Radial Extracorporeal Shock Wave Therapy Research Articles

Comparison of Radial Extracorporeal Shock Wave Therapy and Traditional Physiotherapy in Rotator Cuff Calcific Tendinitis Treatment.

This study aims to investigate the efficacy of radial extracorporeal shock wave therapy (rESWT) in relieving pain and improving range of motion (ROM) and functionality besides conventional physiotherapy methods in the treatment of chronic rotator cuff calcific tendinitis (RCCT). We studied 80 patients (35 males, 45 females; mean age 53.3±9.6 years; range, 40 to 70 years) with chronic RCCT. Patients were randomly divided into two groups: rESWT group (n=40) treated with conventional physiotherapy and rESWT, and control group (n=40) treated only with a conventional physiotherapy program. The traditional physiotherapy program included ultrasound, transcutaneous electrical nerve stimulation, shoulder joint ROM and stretching exercises, and ice applications. All patients received a total of 20 treatments, five days a week for four weeks. rESWT was applied once a week for four weeks in total. Before and after treatment, all patients were evaluated for age, height, weight, Body Mass Index (BMI), pain intensity with a Visual Analog Scale, shoulder ROM, and functional disability status with the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Mean BMI value of the participants was 26.1±3.0 kg/m2. Although all parameters of the patients in both groups improved significantly, patients in the rESWT group had a statistically significant improvement in pain, ROM and QuickDash scores (p<0.001, p<0.001, and p<0.001, respectively). We assume that rESWT is an effective and noninvasive method of reducing pain and increasing ROM and functional status without the need for surgery.

Is radial extracorporeal shock wave therapy combined with a specific rehabilitation program (rESWT + RP) more effective than sham-rESWT + RP for acute hamstring muscle complex injury type 3b in athletes? Study protocol for a prospective, randomized, double-blind, sham-controlled single centre trial

BackgroundAcute injuries of the hamstring muscle complex (HMC) type 3b (interfascicle/bundle-tear) are frequently observed in various sports disciplines both in elite and recreational sport. The treatment of choice of acute HMC injuries type 3b is a progressive physiotherapeutic exercise programme. Besides this, there is currently only insufficient scientific evidence to support other treatment methods, including local infiltrations and injections of platelet-rich-plasma. Very recently, it was demonstrated that extracorporeal shock wave therapy (ESWT) may accelerate regeneration after acute skeletal muscle injury. The aim of the present study is to test the hypothesis that the combination of radial ESWT (rESWT) and a specific rehabilitation program (RP) is effective and safe in treatment of acute HMC injury type 3b in athletes, and is statistically significantly more effective than the combination of sham-rESWT and RP.MethodsWe will perform a double blind, randomized, sham-controlled clinical trial at the clinic KinEf Kinesiología Deportiva, Ciudad Autónoma de Buenos Aires, Argentina. Forty patients with acute HMC injury type 3b will be randomly allocated to receive either rESWT (nine rESWT sessions; three sessions per week; 2500 radial extracorporeal shock waves (rESWs) per session; energy density depending on what the patient tolerates) or sham-rESWT. In addition, all patients will receive a specific rehabilitation program that will last for 8 weeks. The primary outcome measure will be the individual time (days) necessary to return to play. Secondary outcomes will include the presence or absence of reinjury during a time period of 6 months after inclusion into the study.DiscussionBecause of the lack of adequate treatment options for acute HMC injury type 3b in athletes and particularly the high reinjury rate, we hypothesize that the results of this trial will be of importance and have impact on clinical practice.Trial registrationClinicalTrials.gov ID NCT03473899. Registered March 22, 2018.

Comparative Clinical and Functional Outcomes of Two Different Dose Administration of Radial Extracorporeal Shock Wave Therapy in Plantar Fasciitis

