Extracorporeal Shock Wave Lithotripsy 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.

Quadruple-D score in the success rate of extracorporeal shock wave lithotripsy of renal stones in pediatric population.

Evaluation of the validity of the Quadruple-D score in the prediction of success in pediatric stone disease. Of the 292 children treated with SWL between 2007 and 2023, a total of 158 children who had adequate follow-up data and evaluated with non-contrast computed tomography before SWL, were included in the study. Parameters were calculated for each of the stone volume (SV), skin-to-stone distance (SSD), stone density (SD) and stone location (SL) variables. Receiver operator characteristic analysis was used to set cut-off values. Quadruple-D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after three months of final SWL. The median age of the study group was 8 (range 1 to 16). One hundred and one of the 158 (64%) children had stone-free status. Mean SV, SSD and SD values were significantly higher in SWL failed group than stone-free group after detecting cutoff values of 150 mm3, 6.7 cm, and 540 HU, respectively. Stone-free rates were detected as 19.6%, 24.7%, 37.2%, 76.2%, and 90.2% with the Quadruple-D scores of 0, 1, 2, 3 and 4 points. Quadruple-D scoring system can further improve Triple-D scoring system by adding stone position parameter to clarify SFR with a simple and easy calculation. We believe that the Quadruple-D score will have better clinical significance than the Triple-D scoring system in predicting the success of SWL in children.

Comparative Analysis of Cellulite Treatment Modalities: A Systematic Review.

Cellulite is a highly prevalent and aesthetically distressing skin condition. Whilst there are a variety of treatment modalities, none are definitively established. This systematic review aims to assess invasive and noninvasive treatment modalities for cellulite management. The review protocol was published and registered a priori (PROSPERO CRD42022359334). A comprehensive electronic search for relevant randomised controlled trials, (RCTs) was performed in CENTRAL, MEDLINE, Embase and Web of Science databases. Study quality and risk of bias were assessed using Cochrane's risk of bias tool, respectively. Overall, 753 studies were initially identified, of which 24 randomised controlled trials (RCTs) satisfied the eligibility criteria with a total of 2084 patients with a mean follow-up of 3.33 ± 13.4weeks. Evaluated interventions included mechanical stimulation, topical therapy, shock wave therapy (SWT), laser and light-based devices, radiofrequency therapy, subcutaneous injectables, and ultrasound. SWT emerged as a standout intervention, demonstrating a consistent cellulite reduction score of 2.07 ± 0.39 across four studies. Radiofrequency therapy exhibited a statistically significant reduction of thigh circumference (- 2.09cm, p < 0.001) and subcutaneous tissue thickness (- 2.23cm, p < 0.001). Subcutaneous injectables, specifically collagenase Clostridium histolyticum-aaes, demonstrated a statistically significant improvement in the clinician-reported photonumeric cellulite severity scale (17.0%) and patient-reported photonumeric cellulite severity scale (25.7%) (p < 0.001). The overall quality of the studies using the grading of recommendations, assessment, development and evaluation approach was moderate. This is the first methodologically robust systematic review evaluating interventions for cellulite. SWT, radiofrequency therapy, and subcutaneous injectables have shown promising findings in cellulite treatment. The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

