Shock Wave Therapy In Treatment Research Articles

Comparison between the effect of Steroid Injection, Prolotherapy Local Injection and Extracorporal Shock Wave Therapy in Treatment of Symptomatic Calcaneal Spur

Abstract Background Calcaneal spurs are common cause of heel pain occurring anywhere along the calcaneal tuberosity and most frequently found at the insertion of the plantar fascia. They are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. Objective To compare the effectiveness of dextrose prolotherapy injection, corticosteroid injection and extracorporal shockwave in symptomatic calcaneal spur, based on clinical and functional outcome measures. Patients and Methods This study was conducted on forty-five patients diagnosed with symptomatic calcaneal spur (plantar fasciitis) for more than 6 months. The patients were recruited from Physical Medicine, Rheumatology and Rehabilitation department at Ain Shams University Hospitals. Diagnosis was based on detailed history taking, full clinical examination, pain and functional assessments of the foot using visual analogue scale (VAS score) and foot function index (FFI). Results Eight weeks after treatment, the pain score by VAS was significantly improved at ESWT group mostly, less extent at prolotherapy group and least at corticosteroid group. Also the percentage of improvement in ESWT group was found higher than the other groups indicating the long term analgesic effect of ESWT. Eight weeks after treatment, the FFI subscales (pain, disability and activity limitation)and total FFI score significantly improved mostly at ESWT group, less extent at prolotherapy group and least at corticosteroid group indicating the long term beneficial effect of ESWT on the function in patients with chronic PF. Conclusion Although ESWT, dextrose prolotherapy injection, and local corticosteroid injection were all effective in the treatment of symptomatic calcaneal spur during 8weeks of follow-up but, ESWT was superior to all other modalities in its effect on pain intensity and function during daily life activities at long term follow up.

Extracorporeal shockwave therapy in treatment of chronic prostatitis/chronic pelvic pain syndrome: Systematic review and meta-analyses.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) prevalence varies from 8.4% to 25% of the male population and is associated with diminished health-related quality of life. Managing CP/CPPS remains challenging and there is not any common option to treat all patients effectively because of the complex disease nature. The currently available data for the extracorporeal shockwave therapy (eSWT) effect on pain relief and well-being were analyzed in the present study. We adhered to PRISMA 2022 guidelines for reporting the quantitative and qualitative data synthesis. A literature search was conducted in March 2023 using PubMed/Medline, Scopus, and Google Scholar. Randomized prospective studies of eSWT alone or eSWT plus conventional medicinal treatment were included. The risk of bias was estimated using the RoB 2.0. Primary outcomes were self-reported scores, including the NIH-CPSI questionnaire and VAS, at 1 month or 2, 3, and 6, months follow-up. The CP/CPPS patients who receive eSWT have more pronounced pain relief and improvement of other subjective NIH-CPSI scores compared with control groups that received placebo or medication therapy. The effect of eSWT seems to be long-lasting and was confirmed in the 6-month follow-up (p < 0.01). Based on the meta-analysis of accessible studies, we receive the equivalence eSWT applicability for the CP/CPPS treatment and can be offered to patients because of its noninvasiveness, high level of safety, and successful clinical results demonstrated in this analysis.

(116) COMBINED SHOCKWAVE THERAPY AND PLATELET-RICH PLASMA (COCKTAIL) FOR ERECTILE DYSFUNCTION–A PHASE II TRIAL EMPHASIZING SAFETY AND EFFICACY