Amaç: Konservatif tedaviye yanıt alınamayan plantar fasiit olgularında; iki farklı tedavi protokolü ile uygulanan rESWT’nin (radial ekstrakorporeal şok dalga tedavisi) etkinliğinin kıyaslanması amaçlanmıştır. Gereç ve Yöntem: 2010-2017 yılları arasında, tek merkezde rESWT uygulanan ve dahil edilme kriterlerimize uyan 319 hasta değerlendirildi. 181 hastaya 1’er hafta ara ile 1.5 bar, 10Hz,1500 şok, toplam 5 seans(grup 1) ve 138 hastaya ise yine 1’er hafta ara ile 3 bar, 10Hz, 2000 şok, 5 seans(grup 2) rESWT uygulandı. Klinik ve fonksiyonel sonuçlar tedaviden hemen önce, tedavinin 6. haftasında ve 6. ayında Görsel Analog Skalası (VAS) ve Amerikan Ortopedik Ayak ve Ayak Bileği Skorlaması (AOFAS) ile değerlendirildi. Bulgular: Ortalama VAS skoru grup 1’de 8,73(±1,10)’ten 3,20(±2,09)’ye (p=0,0001) ve grup 2’de 8,68(±1,17)’den 2,61(±1,68)’e (p=0,0001) geriledi. Ortalama AOFAS skoru da grup 1’de 55,85(± 11,73)’den 88,38(± 8,23)’e (p=0,0001) ve grup 2’de 58,74(± 12,74)’den 88,47(± 8,10)’ye (p=0,0001) yükseldi. Grup 1 ve 2’nin 6. hafta-6. ay VAS skor değişimlerinde istatistiksel olarak anlamlı farklılık saptanmazken (p=0,451), grup 1’in tedavi öncesi-6. hafta ve tedavi öncesi-6. ay VAS değer değişimleri grup 2’den anlamlı derecede düşük bulundu (p=0,006, p=0,019). Ayrıca grup 1 ve grup 2’nin tedavi öncesi-6. ay ve 6. hafta-6. ay AOFAS skor değişimlerinde de istatistiksel olarak anlamlı farklılık saptanmazken (p=0,094, p=0,174), grup 1’in tedavi öncesi-6. hafta AOFAS skor değişimi grup 2’den anlamlı derecede düşük bulunuştur (p=0,029). Sonuç: Her iki tedavi protokolünün de ağrı ve fonksiyon kaybında azalmaya katkısı olmasına rağmen, 1’er hafta ara ile 3 bar hava basınçlı ve 10Hz frekansında toplam 2000 şok ile uygulanan 5 seanslık rESWT’nin daha üstün olduğu söylenebilir.

Dose-related Effect of Radial Extracorporeal Shockwave Therapy (rESWT) on Lateral Epicondylitis in Active Patients: A Retrospective Comparative Study

Background: Extracorporeal shock wave therapy is a noninvasive, safe, and well- tolerated treatment method which is increasingly used in the treatment of lateral epicondylitis. However, the gold standard treatment protocol is still controversial. Objectives: This study aimed to investigate and compare the efficacy of two different pneumatic pressure levels of radial extracorporeal shockwave therapy (rESWT) in active patients with lateral epicondylitis, unresponsive to conservative treatment. Methods: This retrospective comparative study was carried out in the Department of Orthopedics and Traumatology, Duzce University School of Medicine in 2018. A total of 330 patients with lateral epicondylitis unresponsive to conservative treatment were underwent rESWT during years 2010 - 2017. The patients were divided into two groups of 181 patients (group 1) with a total of 1500 impulses of 10 Hz frequency at 1 bar of air pressure during five treatment sessions at 1 week intervals, and 149 patients (group 2) with a total of 2000 impulses of 10 Hz frequency at 2 bars of air pressure during five treatment sessions at 1 week intervals. Functional and clinical outcomes were assessed just before the treatment, at six weeks and six months after treatment using the visual analogue scale (VAS) and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score. Results: The mean VAS score had significantly decreased in group 1 from 8.34 ± 1.22 to 2.59 ± 1.49 (P = 0.0001) and had also in group 2 from 8.56 ± 1.22 to 2.56 ± 1.76 (P = 0.0001). The mean Q-DASH score decreased significantly in both groups; from 58.92 ± 18.48 to 9.27 ± 5.85 (P = 0.0001), and from 65.36 ± 19.32 to 9.25 ± 6.28 (P = 0.0001) in group 1 and group 2, respectively. No significant difference was observed between the pretreatment VAS and the 6-month scores of groups 1 and 2 (P = 0.103). The mean difference in the Q-DASH pretreatment and 6-week scores and between the pretreatment and 6-month scores in group 2 were higher than those in group 1 (P = 0.011, P = 0.003). Conclusions: Although both rESWT treatment regimens caused a decrease in pain and loss of function, the superior treatment protocol for rESWT appears to be five treatment sessions at 1-week intervals, with 2000 impulses per session and 2 bars. rESWT is a good option for treating lateral epicondylitis, as it is safe and effective and leads to no complications.