COMPLEX PHYSICAL THERAPY OF PATIENTS WITH ADHESIVE CAPSULITIS

Adhesive capsulitis is predominantly an idiopathic condition and is more common in patients with metabolic disorders. PS contracture can be of varying degrees of severity, depending on the pathology of the PS with which we are dealing. This condition greatly aff ects work capacity and quality of life due to the presence of pain, discomfort and limitation of daily life activities. Prolonged pain syndrome can provoke sleep disorders and depression. Disruption of normal sleep, pain and depression form a pathological closed circle and contribute to the maintenance of the pathological process in the locus morbi.The development of a comprehensive program of physical therapy for patients with adhesive capsulitis with the use of modern means of recovery, which will reduce the risk of the disease re-emerging, and will also contribute to the faster recovery of the functional capacity of the musculoskeletal system of the patients.The objective of the study. The develop and practically substantiate a comprehensive program of therapy for patients with adhesive capsulitis using physical therapy.Materials and Research Methods. The study is based on a comprehensive therapeutic approach for 36 patients diagnosed with adhesive capsulitis in the acute phase of the condition. The assessed parameters included X-ray and computed tomography results, evaluation of range of motion in the shoulder joint, joint- muscle apparatus, and analysis of pain intensity indicators.Conclusions. To improve the condition of patients and optimize the process of treatment and rehabilitation of patients with adhesive capsulitis of the shoulder joint in the acute period, it is advisable to use with the diff erentiation of means of therapeutic intervention according to the diagnosis of the international classifi cation of functioning, optimization of physiotherapeutic means and special means of physical therapy allowed to shorten the terms of treatment and recovery of patients with adhesive capsulitis. It was determined that the best combination of means of therapeutic intervention for patients with adhesive capsulitis is the use of a complex of ideomotor exercises to create the patient’s idea of correct movement; correct positioning of the limb during sleep, everyday and professional activity; passive exercises to increase the volume of painless movements (bending, external rotation); restorationof the pattern of typical motor actions and optimization of physiotherapeutic means due to the use of shock wave and TENS therapy signifi cantly improved the eff ectiveness of their recovery in the short-term and long-term stages of the acute period of rehabilitation.

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.

Advanced therapeutic strategies in patellar ligament tendinopathy: from etiology to clinical practice. A literature review.

Introduction: Tendinopathy of the patellar ligament, often referred to as “jumper's knee,” is a significant health problem for athletes subjected to repeated knee strains. The condition, resulting from microtrauma and degeneration of collagen fibers, leads to chronic pain and impaired function of the patellar ligament. Aim of the study: The aim of this study was to present current knowledge about new techniques to prevent and treat patellar tendinopathy. Analyzing current informations, understanding risk factors, and recognizing pathophysiology of patellar tendinopathy can prevent many sportsmen to withdraw from competitions. Materials and methods: A systematic review of scientific and medical literature from the PubMed and Google Scholar databases was conducted. Results: A review of the literature has identified key risk factors for patellar ligament tendinopathy. An analysis of available studies indicates that various therapeutic interventions, including shockwave therapy, eccentric exercise programs can provide pain relief and improve patellar ligament function. However, the effectiveness of these methods may vary depending on individual patient characteristics. Conclusions: Recognition of risk factors, early education and prevention, and prompt introduction of treatment at an early enough stage of the disease allow for the best treatment results and rapid return of patients to sports activities before the onset of pain, and significantly improve patients' quality of life. These findings underscore the comprehensive nature of the management of patellar ligament tendinopathy, including both therapeutic and preventive interventions. Keywords: patellar tendinopathy, orthopeadics, sport medicine, knee

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.

Safety and Effectiveness of Urologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreatolithiasis.

Introduction: Extracorporeal shock wave lithotripsy (SWL) can be used in conjunction with endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of large (≥5 mm) or impacted pancreatolithiasis. We report our experience demonstrating the safety and effectiveness of urologist-directed SWL for pancreatolithiasis. Methods: We performed a retrospective review of all patients undergoing SWL for pancreatolithiasis at our institution between 2016 and 2020. We defined a treatment cycle as one in which the patient underwent a predefined number of SWL procedures prior to performance of a post-SWL ERCP. Stone-free status was defined as the absence of stone fragments at post-SWL ERCP. Multivariable logistic regression was performed to determine characteristics associated with stone persistence after a treatment cycle. Results: There were 44 patients who underwent 59 treatment cycles consisting of 118 pancreatic SWL procedures. Forty-two cycles (71.2%) were staged, and 17 (28.8%) were not staged. The median size of the largest pancreatic stone was 9 mm [IQR 6-11] and was impacted in 38 cases (64.4%). Patients reported pain in 51 cases (86.4%), of which 28 required the use of opioid analgesics. Patients were rendered stone free in 38 cycles (64.4%). Pain improvement was noted in 39 cases (66.1%), and the reduction in opioid use was statistically significant (28 cases vs. 10 cases, P = 0.004). Impacted stones were associated with an increased odds of stone persistence (OR 7.04, 95% CI 1.14-43.43, P = 0.04). Conclusions: In this joint venture with gastroenterology, we demonstrate that urologist-directed SWL for pancreatolithiasis is safe, effective, and in line with published rates.