Abstract Introduction Therapeutic approaches focusing on tissue neovascularization play a crucial role in the development of treatments for erectile dysfunction (ED). Autologous Platelet-Rich Plasma (PRP) and Low-Intensity Shockwave Therapy (SWT) are two restorative therapies that may target underlying causes of ED. Pre-clinical evidence suggests their angiogenic and regenerative properties, indicating a potential synergistic pathway. We aim to assess the safety and treatment efficacy of combined PRP and SWT in men with mild or moderate ED, measured by the International Index of Erectile Function-EF (IIEF) questionnaire. Objective The primary objective of this study is to evaluate the safety and efficacy of a combined PRP and SWT treatment regimen in men with mild to moderate ED. Specifically, we aim to determine if this combination therapy can significantly improve erectile function as measured by the IIEF scores over a period of six months. Methods The COCKTAIL trial, a single-center Phase II study, enrolled 57 men with mild to moderate ED, as evaluated by IIEF scores (12–25). Participants were randomized into two groups: a treatment group receiving PRP/SWT and a placebo group receiving saline/sham SWT. The treatment group received PRP injections in the corpus cavernosum and penile SWT at set intervals, while the placebo group received saline injections and sham SWT. Evaluations included pain assessments, immediate and follow-up examinations for complications, and IIEF scoring at baseline, 3 months, and 6 months. Additionally, penile Doppler ultrasounds were performed at baseline and 6 months to assess changes in penile blood flow. The study adhered to Institutional Review Board (IRB) approval and the data safety monitoring board guidelines to ensure participant safety and data integrity. Results The trial reported no adverse events such as penile bruising, swelling, edema, allergic reactions, or penile fractures in either the treatment or placebo groups. The median IIEF scores for the PRP/SWT group were 20.0 at baseline, 21.0 at 3 months, and 24.0 at 6 months. For the placebo/sham group, the median IIEF scores were 18.0 at baseline, 19.0 at 3 months, and 18.5 at 6 months. There was no statistically significant change over time within the treatment group or the placebo/sham group. Comparing both groups at each time point revealed no statistically significant differences in average IIEF scores between the treatment and placebo groups at baseline (p = 0.25), 3 months (p = 0.14), or 6 months (p = 0.16). Thus, interim analysis suggests that combined PRP and SWT is safe, though it did not lead to statistically significant improvements in erectile function compared to the placebo group over the observed six-month period. Conclusions Initial findings indicate that the combined use of PRP and SWT is safe for treating ED, yet its clinical efficacy may be insignificant due to the small sample size. The lack of statistically significant improvement in erectile function suggests that while the treatment is non-harmful, its benefits are not conclusively proven within this study’s parameters. Further investigation with larger cohorts is necessary to explore the potential efficacy of combined PRP/SWT and its impact on clinical approaches targeting the underlying causes of ED. Disclosure No.

Abstract PO3-12-03: SAFETY AND TOLERABILITY OF SHOCKWAVE THERAPY FOR TREATMENT OF BREAST CANCER-RELATED LYMPHEDEMA: A SYSTEMATIC REVIEW

Abstract Introduction: Breast cancer is currently the most common malignancy among women, after non-melanoma skin cancer. Upper limb lymphedema is the most feared complication of breast cancer treatment. Currently, the approach described in the literature as the most effective for the treatment of lymphedema is Complex Physical Therapy. In the search for more efficient therapeutic actions, Shockwave Therapy emerges as an alternative in the treatment of upper limb lymphedema secondary to breast cancer. Objective: to systematically review the available literature and verify the safety, tolerance and efficacy of using Shockwave Therapy (ESWT) in the treatment of upper limb lymphedema secondary to breast cancer. Methods: The following databases were used: PubMed; PEDro, The Cochrane Library, EMBASE, Web of science and Scopus and through manual search of articles. The PICO research method was adopted, and the descriptors adjusted according to the respective database. This study was registered in PROSPERO: CRD42020209588. Results: Combined searches, including reference lists, manual searches, and database searches, yielded 64 articles, of which 35 articles were duplicates, 23 studies were excluded by title, abstract, or full reading. Six full-text articles were selected. Of these, only 3 randomized clinical trials and 3 non-randomized clinical trials met all established inclusion criteria and were analyzed in this systematic review. Two more RCTs were added by manual search of references from other articles. None of the studies found had safety and tolerability as their primary objective, and one reported transient redness with the use of the device. Shockwave Therapy, combined with other resources, can significantly improve lymphedema volume and shoulder range of motion, but there is not enough evidence to support the use of ESWT as a substitute for complex physical therapy (CPT). Final considerations: There is evidence that it can improve ROM and upper limb volume when used in association with CPT, which is the gold standard for the treatment of lymphedema. Keywords: Lymphedema, Breast Cancer, Extracorporeal Shockwave Therapy. Citation Format: Patricia Lima Ventura, Cinira Haddad, Afonso Nazário, Gil Facina, Vanessa Sanvido, Amanda Estevao, Samantha Lopes de Almeida Rizzi. SAFETY AND TOLERABILITY OF SHOCKWAVE THERAPY FOR TREATMENT OF BREAST CANCER-RELATED LYMPHEDEMA: A SYSTEMATIC REVIEW [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-03.

