Results with Extracorpeal Shock Wave Therapy in Bone and Soft Tissue Pathologies

Russo, Sergio; Gigliotti, S.; Durante, C; R, Canero; Andretta, D.; Corrado, Bruno

doi:10.1007/978-3-642-80427-4_8

Cited by 10 publications

(12 citation statements)

References 9 publications

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“…18 The form of sham treatment which we used was devised to ensure that no energy was delivered to the region under study. Elements used in the techniques of others were included, 3,16 but with additional measures to ensure that this was a true sham. The combination of steps taken make it unlikely that any treatment was delivered to a patient in the sham group.…”

Section: Discussionmentioning

confidence: 99%

“…3,15,16 No local anaesthesia was used. All treatments were applied using a Sonocur Plus Unit (Siemens, Munich, Germany) which generates mechanical shock waves from an electromagnetic generator.…”

Section: Methodsmentioning

confidence: 99%

“…All treatments were applied using a Sonocur Plus Unit (Siemens, Munich, Germany) which generates mechanical shock waves from an electromagnetic generator. After the recommendations by Russo et al, 16 we used two parameters to focus the treatment on the target area in the ESWT group. The area was localised by ultrasound.…”

Section: Methodsmentioning

confidence: 99%

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Extracorporeal shock-wave therapy for tendonitis of the rotator cuff

Speed

Richards

Nichols

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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W e have performed a double-blind placebo-controlled trial of moderate doses of extracorporeal shock-wave therapy (ESWT) for non-calcific tendonitis of the rotator cuff. Adults (74) with chronic tendonitis of the rotator cuff were randomised to receive either active (1500 pulses ESWT at 0.12 mJ/mm 2 ) or sham treatment, monthly for three months. All were assessed before each treatment, and at one and three months after the completion of treatment. The outcome was measured with regard to pain in the shoulder, including a visual analogue score for night pain, and a disability index. There were no significant differences between the two groups before treatment. The mean duration of symptoms in both groups was 23.3 months. Both showed significant and sustained improvements from two months onwards. There was no significant difference between them with respect to change in the Shoulder Pain and Disability Index (SPADI) scores or night pain over the six-month period. A mean (±SD; range) change in SPADI of 16.1 ± 27.2 (0 to 82) in the treatment group and 24.3 ± 24.8 (-11 to 83) in the sham group was noted at three months. At six months the mean changes were 28.4 ± 25.9 (-24 to 69) and 30.4 ± 31.2 (-12 to 88), respectively. Similar results were noted for night pain.We conclude that there is a significant and sustained placebo effect after moderate doses of ESWT in patients with non-calcific tendonitis of the rotator cuff, but there is no evidence of added benefit when compared with sham treatment. Extracorporeal shock-wave therapy (ESWT) by singlepressure pulses of microsecond duration can be guided by ultrasound to focus on a specific site. Having revolutionised the treatment of urolithiasis, ESWT has more recently been used in the treatment of a number of musculoskeletal conditions, including tendinopathies and enthesopathies, at doses of 10% to 20% of those used in lithotripsy for renal calculi.1-5 The theoretical benefits are the stimulation of tissue healing and the breakdown of calcification. [4][5][6][7] In spite of the increasing popularity of this method of treatment, there has been no randomised, controlled trial of its use in specific musculoskeletal conditions. Benefit from ESWT has been demonstrated in calcific tendonitis of the rotator cuff. 4 We present our findings of a double-blind, randomised, controlled trial in non-calcific tendonitis of the rotator cuff. Patients and MethodsWe recruited adult patients with a clinical diagnosis of tendonitis of the rotator cuff. Informed consent was obtained. The patients were more than 18 years of age and had had pain in the shoulder for at least three months with clinical signs of a unilateral tendonitis of the rotator cuff. These included a painful arc and/or an impingement sign and pain, without weakness on resisted testing of one or more musculotendinous units of the rotator cuff. Exclusion criteria were demonstrable shoulder pathology including glenohumeral or acromioclavicular arthritis, instability, polyarthritis, neck pain, a local dermatological condition, n...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Extracorporeal shock-wave therapy for tendonitis of the rotator cuff