Timing of extracorporeal shock wave therapy in rabbits with carpal tunnel syndrome.

The purpose of this study is to evaluate the effect of extracorporeal shock wave therapy (ESWT) according to treatment timing in rabbits with 10% dextrose-induced carpal tunnel syndrome (CTS); 0.1-ml 10% dextrose solution was injected under ultrasound guidance twice weekly to the left forepaw subsynovial connective tissue (SSCT) within the carpal tunnel of 36 New Zealand white rabbits to induce CTS. The rabbits were randomly allocated into four groups: G1-S (sham ESWT), G2-E4 (ESWT at 4weeks), G3-E8 (at 8weeks), and G4-E16 (at 16weeks). Radial ESWT (500 pulses, 0.08mJ/mm2 , 2Hz) was repeated thrice weekly. Median nerve distal motor latency (DML) was measured before injection and at 4, 8, 12, 16, and 20weeks after the first injection. All rabbits were sacrificed 20weeks after injection. The median nerve cross-sectional area (CSA) and SSCT thickness were measured with light microscopy. The mean median nerve DML at 4weeks after the first dextrose injection did not differ from that at preinjection in all groups. The mean median nerve DML significantly increased before ESWT in all groups (p<.05); however, it did not increase in G2-E4 and G3-E8 for 12weeks after ESWT and in G4-E16 for 4weeks (p>.05). Mean CSA of the median nerve and mean SSCT thickness in G2-E4 were significantly lower than those in the other groups (p<.05). ESWT may prevent the progression of CTS for 12weeks in rabbits with dextrose-induced CTS regardless of treatment timing, and early application results in superior outcomes.

Radial extracorporeal shock wave promotes the enhanced permeability and retention effect to reinforce cancer nanothermotherapeutics

Since most cancer nanomedicine relies on the enhanced permeability and retention (EPR) effect to eradicate tumors, strategies that are able to promote nanoparticle (NP) delivery and extravasation are presupposed to elevate the EPR effect for more effective cancer therapeutics. However, nanothermotherapeutics still suffers from limited drug delivery into tumor sites, for even though numerous efforts have been made to enhance the selective tumor targeting of NPs. In this study, we uncovered that radial extracorporeal shock wave therapy (rESWT), an important approach in physical therapy that has been overlooked in cancer treatment in the past, can largely improve the EPR-dependent tumor uptake of NPs. We here defined the optimal low dosage and desirable combinatory manner for rESWT in driving NP accumulation towards tumors. Two underlying biophysical mechanisms responsible for the rESWT-enhanced EPR effect were proposed. On one hand, rESWT-conducted compressive and tensile forces could relieve high intra-tumoral pressure; on the other hand, rESWT-induced cavitation bubbles could directly distend and disrupt tumor blood vessels. All these together synergistically promoted vessel vasodilation, tumor perfusion and NP extravasation. Further experiments revealed that the combinatory therapeutics between rESWT and nanothermotherapeutics greatly improved the tumor-killing efficacy. Thus, our findings open a new path to improve EPR-mediated drug delivery with the assistance of rESWT.

Eфектите од апликација на радијална екстракорпорална терапија со ударни бранови на спастична шака по мозочен удар

Спастицитетот на шаката по мозочен удар ги зголемува тешкотиите на болните во секојдневното самозгрижување и ја ограничува ефикасноста на рехабилитацијата. Радијалната екстракорпорална терапија со ударни бранови (РЕКТУБ) е предложена како алтернативен третман за редукција на спастицитетот. Целта на истражувањето беше да се евалуираат ефектите од апликација на РЕКТУБ на спастична шака по мозочен удар. Материјал и методи: Контролирана клиничка студија во која беа вклучени 30 пациенти со спастична шака по мозочен удар, поделени во две групи. Испитуваната група беше третирана со РЕКТУБ (6 третмани секој втор или трет ден) и стандардна рехабилитациона програма. Контролната група беше третирана само со стандарднарехабилитациона програма. За клиничка евалуација беа користени Модифицираната Ашфорт Сакала (МАС) и супскорот за моторно закрепнување од Фугл-Мајер тестот за процена на сензомоторната функција на горен екстремитет и тоа пред третманот, по завршување на 2-та, 6-та и 14-та недела од почетокот на рехабилитацијата. Резултати: Средната вредност на оцената на МАС беше значително намалена кај испитуваната група веднаш по РЕКТУБ. Кај испитуваната група се забележа значително подобрување на скорот за моторно закрепнување на Фугл-Мајертестот. Овие резултати се задржаа 12 недели по третманот. Заклучок: РЕКТУБ го намали спастицитетот на шаката по мозочен удар и доведе до нејзино подобро моторно закрепнување.