Effectiveness of Extracorporeal Shock Wave Therapy in Treatment of Spasticity of Different Aetiologies: A Systematic Review and Meta-Analysis.

Background: Spasticity is a motor disorder characterised by exaggerated movements of the tendons and accompanied by hyperreflexia and hypertonia. Extracorporeal shock wave therapy (ESWT) is used as a treatment for spasticity, although more evidence is needed on the effectiveness of this therapy in the treatment of spasticity. Therefore, the aim of this study was to assess the effectiveness ESWT in the treatment of upper and lower limbs spasticity in both children and adults through different aetiologies. Methods: A systematic search was performed in different databases from inception to December 2023. Random-effects meta-analysis was used to estimate the efficacy of ESWT on spasticity using the Modified Ashworth Scale. Results: Sixteen studies were included in the systematic review and meta-analysis. The effect of ESWT on spasticity measured with the Modified Ashworth Scale shows a significant decrease in spasticity in the upper limbs and in the lower limbs in adults with chronic stroke and in children with cerebral palsy, is more effective immediately after application, and maintains its effect up to 12 weeks post treatment. Conclusions: These findings are important for clinical practice since they show evidence that ESWT is effective in reducing spasticity in both children and adults.

(151) Safety and Feasibility of the COCKTAIL (Combining Shockwave Therapy and Platelet-Rich Plasma for Erectile Dysfunction) Trial: A Single Center, Randomized, Double-Blind, Sham-Controlled Study Update

Abstract Introduction Therapeutic approaches focusing on tissue neovascularization play a crucial role in the development of treatments for erectile dysfunction (ED). Autologous Platelet-Rich Plasma (PRP) and Low-Intensity Shockwave Therapy (SWT) are two restorative therapies that potentially target underlying causes of ED. Pre-clinical evidence suggests their angiogenic and regenerative properties, indicating a potential synergistic pathway to improve vasculogenic ED. Objective The primary objective aims to investigate and compare the treatment efficacy of PRP injection and SWT vs placebo injection/SHAM treatment in men with mild-moderate ED, as measured by IIEF. The secondary objective aims to study incidence of adverse events and safety of PRP injection and SWT treatment in men with mild-moderate ED, as measured by IIEF. Methods The COCKTAIL (Combining Shockwave Therapy and Platelet Rich Plasma) trial is a Phase II, single-center study assessing the safety and efficacy of PRP and SWT in combination for ED (NCT05048667). Thirty-five men with mild to moderate ED were enrolled based on International Index of Erectile Function-EF subdomain (IIEF-EF) questionnaire (12-25). Data from a cohort of men treated with PRP and SWT were analyzed, comparing it to men who received placebo saline injections and sham SWT. Patients received two PRP or placebo injections directly into the corpus cavernosum and penile SWT every week for 5 weeks. Assessment included pain scale evaluations, immediate post-procedure examination, and follow-up for complications. IIEF scores were recorded at baseline, 3-month, and 6-month follow-up visits. All statistics and analyses were conducted with IBM SPSS Statistics 27.0.1. Non-parametric tests were used for analysis. Mann-Whitney U test was used to compare independent groups (Group A vs. Group B) at different time points. Related Samples Wilcoxon -Signed Rank test was used for dependent repeated groups, the serial measurements of IIEF-EF scores at different time points for each patient within a specific group. Findings at p&amp;lt; 0.05 were considered statistically significant. Results The primary endpoint of this study was to investigate the incidence of Serious Adverse Events (SAEs). Encouragingly, no adverse events were reported, suggesting that the procedure appears to be safe for the participants. The median baseline IIEF scores for patients in Group A were 17 (±4), and at the three-month follow-up, the scores increased to 19 (±4), slightly dropping to 18 (±8) at six months. In Group B, the median baseline IIEF scores were 19.50 (±4), which improved to 20 (±7) at the three-month follow-up and further increased to 21 (±10) at six months. No statistical differences were found likely because this is an ongoing study, and we only have complete data for 12 men. We aim to accrue a total of 30 men in each arm and plan to complete the recruitment by January 2024 and complete the study by July 2024. Currently, both the investigators and the patients remain blinded. Conclusions The combination of PRP and SWT appears to be safe, as no adverse events were reported. Although preliminary data do not show differences between the treatment and sham groups currently, we intend to complete the trial to perform a comprehensive statistical calculation for efficacy. Disclosure No.