Speed

Richards

Nichols

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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“…Manganotti et al [8] demonstrated a long-term eVect of shock wave therapy on patients aVected by stroke. Russo et al [9] saw a stimulation of micro-vascularization after shock wave treatment. CPPS [10], angina pectoris and wound healing [11] are promising new Welds of shock wave application.…”

Section: Introductionmentioning

confidence: 99%

A neural model for chronic pain and pain relief by extracorporeal shock wave treatment

Wess

2008

Urol Res

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The paper develops a new theory of chronic pain and pain relief by extracorporeal shock wave treatment. Chronic pain without underlying anatomical disorder is looked at as a pathological control function of memory. Conditioned reXexes are considered to be engraved memory traces linking sensory input of aVerent signals with motor response of eVerent signals. This feature can be described by associative memory functions of the nervous system. Some conditioned reXexes may cause inappropriate or pathological reactions. Consequently, a circulus vitiosus of pain sensation and muscle and/or vessel contraction is generated when pain becomes chronic (pain spiral). The key feature is a dedicated engram responsible for a pathological (painful) reaction. The pain memory may be explained by the concept of a holographic memory model published by several authors. According to this model it is shown how nervous systems may generate and recall memory contents. The paper shows how extracorporeal shock wave treatment may reorganize pathologic memory traces, thus giving cause to real and permanent pain relief. In a generalized manner, the idea of associative memory functions may help in the understanding of conditioning as a learning process and explain extracorporeal shock wave application as an eYcient treatment concept for chronic pain. This concept may open the door for new treatment approaches to chronic pain and several other disorders of the nervous system.

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“…These are often believed to relieve various soft tissue problems, also epicondyloses [9]. Waves of different energy are sometimes used for degenerative and inflammatory conditions of tendineous insertions [2,[9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Extacorporeal shock wave therapy unsuccessful for chronic medial epicondylitis

Grala

Dadej²

2007

J Orthopaed Traumatol

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Medial epicondylitis is a chronic noninflammatory condition resulting from mechanical injury. Despite many treatment options, including rest, medications, physiotherapy and operative interventions, the results are too often poor; thus new treatment options are sought. We treated 4 men with chronic epicondylitis (5 affected joints) with extracorporeal shock wave therapy after failed attempts of other treatments. The patients' complaints were graded with the Nirschl scoring system prior to and six months after therapy. The treatment consisted of three sessions, at 20-day intervals, of 3000 pulses of ultrasonic shock waves from a Piezolith 3000 unit (energy dosage was gradually increased to reach step 10 equaling 0.9 mJ/mm 2 ). At the 6-month follow-up, no patient was pain free. Three cases had slightly lower Nirschl scores than prior to the procedure but the patients rated this difference as insignificant; two cases were unchanged. No complications were observed but all patients rated the procedure as very unpleasant. The well recognized biologic effects of ultrasonographic waves (heat generation, oscillations, cavitation, etc.) that result in functional and structural changes of cellular membranes with sonochemical reactions (acceleration of normal metabolism, oxygenation and reduction in water solutions, polymer degradation, etc.), even if present in our cases, did not result in a noticeable decrease of symptoms, even though we used high energy and more impulses per session. Significant variations in methodology make inconclusive the results of numerous reports on the use of extracorporeal shock waves in epicondylar degenerative problems, although ineffectiveness of such therapy is the conclusion of a review by Haake and colleagues.

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Results with Extracorpeal Shock Wave Therapy in Bone and Soft Tissue Pathologies

Cited by 10 publications

References 9 publications

Extracorporeal shock-wave therapy for tendonitis of the rotator cuff

Extracorporeal shock-wave therapy for tendonitis of the rotator cuff

A neural model for chronic pain and pain relief by extracorporeal shock wave treatment

Extacorporeal shock wave therapy unsuccessful for chronic medial epicondylitis

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