Comparison of Therapeutic Ultrasound and Radial Shock Wave Therapy in the Treatment of Plantar Flexor Spasticity After Stroke: A Prospective, Single-blind, Randomized Clinical Trial

Background: This study aimed to compare the effects of therapeutic ultrasound (US) and radial extracorporeal shock wave therapy (rESWT) in the treatment of plantar flexor spasticity after stroke. Materials and Methods: In this prospective, single-blind, randomized clinical trial, 32 patients (age range 42-78 years; male 19) with stroke were randomly divided into two groups: The US group (n = 16) received the continuous ultrasound, intensity 1.5 w/cm2, frequency 1 MHz, and duration 10 minutes. The rESWT group (n = 16) was treated with rESWT, 0.340 mJ/mm2, 2000 shots. Both groups received the treatments for 1 session. The H-reflex tests of Hmax/Mmax ratio and H-reflex latency, the Modified Modified Ashworth Scale (MMAS), active range of motion (AROM), passive range of motion (PROM), passive plantar flexor torque (PPFT), and the timed “up and go” test (TUG) were blinded assessed at baseline (T0), immediately post-treatment (T1), and one hour follow-up (T2). Results: The H-reflex tests did not improve across the groups. However, the MMAS spasticity scores, AROM and PROM, PPFT, and TUG improved significantly within groups. The results found no significant differences between groups for all outcome measures. Conclusions: The US and rESWT had similar effects, and the rESWT was not more effective than the US in improving ankle plantar flexor spasticity after stroke.

Corrigendum to: Prolotherapy vs Radial Extracorporeal Shock Wave Therapy in the Short-term Treatment of Lateral Epicondylosis: A Randomized Clinical Trial.

Corrigendum to: Prolotherapy vs Radial Extracorporeal Shock Wave Therapy in the Short-term Treatment of Lateral Epicondylosis: A Randomized Clinical Trial.

Prolotherapy vs Radial Extracorporeal Shock Wave Therapy in the Short-term Treatment of Lateral Epicondylosis: A Randomized Clinical Trial.

The aim of this study was to compare the efficacy of prolotherapy with hypertonic dextrose and radial shock wave therapy in chronic lateral epicondilosis. Prospective single-blind randomized clinical trial. Physical medicine and rehabilitation clinic. Thirty-three patients with at least three months of signs and symptoms of lateral epicondilosis, as well as failure of at least one of the conservative treatments, randomly allocated into two groups. Sixteen patients received three sessions of shock wave therapy, and 17 received one session prolotherapy. Severity of pain via visual analog scale (VAS), grip strength via Baseline Pneumatic Dynamometer, pressure pain threshold (PPT) by algometer and Disabilities of Arm, Shoulder, and Hand quick questionnaire (Quick DASH) were assessed at baseline, four weeks, and eight weeks after the intervention. Within-group analysis showed that in both groups, differences between all of the outcome measures were significant after four and also eight weeks. Between-group analysis after four and eight weeks showed that the VAS and Quick DASH had significantly more improvement in the shock wave group. However, the two groups were similar regarding grip strength and PPT. No complication was observed in the two groups. Based on the results of this study, a regiment of three sessions (weekly) of radial extracorporeal shock wave therapy is significantly more effective than one session of prolotherapy with 20% dextrose regarding pain and function in the management of chronic lateral epicondylosis in short-term follow-up.