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.

Investigating the Effects of Shockwave and Percussion Massage Gun on Subacute Myofascial Pain in Gasterocenemious Muscle

Introduction: Myofascial pain syndrome is a common musculoskeletal injury, especially among athletes, typically treated with symptomatic invasive and non-invasive methods. This study compares the effects of massage guns and radial extracorporeal shock wave therapies on myofascial pain syndrome symptoms in amateur athletes. Materials and Methods: In this clinical trial, 45 amateur athletes (18-30 years old) were recruited, who were randomly assigned to 15-member groups of shock wave, massage gun, and control (routine treatment included electrotherapy and stretching, which was applied on three groups). After initial evaluations of the pain intensity, pain pressure threshold (PPT), isometric muscle strength, and range of motion (ROM), the patients received single-session treatment and were immediately reassessed. Results: The results showed pain relief and improved PPT following shock wave plus routine treatment (P=0.03). The control group had less pain, while pain intensity and PPT did not change. The variables were not significantly different between the groups (P=0.12). Shock wave along with routine treatment increased plantar flexion ROM (P=0.00), unlike the massage gun. Additionally, dorsiflexion ROM (P=0.63) and maximal isometric gastrocnemius muscle strength (P=0.95) remained unchanged in all groups. Conclusion: One session of massage gun therapy immediately reduced gastrocnemius muscle pain, while it failed to change PPT, maximal isometric gastrocnemius muscle strength, or dorsiflexion and plantar flexion ROM. However, shock wave therapy immediately increased plantar flexion ROM and PPT, and reduced pain intensity. These modalities led to limited changes, suggesting the need for repeated sessions and supplementary treatments.

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.

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.

Extracorporeal Shock Wave Therapy (ESWT) vs. Exercise in Thumb Osteoarthritis (SWEX-TO): Prospective Clinical Trial at 6 Months

Rhizarthrosis is the most frequent form of osteoarthritis and is responsible for pain, disability and reduced functionality. The aim of the study is to investigate the clinical effects of shock wave treatment in patients suffering from arthritis of the first finger. A prospective clinical study was designed, in which 72 patients affected by rhizarthrosis were randomized to treatment with shock waves or exercises; in both groups an immobilization brace was used on the first finger. At recruitment and at 1, 3 and 6 months, patients received assessments of pain (VAS), functionality (FIHOA) and disability (DASH); furthermore, the perception of improvement was monitored during follow-ups (Roles and Maudsley Score). In both groups there was a significant improvement in all scores in the comparison between recruitment and 6 months. The perception of improvement was statistically better in the shock wave group than in the exercise group at 1, 3 and 6 months. The regression analysis showed that the reduction of VAS and DASH were statistically influenced by shock wave treatment (p &lt; 0.001). Both therapies are effective in managing patients suffering from arthritis of the first finger, but the shock wave treatment could ensure greater persistence of improvements.

