expression levels of TNF-α, HIF-1α and VEGF in the extracorporeal shock group were higher than the control group (P < .05). The dorsiflexion motion and plantar flexion motion of both groups were increased, and the extracorporeal shock group was higher than the control group (P < .05). Extracorporeal shock wave therapy can regulate subchondral bone homeostasis through TNF-α/HIF-1α/VEGF signaling pathway to treat talus bone marrow edema, reduce the pain degree of talus bone marrow edema, and improve ankle joint function.

High-volume injections in Achilles tendinopathy: a systematic review.

Achilles tendinopathy (AT) is common, particularly in runners. High-volume injections (HVIs) may be beneficial in the management of AT compared to other conservative management options, including exercise regimens, platelet-rich plasma (PRP) injections, and extracorporeal shockwave therapy. The published research on the effectiveness of HVI in the treatment of AT was evaluated in this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed when conducting this systematic review. The electronic databases PubMed, Embase, Cochrane, Web of Science, CINAHL, and OVID were thoroughly searched, from inception to 13 September 2023, for articles assessing HVI for AT. A total of 10 studies with 460 participants met the inclusion criteria. HVI typically consisted of saline, local anaesthetic, and corticosteroids. HVI combined with corticosteroids demonstrated immediate and long-term improvements in ankle function. Compared to HVI without corticosteroids, HVI with corticosteroids exhibited greater, early improvements in pain and function, with no significant differences at later follow-up points. Significant reductions in tendon thickness and neovascularity were also found with HVI treatment over time. No adverse events were reported with HVI, despite the use of corticosteroids. HVI is an effective and safe modality, particularly in the short term, to significantly reduce pain and discomfort in the Achilles tendon, especially when supplemented with corticosteroids. More robust randomized controlled trials, with longer-term follow-ups and homogeneity, are needed to fully establish its efficacy for AT.

EFFECTIVENESS OF RADIAL EXTRACORPOREAL SHOCKWAVE THERAPY IN THE LOCAL MANAGEMENT OF HYPERTONIA (SPASTICITY AND DYSTONIA) IN PATIENTS WITH CEREBRAL PALSY.

To assess the effect of radial extracorporeal shockwave therapy on the reduction of local hypertonia in patients with cerebral palsy. Explorative pre-post intervention study. Forty-five patients with cerebral palsy. All patients received 3 sessions of radial extracorporeal shockwave therapy with a time interval of 1 week for each session. The outcomes were V1 and V3 of the Tardieu scale, the Timed Up and Go test, and the 10-metre walk test. The measurements were collected at baseline, immediately after the last session of shockwaves, at 12 and 24 weeks after baseline. The statistical analysis used was a mixed linear model of repeated measures. The degrees on the Tardieu scale increased significantly in all the treated muscles. The results of the Timed Up and Go test and the 10 m walk test confirmed a significant functional effect after the shockwave therapy (p < 0.001). Functional improvement in patients treated with extracorporeal shockwave therapy has been observed to last up to 24 weeks.

Treatment Options for Plantar Fasciitis: Surgical Release vs. Conservative Therapy

Introduction Plantar fasciitis is one of the most common reasons for visits to orthopedic clinics. This tendinopathy can cause medial heel pain, stiffness, and tenderness on the plantar surface of the foot. Both conservative and surgical methods are employed in its treatment. Aim The aim of this study is to evaluate selected conservative treatment methods, such as stretching, the use of orthotic insoles, splints, injections, extracorporeal shockwave therapy, and taping, as well as surgical treatment options. The study presents a comparison of these methods in terms of their effectiveness, advantages, and disadvantages. State of Knowledge The plantar fascia is a stiff, connective tissue structure extending along the plantar surface of the foot. Biomechanical load on the fascia, which supports the medial longitudinal arch, can lead to degenerative changes that underlie plantar fasciitis. Symptoms include pain, particularly in the mornings and late evenings, which intensifies with palpation of the heel area. Summary (Conclusions) Conservative treatments for plantar fasciitis are effective in 90% of patients. There are no studies that conclusively demonstrate the superiority of one treatment method over another. Thus, the choice of therapy should be tailored to the patient's lifestyle, activity level, and financial capability. Surgical intervention is necessary in cases of chronic plantar fasciitis which remains resistant to conservative treatments.

Low-Energy extracorporeal shockwave therapy improves locomotor functions, tissue regeneration and modulating the inflammation induced FGF1 and FGF2 signaling to protect damaged tissue in spinal cord injury of rat model: An experimental animal study.