Effects of the radial extracorporeal shock wave therapy (rESWT) in patients with calcific tendinopathy of the shoulder

Introduction: Calcific tendinopathy (CT) of the shoulder is frequently a painful condition that is occurring when there are calcium deposits in the tendons of the rotator cuff. There are many options for treatment starting from therapeutic options like medicaments, physical therapy and radial extracorporeal shock wave therapy (rESWT). If conservative treatment fails, surgical treatment is the next option. The purpose of this study was to investigate the outcome effect of rESWT in patients with calcific tendinopathy. Methods: A prospective study from February 2010 to March 2019 monitored 67 patients with CT of the shoulders of the average age of 47.06 ± 15.2 (mean± standard deviation) who were treated with a rESWT. All patients were evaluated clinically with selected radiographic evaluation of the shoulder before therapeutic intervention. The treatment protocol consisted of a sound pressure intensity of 3 bar, a wave frequency of 14/sec, a total of 2,000 waves per session. All patients performed a treatment consisting of three sessions described every seven days. The outcome parameters were VAS scale of pain and shoulder radiography before and after therapy. The Student's t-test was used in the statistical analysis. Results: Clinical and radiographic improvement was recorded in 70% of patients in the treatment of CT of the shoulder 6 weeks after the therapy was performed with a rESWT (p <0.05) in terms of reduced pain and disintegration of calcification. Conclusion: rESWT has showed positive effects in the treatment of patients that have calcific tendinopathy of the shoulder.

Radial Extracorporeal Shock Wave Therapy as a Novel Agent for Benign Prostatic Hyperplasia Refractory to Current Medical Therapy.

This study aimed to assess efficacy and safety data from pilot trials of the radial extracorporeal shock wave therapy (rESWT) to treat benign prostatic hyperplasia (BPH) refractory to current medical therapy. A total of 29 men with lower urinary tract symptoms (LUTS) suggestive of BPH who had responded poorly to medical therapy for at least 6 months and were poor surgical candidates were enrolled. Each participant was treated with rESWT once a week for 8 weeks, each by 2000 impulses at 2.0 bar and 10 hertz of frequency. International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) were evaluated before treatment, after the fourth and eighth rESWT, and 3 months after the end of treatment. Peak urinary flow (Qmax) and postvoid residual (PVR) were assessed. Safety was also documented. Statistically significant clinical improvements were reported for IPSS, QoL, and IIEF-5 after treatment, and those were sustained until 3 months follow-up. Qmax and PVR improved evidently at 8 weeks with a 63% and 70% improvement, respectively. The only adverse event was the occasional perineum pain or discomfort, which usually disappeared within 3 days. The rESWT may be an effective, safe, and noninvasive treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates.

Radial extracorporeal shock wave device appearance does not influence clinical outcomes: A randomized controlled trial.

To determine whether the appearance of a radial extracorporeal shock wave device affects clinical outcomes in chronic plantar fasciitis. Randomized controlled parallel assessor-blinded clinical trial. A total of 135 patients were assigned to 3 groups: group I, standard radial extracorporeal shock wave device; group II, standard radial extracorporeal shock wave device modified to give a more sophisticated appearance; group III, standard radial extracorporeal shock wave device modified to give a more austere appearance. The radial extracorporeal shock waves emitted by the 3 devices were identical. Primary outcome was foot function, measured with the Foot Function Index. Secondary outcomes were pain at different times, measured with a visual analogue scale, and plantar fascia thickness, measured with ultrasound. All variables decreased significantly from baseline assessment, in all 3 groups and at all time-points: 1, 2, 4 and 14 months after the last session (p < 0.001). There were no significant differences between groups for any of the variables assessed. Device appearance had no statistically significant influence on clinical outcomes in patients with chronic plantar fasciitis treated with radial extracorporeal shock wave therapy.

Does radial extracorporeal shockwave therapy impair hearing function in patients with plantar fasciitis?

