Extracorporeal shockwave therapy
||It has been suggested that this article be merged with Extracorporeal pulse activation therapy. (Discuss) Proposed since March 2014.|
|Extracorporeal shockwave therapy|
Device for extracorporeal shockwave therapy
The medical value of extracorporeal shockwave therapy is disputed. A number of both favorable and unfavorable studies exist, some using deficient research practices. IHowever, the use of ESWT continues to expand across medical disciplines, such as cardiology, urology (erectile dysfunction), and wound applications. A 2013 meta-analysis of seven randomized controlled trials found extracorporeal shockwave therapy to be an effective treatment modality for plantar fasciitis pain which has been unresponsive to nonsurgical measures for at least three months with evidence suggesting significant pain relief for up to one year.
In those with calcific tendinitis of the shoulder high energy extracorporeal shock-wave therapy can be useful. A recently published 2015 randomised controlled trial (n=250) illustrates the clinically relevant effect size of focused extracorporeal shock wave therapy without local anesthesia in the treatment of recalcitrant plantar fasciitis, with success rates between 50% and 65%.
When ESWT was used for plantar fascia treatment, the procedure used to be performed in an out-patient setting, under local anesthesia, taking up to 30 minutes. Now with newer and more portable technology, it can be done without anesthesia in the physician's office in less than 10 minutes. There are a variety of ESWT devices, manufacturers include Storz Medical, Dornier and Richard Wolf. Recent developments in applicator technology has led to additional indications such as back pain and fascia treatment.
Research indicates that there is significant reduction in intensity of application pain with the use of castor oil rather than ultrasound jelly. The positive effect of castor oil can be explained by its cavitation-free quality. The patient is afterwards able to walk out, the major complaint being of a thumping feeling on the heel. Because re-inflammation is being introduced, the patient cannot take anti-inflammatory medication afterward, nor should the area be iced. Acetaminophen/Paracetamol with codeine may be utilized.
Contraindications for this procedure include: neurological and vascular disease of the foot; history of rupture of the plantar fascial ligament; open bone growth plates; pregnancy, implanted metal in the area (bone screws and pins); and people on medication that interferes with blood clotting such as coumadin and prophylactic aspirin.
There are several theories as to how ESWT may or may not help promote better healing. The most accepted one is that the microtrauma of the repeated shock wave to the affected area creates neo-vascularization (new blood flow) into the area. It is this new blood flow that promotes tissue healing. For treatment of heel pain, the FDA study criteria are quite specific. A person has to have experienced heel pain for at least six months and had at least three other types of treatments (cortisone injections, oral anti-inflammatory medication, orthotics, physical therapy, etc.) without relief.
The UK advisory body - National Institute for Health and Care Excellence (NICE) have issued guidance on ESWT to UK clinicians for a number of clinical indications - Calcific Tendinitis of the shoulder, refractory plantar fascitiis, refractory Achilles Tendinopathy, refractory tennis elbow and refractory greater trochanteric pain syndrome. NICE state ESWT raises no major safety concerns however the current 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. NICE guidance has led to the launch in 2012 of the Assessment of the Effectiveness of ESWT for Soft Tissue Injuries (ASSERT Protocol) . ASSERT facilitates the clinical governance and audit function of NICE's guidance for clinicians wishing to offer ESWT to patients.. Through the use of validated outcome score measurement tools ASSERT has facilitated access for patients to ESWT in the UK and has become globally one of the largest collections of data over a 2 year period. ASSERT 1 ceased actively recruiting patients in 2014 however the follow ups will continue into 2016 at which the data will be published. ASSERT 2 superseded the original ASSERT Protocol in May 2014 and continues to actively collect data of patients who have received ESWT.
ESWT is commonly used for treating orthopedic problems in horses, including tendon and ligament injuries, kissing spine, navicular syndrome, and arthritis. Because it can produce temporary analgesia, usually around 4 days, care must be taken not to push the horse too hard after treatment, since the animal may not guard the injury as well as they did previously. ESWT is often used in conjunction with rest and other therapies to help return the horse to soundness. Since the treatment is slightly uncomfortable, horses are sedated for treatments.
- http://eswt.net/equine Focus-It, LLC
- Extracorporeal Shockwave Therapy: Hope Or Hype? Podiatry Today
- Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP. (November 2013). "Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs". Clin Orthop Relat Resl 471 (11): 3645–52. doi:10.1007/s11999-013-3132-2. PMID 23813184.
- Bannuru, RR; Flavin, NE; Vaysbrot, E; Harvey, W; McAlindon, T (Apr 15, 2014). "High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review.". Annals of internal medicine 160 (8): 542–9. doi:10.7326/m13-1982. PMID 24733195.
- Gollwitzer, Hans; Saxena, Amol; DiDomenico, Lawrence A.; Galli, Louis; Bouché, Richard T.; Caminear, David S.; Fullem, Brian; Vester, Johannes C.; Horn, Carsten (2015-05-06). "Clinically Relevant Effectiveness of Focused Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis". J Bone Joint Surg Am 97 (9): 701–708. doi:10.2106/JBJS.M.01331. ISSN 0021-9355. PMID 25948515.