COMPARISON OF LASER AND PNEUMATIC LITHOTRIPSY FOR MID AND LOWER URETERAL STONES: “AN ANALYTICAL REVIEW” AT TERTIARY CARE CENTER

Objectives: Management of large lower and mid ureteric stones represents a treatment challenge. The main objective of stone treatment is to achieve the highest stone-free rate with minimal morbidity. Available modalities are medical therapy, open surgery, laparoscopic surgery, endoluminal surgery and extracorporeal shock wave lithotripsy (ESWL). After the invention of uretero-renoscopy (URS) and ESWL in 1980s, there has been a paradigm shift in the treatment modality of ureteric calculus from open surgery to endoluminal and non-invasive method. There are various modalities for stone fragmentation in URS – electrohydrolic lithotripsy, pneumatic. Ultrasonic, laser and dual energy source (Ultrasound+Pneumatic) Lithotripsy. Both laser lithotripsy (LL) and pneumatic lithotripsy (PL) have favourable outcomes The aim of this study was to compare efficacy of pneumatic versus laser lithotripters for Mid and lower ureteric calculi in regional population at KIMS, Hubballi. Methods: This was a prospective comparative study done in 116 cases of mid and lower ureteric calculi (58 in PL and 58 in LL) at karnataka institute of medical sciences, Huballi from May 2022 to November 2022. Patients were randomly divided into two groups: Group 1 had PL, while Group 2 had lithotripsy using a laser energy source. For PL group, 0.8 and 1 mm probe was passed through working channel of URS. LL was performed using a 100- W holmium:yttriumaluminium-garnet (YAG)-pulsed laser machine, with 365 μm fibres. Complications were graded according to the Clavien-Dindo Grading System. Results: In all, 116 patients (78 male and 38 female) with a mean age of 36.21 years were included in the study, Varying from 18 to 75 years. In group one 58 patients under went PL out of which 41 were males and 17 were females. In group two 58 patients under went LL out of which 37 were males and 21 were females. In group one (PL) mean operative with SD was 42.10±(10.16) min, and in group two (LL). Mean operative with SD was 46.78±(9.36) min, with p=0.011, which was statistically significant. Mean hospital stay ±SD (days) in PL group was 2.69±(0.730) days, and in group two LL mean hospital stay ±SD (days) was 2.40±(0.591) with p=0.019, which was statistically significant. In group one out of 58 patients, 11 patients had stone migration with % of an 18.96% and in group two out of 58 patients 2 patient had stone migration of, with % of 3.44%, with p=0.008, which is statistically very significant. Post operatively 7 patients in group one needed auxillary procedures, 3 patients needed ESWL, 3 patients needed. Re URSL and one patient needed bladder clot evacuation with DJ stenting, In all these patients stone size was larger than 15 mm, In Group 2 no patient needed Auxillary procedure, with p=0.003 which is statistically significant. Conclusion: Both pneumatic and LL are standard and safe techniques for the management of lower and mid ureteric calculi. Our study showed LL had less stone migration, and no need for reintervention.

The effects of pretreatment oral hydration on extracorporeal shockwave lithotripsy outcomes: A randomized controlled trial.

We sought to investigate the effects of pretreatment oral hydration on the outcomes of extracorporeal shockwave lithotripsy (ESWL). Patients who undergoing ESWL for a single radio-opaque renal or proximal ureteric calculus ≤2 cm in size were randomized into two groups. The oral hydration group (OHG) administered 600 ml of water before ESWL, while the control group (CG) did not. The urine was held during ESWL to create a full bladder induced hydronephrosis. Both groups received the same ESWL protocol at four-week intervals and a maximum of three sessions. The primary outcome was stone-free rate (SFR) at 12 weeks and the secondary outcomes were the total number of shockwaves and the number of ESWL sessions. A total of 154 patients completed the study, 77 patients in each group; both groups were comparable in demographic data and stone characteristics. The SFR was 84.4% in the OHG and 68.8% in the CG group (p=0.036). Stone fragmentation in OHG was significantly higher than CG, 75.3% vs. 58.4% (p=0.040). OHG had more cases of artificial hydronephrosis (55.8% vs. 27.3%, p=0.001) and higher urine volume (375 [148] ml vs. 230 [110] ml, p<0.001). There were no statistically significant differences in the total number of shockwaves and the number of ESWL sessions. The auxiliary procedures in OHG were less than CG (15.6% vs. 31.2%, p=0.049). Pretreatment oral hydration, together with holding urine during ESWL, has increased stone disintegration and SFR. This simple and safe technique improves the ESWL outcomes.