Background:Radial extracorporeal shock wave therapy (r-ESWT) is commonly used for the treatment of chronic plantar fasciitis. Previously in the urology literature, some studies reported hearing impairment after extracorporeal shock wave lithotripsy. However, there is no study that evaluates the possible side effects of r-ESWT on the hearing function of patients. The aim of this study was to investigate the effects of r-ESWT on the pure tone audiometry of the patients on whom r-ESWT was applied for chronic plantar fasciitis.Material and Methods:Patients with the diagnosis of plantar fasciitis who were treated with r-ESWT were included in this prospective case-control study. Before and after the r-ESWT application, all patients were consulted to our otolaryngology department for pure tone audiometric examination to detect any hearing impairment before and after the treatment. A control group was also constructed that consisted of patients who were admitted to our department for any complaint.Results:A total of 67 patients participated in the study. Radial ESWT group consisted of 47 patients (39 female, 8 male) with the mean age of 44.1 years. The control group consisted of 20 patients (12 female, 8 male) with the mean age of 36.9 years. We observed a 20-dB threshold shift at 8000Hz in 1 patient who had no clinical symptom. This patient had no threshold shift at the 1-month control audiometric measurement.Conclusion:According to the results acquired from this study, we can consider that r-ESWT treatment in patients with chronic plantar fasciitis has no markedly detrimental effect on the hearing function.

Rehabilitation treatment of spastic cerebral palsy with radial extracorporeal shock wave therapy and rehabilitation therapy.

This aims to investigate the effect of combined use of radial extracorporeal shock wave therapy (rESWT) and conventional rehabilitation therapy on postoperative rehabilitation of children with spastic cerebral palsy.Children with spastic cerebral palsy 6 weeks after multistage surgery were randomly divided into treatment group (received rESWT and conventional rehabilitation therapy) and control group (received conventional rehabilitation only). Before treatment, 2 weeks and 1 month after treatment, the Gross Motor Function Measure (GMFM), modified Ashworth Scale (MAS) of the hamstrings and triceps, plantar area and plantar pressure were examined for efficacy assessment.A total of 82 children with spastic cerebral palsy were recruited, including 43 children in treatment group and 39 children in control group. There was no significant difference in the age, MAS score, and GMFM score between the 2 groups before treatment. There were statistically significant differences between the 2 groups at 2 weeks and 4 weeks after treatment, including the MAS score, GMFM score, plantar area and plantar pressure (P < .05). Within groups, there were also significant differences at different times (P < .05).The rESWT combined with rehabilitation can quickly and effectively relieve paralysis of lower extremities, reduce the tension of hamstrings and calf muscles, relieve muscle spasm, and rapidly improve limb function in children with spastic cerebral palsy.

Comparative effectiveness of extracorporeal shock wave, ultrasound, low-level laser therapy, noninvasive interactive neurostimulation, and pulsed radiofrequency treatment for treating plantar fasciitis: A systematic review and network meta-analysis.

Plantar fasciitis is one of the most common causes of adult heel pain. The aim of this study is to comprehensively compare the effectiveness of various therapies for plantar fasciitis using network meta-analysis. Studies were comprehensively searched on Embase, MEDLINE via PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) up to December 4, 2017. Randomized controlled trials that used extracorporeal shock wave therapy, ultrasound, ultrasound-guided pulsed radiofrequency treatment (UG-PRF), intracorporeal pneumatic shock therapy (IPST), low-level laser therapy (LLLT), and noninvasive interactive neurostimulation (NIN) for the treatment of plantar fasciitis were included. The primary outcome is change in pain relief. Risk of bias was assessed using the Cochrane risk of bias tool. Quality assessment was performed using the GRADE system. Nineteen trials with 1676 patients with plantar fasciitis plantar fasciitis were included. In the pair-wise meta-analysis, radial extracorporeal shock wave therapy (RSW), LLLT, and IPST showed a significant pooled reduction in the visual analogue scale (VAS) compared with placebo at 0 to 6 weeks [mean difference (MD) = 6.60, 95% confidence interval (CI): (6.04, -7.16); MD = 2.34, 95% CI: (1.60, 3.08); MD = 2.24, 95% CI: (1.44, 3.04), respectively]. Compared with placebo, UG-PRF [MD = 2.31, 95% CI: (1.26, 3.36)] and high-intensity focused extracorporeal shock wave (H-FSW) [MD = 0.82, 95% CI: (0.20, 1.45)] showed superior pain-relieving effects at 2 to 4 months; UG-PRF [MD = 1.11, 95% CI: (0.07, 2.15)] and IPST [MD = 4.92, 95% CI: (4.11, 5.73)] showed superior effects at 6 to 12 months. In the network meta-analysis, only RSW induced significant pain reduction compared with placebo at 0 to 6 weeks [MD = 3.67, 95% CI: (0.31, 6.9)]. No significant differences were found for the 2 to 4-month and 6 to 12-month periods because of the wide 95% CIs. We recommend treating plantar fasciitis with RSW. The commonly used ultrasound and focused extracorporeal shock wave (FSW) therapies can be considered as alternative treatment candidates. IPST, NIN, and LLLT may potentially be better alternatives, although their superiority should be confirmed by additional comprehensive evidence.PROSPERO registration number: PROSPERO (CRD42015017353).

