Extracorporeal Shockwave Therapy
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History of extracorporeal shockwave therapy[edit | edit source]
Clinical use of ESWT was first introduced into practice in 1982 for urologic conditions [1]. The success of this technology for the treatment of urinary stones quickly made it a first-line, noninvasive, and effective method[2]. Subsequently, ESWT was studied in orthopedics where is was identified that ESWT could loosen the cement in total hip arthroplasty revisions[3]. Further, animal studies conducted in the 1980s revealed that ESWT could augment the bone-cement interface and also found an osteogenic response and improve fracture healing [4][5]. While benefits in fracture healing have been shown with ESWT the majority of orthopedic research has focused on upper and lower extremity tendinopathies, fasciopathies, and soft tissue conditions.
Physiology of ESWT[edit | edit source]
Shockwaves are sound waves that have specific physical characteristics, including nonlinearity, high peak pressure followed by low tensile amplitude, short rise time, and short duration (10 ms). They have a single pulse, a wide frequency range (0-20 MHz) and a high pressure amplitude (0-120 MPa)
These characteristics produce a positive and negative phase of shockwave. The positive phase produces direct mechanical forces, whereas the negative phase generates cavitation and gas bubbles that subsequently implode at high speeds, generating a second wave of shockwaves.[6]
In comparison to ultrasound waves, the shockwave peak pressure is approximately 1000 times greater than the peak pressure of an ultrasound wave.[7]
Clinical Guidelines[edit | edit source]
Extracorporeal shockwave therapy (ESWT) is primarily used in the treatment of common musculoskeletal conditions. These include both upper and lower extremity tendinopathies, greater trochanteric pain syndrome, medial tibial stress syndrome, patellar tendinopathy, plantar fasciopathy.
There is no standardized ESWT protocol for the treatment of musculoskeletal conditions.
Resources[edit | edit source]
References[edit | edit source]
- ↑ C. Chaussy, E. Schmiedt, D. Jocham, W. Brendel, B. Forssmann, V. Walther First clinical experience with extracorporeally induced destruction of kidney stones by shock waves J Urol, 127 (1982), pp. 417-420
- ↑ A.N. Argyropoulos, D.A. Tolley Optimizing shock wave lithotripsy in the 21st century Eur Urol, 52 (2007), pp. 344-352
- ↑ S.H. Park, J.B. Park, J.N. Weinstein, S. Loening Application of extracorporeal shock wave lithotripter (ECSWL) in orthopedics. I. Foundations and overview J Appl Biomater, 2 (1991), pp. 115-126
- ↑ J.N. Weinstein, D.M. Oster, J.B. Park, S.H. Park, S. Loening The effect of the extracorporeal shock wave lithotriptor on the bone-cement interface in dogs Clin Orthop Relat Res, 235 (1988), pp. 261-267
- ↑ G. Haupt, A. Haupt, A. Ekkernkamp, B. Gerety, M. Chvapil Influence of shock waves on fracture healing Urology, 39 (1992), pp. 529-532
- ↑ H. van der Worp, I. van den Akker-Scheek, H. van Schie, J. Zwerver ESWT for tendinopathy: Technology and clinical implications Knee Surg Sports Traumatol Arthrosc, 21 (2013), pp. 1451-1458
- ↑ C.J. Wang Extracorporeal shockwave therapy in musculoskeletal disorders J Orthop Surg Res, 7 (2012), p. 11
- ↑ Langmore Podiatry. Shockwave Therapy Demonstration. Available from: https://www.youtube.com/watch?v=P5dibaAu7pQ [last accessed 6/17/2018]