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.

Ultrasound-Guided Needling Combined With High- or Low-Energy Extracorporeal Shock Wave Therapy Versus Needling Alone for Calcified Rotator Cuff: A Retrospective Study.

Rotator cuff calcific tendinitis is a common shoulder joint disorder. Nonsurgical treatment methods, including multiple needling and extracorporeal shock wave therapy (ESWT), can effectively treat calcific tendinitis. To evaluate the clinical results and radiological outcomes of treatment with ultrasound-guided needling (UGN) alone versus UGN with high-energy ESWT (UGN-H) or UGN with low-energy ESWT (UGN-L) in patients with calcific tendinitis of the rotator cuff. Cohort study; Level of evidence, 3. Outpatient records for patients with calcific tendinitis of the rotator cuff were evaluated retrospectively. Patients were grouped into those treated with UGN-H, UGN-L, or controls with UGN alone. The visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) scores, Constant-Murley scores, and radiographic evaluation to assess calcification size were available before treatment and at 3, 6, and 12 months after the first treatment. Post event pairwise analysis to analyze score differences between treatment groups was used. Overall, 130 patients were included for analysis (42 UGN-H, 44 UGN-L, and 44 with UGN alone). At 3 months, the VAS scores were UGN-H (4.13 ± 0.84; P < .001) and UGN-L (4.47 ± 1.01; P < .001) which were significantly better than UGN alone (5.35 ± 1.00) in terms of the VAS score; however, the difference was not significant between UGN-H and UGN-L. These differences persisted at months 6 and 12 (6 months: UGN-H, 2.66 ± 1.00; P < .001; UGN-L, 3.16 ± 1.05; P = .033; 12 months: UGN-H, 1.93 ± 0.43; P < .001; UGN-L, 2.04 ± 0.46; P < .001). The results of the ASES and Constant-Murley scores were similar to those of the VAS score. In terms of radiographic outcome, follow-up at months 3, 6, and 12 revealed that UGN-H and UGN-L were superior to UGN alone at removing calcification (median 95% CI; 3 months: UGN-H, 1.4 mm2 [1.08, 7.25 mm2); P = .002; UGN-L, 5.79 mm2 (1.17, 7.85 mm2]; P = .041; 6 months: UGN-H, 0.91 mm2 [0, 1.15 mm2); P < .001; UGN-L, 1.13 mm2 [0.84, 5.10 mm2]; P < .001; 12 months: UGN-H, 0 mm2 [0, 0 mm2]; P < .001; UGN-L, 0 mm2 (0, 4.33 mm2]; P = .023). There was no significant difference between UGN-H and UGN-L at the month 3 follow-up, but the month 6 and 12 follow-ups revealed that UGN-H was more effective at removing calcification compared with UGN-L. The study demonstrated that, for pain relief and recovery of shoulder joint function, UGN + ESWT was significantly superior to UGN alone. No significant difference was observed between different energy levels of ESWT. UGN + ESWT was significantly superior to UGN alone on radiographic evaluation. Furthermore, UGN-H performed better radiographically with reducing calcifications compared with UGN-L at 12 months.