The effects of ultrasound and shockwave treatment on muscle regional oxygen saturation using near-infrared spectroscopy

ABSTRAKTWstęp: Terapeutyczne fale ciśnieniowe są często stosowane w leczeniu różnych schorzeń układu mięśniowo-szkieletowego, niemniej jednak efekt biologiczny ich odziaływania wciąż nie został w pełni poznany. W przedstawionych badaniach oceniono wpływ fal dźwiękowych o różnej sile bodźca stosowanych w terapii falą ultradźwiękową (ultrasound therapy – UST) i pozaustrojową radialną falą uderzeniową (radial extracorporeal shockwave therapy – rESWT) na wysycenie tlenem tkanki mięśniowej i temperaturę powierzchniową w kontekście potencjalnego efektu troficznego przy użyciu spektroskopii bliskiej podczerwieni (near-infrared spectroscopy).Materiały i metody: Badaniem objęto 41 zdrowych ochotników, w tym 27 poddanych UST i 14 rESWT, w wieku 22–48 lat. Pomiar saturacji tkankowej i temperatury powierzchni obszaru mięśnia podgrzebieniowego wykonano 4-krotnie: bezpośrednio przed (T0) i po (T1) oraz 15 (T2) i 30 min po aplikacji bodźca (T3). Saturacje mięśni zmierzono na 2 głębokościach: 20 mm (czujnik 1 – S1) i 12,5 mm (czujnik 2 – S2).Wyniki: Wartość regionalnej perfuzji tkankowej (rSO2 [%]) istotnie zmniejszyła się natychmiast oraz po 15 i 30 min od UST. Wartości początkowe, wynoszące 71,26 ±5,47% (S1) i 88,26 ±2,89% (S2) dla odpowiednich głębokości, znacząco spadły po bodźcowaniu odpowiednio do 68,89 ±5,26% (T2) i 68,93 ±5,12% (T3) na głębokości 20 mm i 86,63 ±5,37% (T1) i 86,52 ±3,38% (T2) na głębokości 12,5 mm.Wnioski: Uzyskane wyniki wskazują, że tylko leczenie za pomocą UST ma znaczący wpływ na zmiany oksymetrii regionalnej, co tłumaczy się ich działaniem przekrwiennym i termicznym w tkankach głębokich, które z kolei indukują dysocjacje tlenu z hemoglobiny do tkanek i efekt troficzny.

Radial extracorporeal shock wave therapy promotes osteochondral regeneration of knee joints in rabbits.

Radial extracorporeal shock wave therapy (rESWT) has been proven to be effective for nonunion fractures. It was, thus, hypothesized that it may be used as a supplement therapy to promote osteochondral regeneration when combined with a scaffold previously prepared by our research group. In the present study, to verify this hypothesis, New Zealand white adult rabbits were anaesthetized and divided into three groups, as follows: Untreated control group, in which full-thickness cylindrical osteochondral defects were created without repairing; scaffold group, in which rabbits were implanted with the scaffolds; scaffold plus rESWT group, in which rabbits were implanted with scaffolds and then treated with rESWT at 2 weeks post-surgery. At 6 and 12 weeks after surgery, the animals were sacrificed. Nitric oxide (NO) levels in the synovial cavity of the knee joints were measured by the Griess method. In addition, macroscopic observation and the gross score according to the International Cartilage Repair Society (ICRS) histological scoring system were determined. Histological evaluation was also performed by hematoxylin-eosin and Safranin O/fast green staining. The results demonstrated that both the scaffold and scaffold plus rESWT treatments significantly reduced NO levels in the synovial cavity at 6 weeks after surgery (P<0.05), whereas no significant difference was observed at 12 weeks after surgery. The ICRS scores of the scaffold and scaffold plus rESWT groups were significantly higher in comparison with those in the control group (P<0.05), and rESWT further increased these scores at 12 weeks after surgery (P<0.05). Histological results revealed that osteochondral regeneration was improved after treatment with scaffold or scaffold plus rESWT, with the latter displaying better results. These data suggested that rESWT improved the osteochondral regeneration when applied in combination with the scaffold, and that one of the underlying mechanisms may involve the reduction of NO in the synovial fluid. Therefore, rESWT may be a useful treatment for knee osteochondral regeneration.