Spinal cord injury (SCI) is a debilitating condition that results in severe motor function impairments. Current therapeutic options remain limited, underscoring the need for novel treatments. Extracorporeal shockwave therapy (ESWT) has emerged as a promising noninvasive approach for treating musculoskeletal disorders and nerve regeneration. This study explored the effects of low-energy ESWT on locomotor function, tissue regeneration, inflammation, and mitochondrial function in a rat SCI model. Experiments were performed using locomotor function assays, CatWalk gait analysis, histopathological examination, immunohistochemical and immunofluorescence staining. The findings demonstrated that low-energy ESWT had a dose-dependent effect, with three treatment sessions (ESWT3) showing superior outcomes compared to a single session. ESWT3 significantly improved motor functions (run patterns, run average speed, and maximum variation, as well as the Basso, Beattie, and Bresnahan (BBB) score) and promoted tissue regeneration while reducing inflammation. ESWT3 significantly decreased levels of IL-1β, IL6 and macrophages (CD68) while increasing leucocyte (CD45) infiltration. Additionally, ESWT3 upregulated NueN and mitofusin 2 (MFN2), suggesting enhanced neuronal health and mitochondrial function. Moreover, ESWT3 modulated the expression of fibroblast growth factor 1 (FGF1), FGF2, their receptor FGFR1 and phosphorylation of ERK, aiding tissue repair and regeneration in SCI. This study highlights the potential of low-energy ESWT as an effective noninvasive treatment for SCI, demonstrating significant improvements in motor recovery, tissue regeneration, anti-inflammatory effects, and mitochondrial protection. These findings provide valuable insights into the mechanisms of ESWT and its therapeutic application for SCI recovery.

Focal Versus Combined Focal Plus Radial Extracorporeal Shockwave Therapy in Lateral Elbow Tendinopathy: A Retrospective Study.

Background: Lateral epicondylitis of the elbow, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and degeneration of the common extensor tendon. Despite various treatments, optimal management remains debated. Objective: This study aimed to compare the effectiveness of focal extracorporeal shockwave therapy (F-ESWT) alone versus a combination of focal and radial pressure waves (F-ESWT+R-PW) in treating chronic lateral epicondylitis. Methods: This retrospective observational study included 45 patients diagnosed with chronic lateral epicondylitis divided into two groups based on the treatment received: group A (F-ESWT, n = 23) and group B (F-ESWT+R-PW, n = 22). Both groups underwent three weekly sessions of their respective treatments. Patients were also given a home exercise protocol. Primary outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Patient-Rated Tennis Elbow Evaluation (PRTEE) for pain and functional impairment at baseline (T0), 4 weeks (T1), 12 weeks (T2), and 24 weeks (T3) post-treatment. Secondary outcomes included grip strength and ultrasonographic measurements of common extensor tendon (CET) thickness and vascularization. Results: Significant improvements in VAS and PRTEE scores were observed in both groups at all follow-up points. Group B showed greater pain reduction at T1 (VAS: 3.0 ± 1.6 vs. 4.43 ± 1.47; p < 0.005) and T2 (VAS: p < 0.030) compared to group A. Functional outcomes (PRTEE) also favored group B at T1 (p < 0.030) and in the pain section at T2 (p < 0.020). Grip strength improved similarly in both groups. CET thickness showed no significant differences at T3. Vascularization decreased significantly in both groups, with a non-significant trend favoring group B. Conclusions: The combined F-ESWT+R-PW therapy proved more effective than F-ESWT alone in the short- to mid-term management of chronic lateral epicondylitis, significantly enhancing pain reduction and functional outcomes. The combination of focal and radial pressure waves offers a superior therapeutic approach, leveraging the distinct mechanisms of each modality for better clinical results. Further research is needed to confirm these findings and establish long-term efficacy.

Effectiveness of extracorporeal shock wave therapy in comparison with other methods of treatment of patients with plantar fasciitis: literature review