High intensity laser therapy versus radial shock wave therapy in treatment of shoulder impingement syndrome

Background. Shoulder pain is very common problem in medical practice, ranked third after lower back and neck issues. Shoulder impingement syndrome is thought to be the most common reason for shoulder pain. It accounts for around 44% to 65% of all shoulder problems. Purpose. to compare between the effects of High Intensity Laser Therapy versus Radial Shock Wave Therapy in treatment of shoulder impingement syndrome. Methods. 45 patients were randomly enrolled into three equal groups. Group A (n = 15) received HILT plus conventional physical therapy program, Group B (n = 15) received RSWT plus the same conventional physical therapy program, and Group C (n = 15) received a conventional physical therapy program. The assessment were conducted pre and post treatment using the Visual Analogue Scale, Shoulder pain and disability index and electro goniometer to active shoulder flexion and abduction range of motion. Results. MANOVA test demonstrated a significant (P &lt; 0.05) decrease in VAS and SPADI and a significant (P &lt; 0.05) increase in shoulder flexion and abduction ROM in the three groups. VAS, SPADI, shoulder flexion, abduction ROM revealed that there was more improvement in-group A (P &lt; 0.05). Conclusion: HILT showed a superior effect compared with RSWT on pain, function and shoulder flexion and abduction ROM in treatment of SIS.

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.

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.

The role of magnetic resonance imaging in efficacy of low-dose extracorporeal shock wave therapy for patients with knee osteoarthritis

Among many diseases of the joints, the most common is osteoarthritis and, in particular, knee osteoarthritis. Current medicine requires new and improved imaging techniques to assess patients with knee osteoarthritis, which enable early diagnosis, improved understanding of the pathophysiology of osteoarthritis, and the efficacy of the ongoing treatment. Scientific data on the use of magnetic resonance imaging (MRI) as an objective method to assess the impact of shock wave therapy (SWT) on the restoration of damaged cartilage and bone marrow in patients with knee osteoarthritis was analyzed. A search for publications in the PEDro and PubMed databases for the period from 2017 to 2022 was performed. The search was done using the following keywords: osteoarthritis/knee osteoarthritis, shock wave therapy, magnetic resonance imaging. Five foreign studies were included in the review as a result of the search (no Russian publications were available). Two studies analyzed the effects of SWT on altered cartilage in patients with knee osteoarthritis. Patients who received oral non-steroidal anti-inflammatory drugs were selected as a comparison group. The authors assessed SWT effects on cartilage using quantitative estimates of T2 relaxation time (T2 mapping) and the severity of bone marrow edema on MRI images. At 24 weeks after treatment, differences in relaxation time on T2-weighted MRI images of the patella, acetabulum, and medial and lateral articular surfaces of the femur and tibia showed no statistical significance compared to those before treatment (t= 1.859; P= 0.076). In conclusion, the authors suggested that the resulting effect of SWT in patients with knee osteoarthritis was due to the use of low energy and stated that research will continue using higher SWT parameters. Another study reported that patients with knee osteoarthritis showed a statistically significant reduction in the area of the subchondral bone marrow lesion 6 months after SWT. In addition, the authors found a correlation between the reduction in subchondral bone marrow lesion size and the improvement in pain scores resulting from the SWT treatment. In another study, MRI scans in patients with knee osteoarthritis documented a positive SWT effect by reducing bone marrow edema. After one year of follow-up, MRI images showed complete regression of bone marrow edema among patients who received SWT. The number of studies that investigated SWT effects on cartilage and bone marrow restoration in patients with knee osteoarthritis using MRI is limited, indicating the need for continued research in this area.

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.