Efficacy of radial extracorporeal shock wave therapy compared to botulinum toxin type a in the treatment of lower extremity spasticity in patients with cerebral palsy

Radial extracorporeal shock wave therapy (rESWT) and infiltration with botulinum toxin type A (BoNT-A) are established therapies for spasticity in cerebral palsy. Using a randomized, controlled, cross-over clinical trial design (level of evidence, 1) this study tested the null hypothesis that infiltration with BoNT-A is more efficient in reducing plantar flexor muscle spasticity in patients with cerebral palsy than rESWT. Seventy patients were randomly allocated to rESWT (Group A; n = 35) (three rESWT sessions; one session per week; 2000 radial extracorporeal shock waves [rESWs] per session; positive energy flux density of the rESWs between 0.10 and 0.12 mJ/mm 2 ) or a single infiltration with BoNT-A (Group B; n = 35) at time point T0. Six months after T0 (i.e., at time point T1) patients in Group A received a single infiltration with BoNT-A, and patients in Group B three rESWT sessions as described for patients in Group A. Treatment success was evaluated using V1 and V3 of the Tardieu scale at three weeks (W3), two months (M2) and three months (M3) after both T0 and T1. In six out of 32 direct comparisons (two muscles [soleus and gastrocnemius], two tests [V1 and V3 of the Tardieu scale], two rounds of treatment [starting at T0 and T1] and four times of evaluation per round of treatment [at T0 and T1 baseline as well as at W3, M2 and M3 after both T0 and T1]) rESWT resulted in statistically significantly better outcome than infiltration with BoNT-A. The null hypothesis was rejected. There were no significant complications. This study demonstrates that rESWT may be superior to infiltration with BoNT-A in the treatment of plantar flexor muscle spasticity in patients with cerebral palsy. Further studies need to evaluate long-term effectiveness and safety of rESWT in the treatment of plantar flexor muscle spasticity in patients with cerebral palsy.

Radial extracorporeal shock wave therapy for adhesive capsulitis of the shoulder: A prospective, randomized, placebo controlled, double-blind study with subjective and objective endpoints

This study tested the hypothesis that radial extracorporeal shock wave therapy (rESWT) is effective and safe in the treatment of adhesive capsulitis of the shoulder (adC-S). One hundred and six patients (mean age, 55.8 years; range, 39–77) with pain and limitations in shoulder mobility due to adC-S lasting for averaged 11.6 months (range, 9–14) were randomly allocated to either rESWT ( n = 53) (four sessions, one session per week, Swiss DolorClast [Electro Medical Systems S.A., Nyon, Switzerland], radial handpiece, 15-mm applicator, 2000 rESWT impulses per session, positive energy flux density 0.14 mJ/mm 2 , rESWT impulses applied at 8 Hz) or placebo treatment ( n = 53). Patients completed the Visual Analog Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline (BL) as well as at one month (M1), six months (M6) and twelve months (M12) after baseline. Moreover, passive and active abduction of the arm (pA and aA) as well as passive external rotation of the shoulder (pER) were measured at BL, M1, M6 and M12. All patients completed the final review at M12 and were included in the study. Mean pretreatment VAS scores, DASH scores and pA, aA and pER measurements for the rESWT and control groups were 6.3 and 6.3 (VAS), 73.5 and 72.5 (DASH), 98.2 and 99.3 degrees (pA), 65.8 and 68.8 degrees (aA), and 20.3 and 22.0 degrees (pER), respectively. Compared to placebo treatment rESWT resulted in statistically significantly reduced VAS score (by averaged 3.5 points) and statistically significantly improved DASH score (53.8 points), pA (63.9 degrees), aA (79.1 degrees) and pER (43.3 degrees) at all follow-up examinations. rESWT as performed in the present study is an effective and safe treatment for adhesive capsulitis of the shoulder.