Plantar fasciitis (PF) is one of the most common causes of pain in the heel area, which is associated with the presence of inflammation in the plantar fascia and is most often localized in the medial part of the heel area. Extracorporeal shock wave therapy (ESWT) is a method of hardware treatment that has been used in orthopedics and traumatology for the past decades. One of the main diseases successfully treated with this method is plantar fasciitis. The aim of the work was to determine the effectiveness of extracorporeal shock wave therapy in the treatment of plantar fasciitis compared to other methods of conservative treatment based on the literature review. Research literary sources from scientific electronic databases PubMed, Medline and other sources of scientific and medical information were analyzed. A literature search was performed using search queries specifying the method under study and plantar fasciitis, namely: «Extracorporeal Shockwave Therapy», «Plantar Fasciitis», «Conservative Treatment», «Physiotherapy». During the search, 473 scien­tific articles devoted to the treatment of plantar fasciitis were selected. Given the large number of articles and the desire to present up-to-date data, the query was limited to the last 9 years (from 2015 to 2023) and 417 articles were selected. Articles devoted to other methods of treatment of PF (conservative and surgical) and articles devoted to the use of ESWT in orthopedic and traumatological diseases of other localizations were excluded from the search results. At the second stage of the search, articles devoted exclusively to the treatment of PF by the ESWT method were excluded, and sources comparing the effectiveness of ESWT treatment with other methods of conservative treatment were selected (31 articles). The main results – it was determined that extracorporeal shock wave therapy continues to remain one of the main methods of conservative treatment of PF, which has been used for the last decades. It has proven its high efficiency and safety in the treatment of PF. Compared with other methods of conservative treatment of PF, extracorporeal shock wave therapy remains one of the most effective, it is successfully used in the treatment of PF.

Comparison of the Effectiveness of Autologous Blood Injection and Steroid Injection in Managing Tennis Elbow.

Background Local depot steroid injections can consistently and predictably relieve tennis elbow pain in the short term. Prolotherapy, extracorporeal shockwave therapy, autologous blood, and local injections of platelet-rich plasma (PRP) are examples of novel treatment approaches. Objective The objective of this study is to compare the effectiveness of autologous blood injection and local steroid injection in providing pain relief for patients with lateral epicondylitis (tennis elbow)using the visual analog scale (VAS) over 12 weeks. Methods A descriptive case series was conducted from July 10, 2019, to July 9, 2021, at the Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital. A total of 396 patients with tennis elbow, aged 20 to 50 years, were included (198 in each group). Patients managed with non-operative methods and those with other associated injuries in the same elbow were excluded. Group I received an injection of 40 mg of methylprednisolone acetate with 1 ml of 2% lignocaine solution. Group II received an injection of 2 ml of autologous venous blood. The final outcome was assessed at 12 weeks. Results In Group I, the average age of the patients was 36.04 ± 8.26 years, while in Group II, it was 37.23 ± 7.32 years. The male-to-female ratio was2.3:1; 276 (69.81%) of the 396 patients were male, while 120 (30.19%) were female. Group I's mean baseline VASscore was 6.99 ± 0.99, while Group II's mean baseline VAS score was 6.99 ± 1.06 (p = 1.000). Group I had a mean post-therapy VAS score of 3.11 ± 1.62, while Group II had a mean score of 2.48 ± 1.26 (p = 0.0001). About 118 (59.60%) individuals in Group I and 156 (78.79%) patients in Group II experienced pain alleviation from lateral epicondylitis (p = 0.0001). Conclusion This study found that autologous blood injection significantly reduces pain in patients with lateral epicondylitis compared to steroid injection, with a statistically significant p-value of 0.0001. Pain relief was more frequent in the autologous blood group (78.79%) than in the steroid group (59.60%). These findings suggest that autologous blood injections may offer a more effectivetreatment, reducing the need for repeat procedures and improving patient outcomes.

Effects of dexamethasone on the EC50 of remifentanil combined with dexmedetomidine achieving analgesia during pancreatic extracorporeal shockwave lithotripsy: a prospective, randomized and controlled study