Focused, radial and combined shock wave therapy in treatment of calcific shoulder tendinopathy

ABSTRACT Objective: The aim of this work is to compare the clinical, functional, and ultrasonographic outcomes of focused, radial, and combined extracorporeal shock-wave therapy (ESWT) in the treatment of calcific shoulder tendinopathy. Methods: we enrolled 45 patients with calcific shoulder tendinopathy, their ages ranged from 30 to 68 (50.93 ± 9.44) years, classified according to the line of treatment into three groups, all received four sessions of ESWT 1 week apart. Group I: 15 patients received focused shock waves (F-SW) 1500 shocks. Group II: 15 patients received radial shock waves (R-SW) 2000 shocks. Group III: 15 patients received combined focused and radial shock waves (C-SW). All patients were evaluated by musculoskeletal ultrasound (MSK US) before treatment, at 1 week and at 3 months after the last session. Results: In the three studied groups, there was a significant improvement in shoulder pain, active range of motion (ROM), and shoulder function by shoulder disability questionnaire (SDQ) at 1 week after the end of treatment and after 3 months follow up. Moreover, there was a significant sonographic reduction in calcification size in the three groups. At the end of the study, the best improvement as regards a decrease of calcification size was obtained in group III when compared with group I and group II. Conclusion: These results demonstrated clinical, functional, and sonographic improvement in all groups. The best therapy in calcific shoulder tendinopathy appears to be combined focused and radial ESWT compared to interventions alone. Level 1 Evidence Randomized control study.

1002 - Long term efficacy of extracorporeal shock wave therapy for treatment of III-a chronic prostatitis

1002 - Long term efficacy of extracorporeal shock wave therapy for treatment of III-a chronic prostatitis

Extracorporeal shock wave therapy for treatment of vulvodynia: a prospective, randomized, double-blind, placebo-controlled study.

Currently, there are no effective therapy strategies for idiopathic, non-organic vulvodynia in women. ESWT (extracorporeal shock wave therapy) is a nonsurgical/noninvasive technique widely used to treat musculoskeletal diseases, muscle spasticity and hypertonia, renal and biliary calculi and urological disorders. We examined the effects of ESWT on vulvodynia in women. A prospective, randomized, double-blind, placebo-controlled study was conducted between 2015 and 2018 following a feasibility study. Obstetrics and Gynecology Hospital departments. The study included 62 women with vulvodynia for at least 3 months. The women were randomly assigned to either a treatment group (N.=31) or a placebo group (N.=31). The patients in the treatment group received perineally applied ESWT weekly (3000 pulses each for four consecutive weeks). The energy flux density was 0.25 mJ/mm2, frequency 4 Hz, focus zone 0-30 mm, therapeutic efficacy 0-90 mm, stand-off II. The device used was a standard electromagnetic shock wave unit with a focused shock wave handpiece. The position of the shock wave transducer was changed six times after every 500 pulses. Patients in the placebo group underwent the same treatment procedure, but the handpiece was provided with a placebo stand-off that disabled energy transmission. Subjective pain was self-evaluated by each patient using two tools before and after treatment: a 10 cm linear visual analogue scale (VAS, 0-10) and a cotton-swab test (CST, Goetsch scale 0-4). Follow-ups were done 1, 4, and 12 weeks post-ESWT. In all, 61 women completed the study. We tested for differences in the VAS and CST within and between the treatment and placebo groups. The testing was between before treatment and particular follow-up. We found significant changes in the treatment group. Reductions in VAS (P<0.01) and CST (P<0.01) were observed at all three follow-ups. At all assessments, pain reduction was always >30%. In the placebo group there were no statistically significant changes between before and after treatment. There were no differences between the treatment and placebo groups before treatment but statistically significant differences at all three follow-ups (VAS P<0.01); CST P<0.01). ESWT seems to reduce pain perception in our treatment group. Thus, we are encouraged to explore this technique further. The method is easily replicable, inexpensive, and without known side effects.

Effectiveness of shockwave therapy in the treatment of plantar fasciitis.

