Extracorporeal shockwave therapy
|Extracorporeal shockwave therapy|
The most common use of extracorporeal shockwave therapy (ESWT) is for lithotripsy to treat kidney stones (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver) using an acoustic pulse. It is also reported to be used for salivary stones and pancreatic stones.
In the UK, the National Institute for Health and Care Excellence (NICE) found that the evidence for ESWT in the majority of indications is conflicting, as such ESWT should only be used where there are special arrangements for clinical governance and audit. Two 2017 reviews had similar findings, with moderate level evidence at best.
Extracorporeal shockwave therapy is used as a second line measure to treat tennis elbow, shoulder rotator cuff pain, achilles tendinitis, plantar fasciitis, and greater trochanteric pain syndrome.
ESWT is used for wound healing and has shown positive results in short-term and long-term outcomes in diabetic patients suffering from foot ulcers. Randomised controlled trials into the use of ESWT for healing venous leg ulcers are needed as there is a lack of evidence in this area.
The lithotriptor attempts to break up the stone with minimal collateral damage by using an externally applied, focused, high-intensity acoustic pulse. The patient is usually sedated or anesthetized for the procedure in order to help them remain still and reduce possible discomfort. Sedation is not required in its application for soft tissue injuries.
Beginning in 1969 and funded by the German Ministry of Defense, Dornier began a study of the effects of shock waves on tissue. In 1972, on the basis of preliminary studies performed by Dornier Medical Systems, an agreement was reached with Egbert Schmiedt, director of the urologic clinic at the University of Munich. The development of the Dornier lithotripter progressed through several prototypes, ultimately culminating in February 1980 with the first treatment of a human by SWL.The production and distribution of the Dornier HM3 lithotripter began in late 1983, and SWL was approved by the U.S. Food and Drug Administration in 1984.
In the 1980s people using ESWT for kidney stones noticed that it appeared to increase bone density in nearby bones, leading them to explore it for orthopedic purposes.
As of 2018 use of ESWT had been studied as a potential treatment for chronic prostatitis/chronic pelvic pain syndrome in three small studies; there were short term improvements in symptoms and few adverse effects, but the medium term results are unknown, and the results are difficult to generalize due to low quality of the studies.
ESWT is used in physical therapy for pain reduction, increase in metabolism at the cellular level, revascularisation, and recovering normal muscle tone following various disorders. The use of ESWT was demonstrated in patients with frozen shoulders compared to therapeutic ultrasound with exercises.
Research suggests that ESWT can accelerate the blood flow, facilitating the healing of the inflamed Achilles tendon. In one study involving 23 patients with chronic plantar fasciitis, 20 reported improvement in their condition and pain scores after ESWT; three saw no change, and none reported any worsening.
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- Cooper, Ben; Bachoo, Paul (2018-06-11). "Extracorporeal shock wave therapy for the healing and management of venous leg ulcers". The Cochrane Database of Systematic Reviews. 2018 (6): CD011842. doi:10.1002/14651858.CD011842.pub2. ISSN 1469-493X. PMC 6513251. PMID 29889978.
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- Franco, Juan Va; Turk, Tarek; Jung, Jae Hung; Xiao, Yu-Tian; Iakhno, Stanislav; Garrote, Virginia; Vietto, Valeria (12 May 2018). "Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome". The Cochrane Database of Systematic Reviews. 5: CD012551. doi:10.1002/14651858.CD012551.pub3. ISSN 1469-493X. PMC 6494451. PMID 29757454.
- Gündüz, Rukiye; Malas, Fevziye Ünsal; Borman, Pınar; Kocaoğlu, Seher; Özçakar, Levent (2012-05-01). "Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis". Clinical Rheumatology. 31 (5): 807–812. doi:10.1007/s10067-012-1939-y. ISSN 1434-9949. PMID 22278162. S2CID 13109216.
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