Comparison of the efficacy and safety of basket catheters and balloon catheters for endoscopic pancreatic duct stone clearance

BackgroundThe choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography (ERCP) for the clearance of pancreatic duct stones in patients with chronic pancreatitis (CP) remains controversial. This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions. MethodsWe compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions. We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital, Naval Medical University between February 2012 and December 2021. After propensity score matching (1:1), 101 patients were included in each group. The primary outcome was the rate of pancreatic stone clearance. Secondary outcomes included the rate of adverse events during hospitalization, long-term pain relief, and quality of life after one year follow-up period. ResultsThe rate of complete clearance was comparable between the two groups (86.1% vs. 84.2%, P = 0.692). In patients with stones ≥ 2 cm before extracorporeal shock wave lithotripsy (ESWL), the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group [100% (19/19) vs. 70.0% (14/20), P = 0.031]. In the multivariate analysis, ESWL prior to stone extraction was the only independent predictor of complete clearance [with ESWL 58.4% (264/452) vs. without 41.6% (188/452), OR = 2.3, 95% confidence interval: 1.2-4.3; P = 0.013]. No significant differences between groups were found regarding the rates of adverse events during hospitalization, quality of life, and pain relief after one year of follow-up. ConclusionsBasket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions. However, the balloon catheter was superior to the basket catheter if the pancreatic stone size was ≥ 2 cm before ESWL.

Are Extracorporeal Shock Waves Just a Therapeutic Tool?

Focused extracorporeal shock wave therapy (ESWT) has been successfully used to treat musculoskeletal conditions, but ESWT stimulates nociceptors, causing pain deep in the tissue during treatment. The occurrence of pain during ESWT is a side effect, but it can help identify painful sites and assess minimum (MiTI) and maximum (MaTI) pain thresholds to ESWT pressure stimuli. This topic has received limited attention in literature. This observational study describes a specific approach to using ESWT to study pain in 71 patients. The approach proposes moving the ESWT transducer head of the device over the entire joint surface, progressively increasing the energy level until the patient experiences pain. In the study, MiTI and MaTI were 0.218 ± 0.090 and 0.416 ± 0.165 mJ/mm2 in the affected joint and 0.282 ± 0.128 and 0.501 ± 0.174 mJ/mm2 in the contralateral homologous healthy joint, being significantly lower in the affected joint (MiTI: p < 0.001 and MaTI: p = 0.003, respectively). ESWT induced pain in 94.37% of the sites with the highest subjective pain and in a greater number of sites (204) than digital pressure (123) (p < 0.001). All sites with digital pressure pain also had ESWT pain. These results suggest that the ESWT device may be useful in investigating pain in musculoskeletal conditions and tailoring therapy.

Evaluation of the impact of shockwave therapy on the functioning of a patient with a lower calcaneal spur

Introduction. A common cause of heel pain is the presence of a calcaneal spur. This condition may disrupt the posterior superficial fascia chain and can also lead to problems in distant areas of the body. Among the physical methods used, shockwave therapy is often applied. The aim of the study was to assess the effectiveness of shockwave therapy and its effect on the tension of the gastrocnemius muscle, which is part of the posterior fascia chain. Materials and Methods. A 52-year-old female patient diagnosed with a left lower calcaneal spur underwent a series of six radial shockwave therapy sessions, performed twice a week. The method for assessing the therapy’s effectiveness involved measuring pain on the Visual Analogue Scale (VAS) and changes in tissue temperature before, immediately after, and five minutes post-therapy. Electromyographic (EMG) examination was used to assess the tension of the gastrocnemius muscle. Results. An average decrease in temperature was observed immediately after the treatment (from 25.3°C to 24.45°C). After five minutes, the temperature increased to 27.05°C compared to the initial measurement. The resting tension of the gastrocnemius muscle, as measured by EMG, decreased as follows: channel 1: from 0.6 µV to 0.4 µV, channel 2: from 4.3 µV to 3.2 µV. Pain decreased from a level of 7 to 2 on the VAS scale. Conclusions. Shockwave therapy is an effective solution for alleviating pain in the case of a calcaneal spur. The reduction of resting tension in the gastrocnemius muscle leads to a decrease in elevated tension within the posterior myofascial chain, which may help reduce the risk of secondary pathologies in distant areas along the chain.