Reduced Local Perfusion After Shock Wave Treatment of Rotator Cuff Tendinopathy

Notarnicola, Angela; Moretti, Luigi; Tafuri, Silvio; Forcignanò, Maria; Pesce, Vito; Moretti, Biagio

doi:10.1016/j.ultrasmedbio.2010.11.019

Cited by 13 publications

(13 citation statements)

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“…It has still not been determined whether vascular changes occur or are associated with rotator cuff pathology [39], however, experimental studies have demonstrated that shockwaves improve the blood supply to the tendon tissue throughout a neovascularization process [40] and low energy ESWT modulates the synthesis of nitric oxide [41,42], a molecule that plays a critical role in the regulation of vascular tone, angiogenesis [42], and in the degeneration of the tendon [43-45]. Recently, it has been suggested that shock waves behave fairly differently according to the clinical phase of the disease, even reducing the pathological angiogenesis associated with rotator cuff disease [46]. Further therapeutic mechanisms of ESWT in the treatment of tendinopathies have been hypothesized.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial

Galasso

Amelio²,

Riccelli

et al. 2012

BMC Musculoskelet Disord

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BackgroundThere is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in calcific tendinopathy of the rotator cuff, but the best current evidence does not support its use in non-calcifying tendinopathy. We conducted a randomized placebo-controlled trial to investigate the efficacy and safety of low energy ESWT for non-calcifying tendinopathy of the rotator cuff.Methods20 patients with non-calcifying supraspinatus tendinopathy (NCST) were randomized to an active or a sham treatment group. Physical, blood, roentgenographic, and MRI examinations of the shoulder were conducted to verify that patients met the inclusion and exclusion criteria. These examinations were repeated six and twelve weeks after treatments. Effectiveness was determined by comparison of the mean improvement in the Constant and Murley score (CMS) between the treatment and the placebo groups at three months. Safety was assessed by analyzing the number and severity of adverse events.ResultsAll the patients completed the investigation protocol. At the final follow-up, significant improvement in the total CMS score and most of the CMS subscales was observed in the ESWT group when compared to the baseline values. Significantly higher total CMS, and significantly higher scores for CMS pain and ROM were observed in the ESWT group when compared to the placebo. No serious adverse events were noted after ESWT.ConclusionsPatients suffering from NCST may benefit from low energy ESWT, at least in short-term. The application protocol of ESWT is likely to play a key-role in a successful treatment. Future investigations should be undertaken on the long-term effects of this technique for the treatment of NCST.Trial registrationCurrent Controlled Trials ISRCTN41236511

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Section: Discussionmentioning

confidence: 99%

Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial

Galasso

Amelio²,

Riccelli

et al. 2012

BMC Musculoskelet Disord

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“…By oximetry in a previous experience in 30 patients affected by RC tendinopathy we demonstrated statistically significantly higher values in the dominant arm than in the unaffected contralateral arm (80.6% vs 45.66%, p < 0.0001). After treatment, a reduction of local perfusion was demonstrated at 2 and 6 months follow-up (53.2% and 51.5%, respectively, p < 0.001), associated with an improved clinical-instrumental picture [54]. On the other hand, the vascular theory for tendinopathy has not yet been accepted by the international Community.…”

Section: Discussionmentioning

confidence: 99%

“…The strong points include the fact that tissue oximetry has a greater sensitivity in the study of perfusion of the microcirculation than other, previously used instrumental techniques such as color- and power-doppler [54]. …”

Section: Discussionmentioning

confidence: 99%

Overload and neovascularization of shoulder tendons in volleyball players

et al. 2012

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BackgroundIn overhead sports like volleyball, the onset of a rotator cuff tendinopathy due to functional overload is a common observation. An angiofibroblastic etiopathogenesis has been hypothesized, whereby a greater anaerobic metabolism occurs in critical zones of the tendon with a lower degree of vascularization; this would induce collagen and extracellular matrix degradation, that could then trigger a compensatory neovascularization response. We performed a clinical observational study of 80 elite volleyball players, monitoring the perfusion values of the supraspinatus tendons by oximetry.ResultsNo statistically significant differences were found between the oximetry data and age, sex or years of sports activity, nor when comparing the right and left arm or the dominant and non-dominant arm. A statistically significant difference was found for the dominant arm values in relation to the competitive role, higher values being obtained in outside hitters (62.7%) than middle hitters (53.7%) (p = 0.01), opposite hitters (55.5%) (p = 0.02) and libero players (54.4%) (p = 0.008), whereas there were no differences in setters (56.2%) (p > 0.05).ConclusionsThe different tendon vascularization values found in players with different roles in the team may be attributed to a response to the specific biomechanical demands posed by the different overhead throwing roles.

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“…Hier war die Gewebeperfusion nach extrakorporeller Stoßwellen-therapie bei den Rotatorenmanschettensehnen sogar vermindert [24].…”

Section: Indirekte Biologische Augmentationunclassified

Intraoperative biologische Augmentation an Sehnen und Enthesen

et al. 2013

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Intraoperative biologische Augmentation an Sehnen und EnthesenSehnen-und Sehenansatzläsionen gehören zu den häufigsten Verletzungen in der Orthopädie. Trotz technischer Weiterentwicklung in der Sehnenrekonstruktionschirurgie besteht postoperativ nach wie vor eine relativ hohe Versagensrate. Ein Grund dafür ist die Tatsache, dass bei der Sehnenansatz-und Sehnenheilung, bedingt durch eine limitierte Regenerationskapazität, Narbengewebe anstelle von normalem Gewebe gebildet wird. Narbengewebe ist dem normalen Gewebe sowohl in funktioneller als auch biomechanischer Sicht unterlegen.Mehrere Strategien zur biologischen Augmentation von Sehnen-und Sehnenansatzläsionen wurden in den letzten Jahren entwickelt und getestet [2, 3, 9-12, 16, 26, 28]. Einige dieser biologischen Augmentationsstrategien zur Verbesserung der Sehnen-Sehnen-bzw. Knochen-SehnenHeilung wurden bis jetzt erst im Tiermodell untersucht [3,[9][10][11][12]16]

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Reduced Local Perfusion After Shock Wave Treatment of Rotator Cuff Tendinopathy

Cited by 13 publications

References 54 publications

Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial

Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial

Overload and neovascularization of shoulder tendons in volleyball players

Intraoperative biologische Augmentation an Sehnen und Enthesen

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