BackgroundIn addition to their classic genomic effects, glucocorticoids also manifest rapid non genomic effects. We speculate that dexamethasone has the potential prompt onset of analgesic effects. The objective of this study is to investigate the influence of a single preoperative dose of dexamethasone on the half maximal effective concentration (EC50) of remifentanil when combined with dexmedetomidine for pain relief during pancreatic extracorporeal shockwave lithotripsy (P-ESWL).MethodsA total of 60 patients undergoing P-ESWL were enrolled and randomized at 1:1 ratio into the dexamethasone (DXM) group and the placebo group. Before anesthesia induction, patients in DXM group received an intravenous injection of 8 mg dexamethasone, while subjects in placebo group received an equal dose of physiological saline. Monitored anesthesia care (MAC) was performed based on remifentanil in combination with dexmedetomidine. Remifentanil was administered by TCI with an initial target concentration of 2.5 µg/mL for both groups. A positive response was defined as that VAS score > 3 by the patient at any time during the procedure. Subsequent target concentrations were adjusted by Dixon up-down sequential method, where dose modifications were performed by 0.3 ng/mL intervals, based on the response of the previous patient. The EC50 of remifentanil for pain relief during P-ESWL treatment was calculated using Dixon’s up-and-down method. Hemodynamic variables, oxygen saturation and adverse events were also recorded.ResultsDixon up-and-down method revealed that the EC50 of remifentanil was significantly higher in placebo group (2.65 ± 0.28 ng/mL) than in DXM group (2.02 ± 0.23 ng/ml) (P < 0.001). Hemodynamic parameter exhibited a significant decrease in mean arterial pressure (MAP) and heart rate (HR) before and after induction in placebo group; however, data of the two groups were comparable (P>0.05). Less adverse events occurred in DXM group, including the incidence of postoperative nausea and vomiting (PONV) and analgesia requirement with in the first 24 h following the procedure at ward.ConclusionDexamethasone exerted analgesic effects with a rapid onset, and patients received dexamethasone 8 mg preoperative had a lower required EC50 of remifentanil during P-ESWL. It is also associated with reduced PONV in addition to reduced postoperative analgesic consumption in the first postoperative 24 h.Trial registrationRegistered in the Chinese Clinical Trial Registry (ChiCTR2300078171) on 30/11/2023.

New "conservative" treatments for Peyronie's disease-real alternatives or expensive pastime?

Conservative treatment of Peyronie's disease (induratio penis plastica, IPP) remains largely unsuccessful despite decades of research, as the exact disease pathogenesis remains unclear. Currently, IPP is understood as abenign, localized, progressive connective tissue disorder of the tunica albuginea, in which repetitive microtrauma triggers an inflammatory process leading to fibrosis formation. The new "conservative" treatment approaches focus on immune-modulatory and regenerative mechanisms, but significant therapeutic success is still lacking. Treatments such as extracorporeal shockwave therapy, platelet-rich plasma (PRP), stem cell therapy, hyaluronic acid, and botulinum toxin are promising theoretical approaches, but their efficacy is often contradictory and they remain disputed and inadequately supported by studies. Research on these therapeutic approaches is often limited by extremely high costs and the regulations for clinical studies according to the Medicines Act, albeit necessary to further evaluate their effectiveness.

The dose effectiveness of extracorporeal shockwave on plantar flexor spasticity of ankle in stroke patients: a randomized controlled trial

BackgroundExtracorporeal shockwave therapy (ESWT) has been proven beneficial for post-stroke spasticity (PSS) of ankle plantar flexor muscles. This study aims to investigate the dose-response effectiveness of focused-ESWT and the duration of its effect on the treatment of ankle PSS in stroke patients.MethodsIn this double-blinded randomized controlled trial, stroke patients diagnosed with PSS in the ankle plantar flexor muscles were randomly assigned to two groups. The experimental group received double-dose ESWT (4000 pulses per session) targeting spastic calf muscles, while the control group received half the dose (2000 pulses per session). Both groups underwent four sessions over two weeks. The outcomes, including modified Ashworth Scale (MAS), modified Tardieu Scale (MTS), passive range of motion (PROM) of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography were evaluated at baseline, 1st, 4th, 12th, and 24th week after ESWT.ResultsWithin-group analysis revealed significant improvements in MAS, PROM, TUG Test, and Barthel index for the double-dose ESWT group and improvements in Barthel index for the control group. Between-group analysis revealed greater improvements in TUG Test, Barthel Index and strain elastography for the double-dose ESWT group. Generalized estimating equations analysis indicated that the double-dose ESWT group achieved superior outcomes in the TUG Test, Barthel Index, and strain elastography across various time points and groups.ConclusionsDouble-dose ESWT showed better functional improvement and elastography compared to the control group. ESWT demonstrated dose-response effectiveness for PSS of ankle-equinus.Trial registrationNCT05878223.

Extracorporeal Shockwave Therapy Is Associated With Similar Functional Outcomes for Male and Female Runners With Patellar or Quadriceps Tendinopathy: A Pilot Investigation