ABSTRACTObjective:To evaluate the effectiveness of single-dose focal shockwave therapy in plantar fasciitis treatment.Methods:a primary, prospective study of a series of cases, conducted in the city of São Paulo, Brazil, by the Department of Orthopedics and Traumatology of the Universidade Federal de São Paulo, in Hospital São Paulo. All outcomes were measured at the time of inclusion of the patient in the study and at the post-intervention moments as it follows: three, six and twelve weeks. The VAS, AOFAS and SF-36 scales were applied by teams other than those who performed the SWT.Results:Data from 56 patients were collected during 2017 and 2018. There was improvement of the parameter evaluated (p < 0.005 and 95%CI) in all the periods in which the patients were reevaluated (3, 6 and 12 weeks), progressive improvement were observed in the three outcomes evaluated.Conclusion:Shock wave therapy was effective for plantar fasciitis treatment according to the proposed protocol considering pain, function and quality of life. Level of Evidence Ic, Case-series Study.

The Effect of Shock Wave Therapy as a New Modality for Treatment of Primary Knee Osteoarthritis

Background: osteoarthritis, the most common form of arthritis, is a chronic disease characterized by slow degradation of cartilage, pain, and increasing disability. Objective: to study the effect of shock wave therapy in treatment of primary knee osteoarthritis. Patients and Methods: thirty patients with primary knee osteoarthritis were classified equally into 2 groups according to the line of treatment; Group I received extra-corporeal shock wave therapy and Group II received continuous ultrasonic waves. Patients were evaluated for pain using visual analogue scale, active range of motion, and physical and functional assessment. Bilateral anteroposterior weight bearing radiographs were done for all patients before treatment and degree of osteoarthritis was assessed by Kallgren and Lawrence Radiographic criteria. Results: there was significant improvement in group I more than group II (as regard to pain assessed by visual analogue scale (VAS) after treatment (p=0.039) and in follow up (p <0.001). There was significant improvement in morning stiffness in both groups with insignificant difference between both them. Regarding active range of motion (ROM), there was significant improvement in flexion in both groups with significant difference between both groups before and after treatment (p =0.001) and in follow up (p <0.001). Regarding chair stand test, there was significant improvement in both groups with in significant difference between them. Regarding stair climb test (SCT), there was significant improvement in both groups with insignificant difference between them. Conclusions: shock wave had an effect in treatment of primary knee OA as a new modality for improving clinical and functional performance.

208 Low-Intensity Shock Wave Therapy for Treatment of Vasculogenic Erectile Dysfunction: Phase 1 Results of the Dornier Aries in the First United States Clinical Trial

208 Low-Intensity Shock Wave Therapy for Treatment of Vasculogenic Erectile Dysfunction: Phase 1 Results of the Dornier Aries in the First United States Clinical Trial

Effectiveness of extra corporeal shockwave therapy in treatment of lower back pain in patients with osteoporosis

Effectiveness of extra corporeal shockwave therapy in treatment of lower back pain in patients with osteoporosis

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm2; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm2); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles–Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes.

A Comparison of Laser and Extracorporeal Shock Wave Therapies in Treatment of Lateral Epicondylitis

Objective: Lateral epicondylitis (LE) is a common painful problem of the elbow. This study was conducted to evaluate and compare the effectiveness of extracorporeal shock wave therapy (ESWT) and lowintensity laser therapy in LE treatment. Material and Methods: The study included 60 LE patients. Subjects were divided into two groups randomly. Group 1 received ESWT, while group 2 received laser therapy. Presence of lateral epicondyle tenderness, elbow pain, and hand grip strength (HGS) were evaluated at the beginning and at 4 and 12 weeks. Elbow pain was evaluated with the Short-Form McGill pain questionnaire (SF-MPQ). Results: The patients with tender lateral epicondyle were not significantly different between groups at each time point. Both groups had improvement on HGS evaluated at the 4th and 12th weeks, but in the ESWT group, the improvement was significantly higher. All SFMPQ parameters improved significantly after each therapy evaluated at the 4th and 12th weeks. However, mean visual analog scale, present pain intensity, affective pain subscale, and total pain scale scores were significantly lower in the ESWT group at the 4th and 12th weeks. Conclusion: Both ESWT and laser therapy are effective and safe treatment options for LE; however, ESWT seems to be more efficient in pain reduction and improvement of functions.