PurposeThe purpose of this study is to characterize functional outcomes in runners with patellar tendinopathy (PT) and quadriceps tendinopathy (QT) following extracorporeal shockwave therapy (ESWT) and explore differences in response by tendinopathy (PT or QT) and by sex (female or male). MethodThis is a retrospective cohort study of runners with PT or QT treated with ESWT (radial or combined) at a single sports medicine clinic during a 5-year period. Individuals were included if they had a primary diagnosis of PT or QT, self-identified as a runner, and had complete baseline and final functional outcome questionnaires for ESWT with treatment duration defined by response based on best practices. Functional outcome at baseline and following treatment were assessed using the Victorian Institute of Sport – Patellar Tendon (VISA-P) questionnaires. Treatment success was defined as meeting minimal clinically important difference (MCID) of ≥13 points. ResultsOf the 19 runners included, 26% identified as female and 74% as male; all runners identified as cisgendered. There were 12 runners with PT (17% female, 83% male) and 7 with QT (43% female, 57% male). Median follow-up was 3.0 months (range: 1.0-23.0, IQR: 3.0, 6.0). Of all runners, 67% with PT and 71% with QT achieved MCID with no significant difference between tendinopathy groups (p= 0.90). There was also no difference in the percentage that achieved MCID between sexes, with 80% females and 64% males meeting MCID (p=0.72). ConclusionsSimilar functional outcomes were observed in female and male runners with QT or PT following radial and combined ESWT, with the majority achieving MCID. This study suggests that ESWT, in combination with physical therapy, may be an effective treatment for runners with PT or QT and that ESWT could be considered for PT or QT refractory to physical therapy. Level of EvidenceLevel IV, retrospective case series.

Effectiveness of extracorporeal shockwave therapy versus conventional physiotherapy in treatment of chronic Achilles tendinopathy

Abstract Background Achilles tendinopathy (AT) is one of the most frequent overuse injuries in athletes. Extracorporeal Shock Wave Therapy (ESWT) has been proposed as an effective conservative treatment in chronic Achilles tendinopathy. Conventional physical therapy is also beneficial in the treatment of chronic Achilles tendinopathy. Aim of the Work To compare the effect of ESWT versus conventional physiotherapy (therapeutic ultrasound, LASER, deep friction massage) in the treatment of chronic AT, by using musculoskeletal ultrasound and other clinical parameters for assessment. Methods Thirty chronic AT patients were randomly divided in to two groups (15 per group): group 1 received ESWT and group 2 received conventional physical therapy for 6 weeks. Visual analogue scale (VAS), Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hind foot scale were used to assess pain, function and physical activity. Ultrasonography was also used to assess the ultrasonographic findings in chronic AT. All patients were evaluated at baseline and after 6 weeks of treatment. Results Our study revealed that both ESWT and conventional physical therapy recorded highly significant VAS reduction and highly significant improvement in VISA-A and AOFAS after 6 weeks of treatment. Moreover, ESWT showed significant improvement in the tendon thickness and heterogenicity with no significant effect on calcifications or neovascularization. Conclusion ESWT and Conventional physical therapy are both effective in reducing pain, improving function and physical activity in chronic Achilles tendinopathy patients. Moreover, ESWT is superior to conventional physiotherapy in improving tendon thickness and heterogenicity with no significant effect on calcifications or neovascularization.

Early intervention of extracorporeal shockwave therapy sustained positive long-term effect on rotator cuff healing: A randomized controlled trial with 3-year follow-up

BackgroundThe long-term effects of extracorporeal shockwave therapy (ESWT) on rotator cuff repair are unknown. ObjectivesTo investigate the functional outcomes and structural changes of ESWT at 3-year follow-up after rotator cuff repair. MethodsA randomized clinical trial was conducted, including patients who underwent rotator cuff repair. The patients were assigned to two groups based on whether they underwent radial ESWT 3 months postoperatively. The ESWT Group received 5 weeks of rehabilitation and ESWT weekly, whereas the CONTROL Group received only rehabilitation. Visual analog scale (VAS) pain score and functional scores were analyzed at 3 months (baseline), 6 months, and 3 years follow-up. In addition, MRI and ultrasonography were used to assess tendon maturation, integrity, tendon quality, acromiohumeral distance (AHD), and muscle fatty infiltration. ResultsFinally, 32 participants completed all the assessments. At the final follow-up, 2 patients in the ESWT Group (16.5 %) versus one patient in the CONTROL Group (6.25 %) had rotator cuff failure (P = 0.176). The ESWT treatment showed similar clinical outcomes in VAS-pain score, functional scores, tendon quality, AHD, and muscle fatty infiltration versus the CONTROL Group (Ps > 0.05). MRI analysis indicated improved tendon healing after ESWT treatment at both 6-month (P = 0.036) and 3-year follow-up (P = 0.028). ConclusionEarly intervention with radial ESWT sustained long-term effects on the healing of the repaired rotator cuff and similar functional outcomes at long-term follow-up compared with standard rehabilitation.