Saturday, September 27, 2008

Extracorporeal shockwave therapy (ESWT)

During the past decade application of extracorporal shock waves became an established procedure for the treatment of various musculoskeletal diseases in Germany. Extracorporeal shockwave therapy (ESWT) has been in use for the treatment of tendinopathies since the early 1990s.
Mechanism of working:
The exact mechanism by which ESWT relieves tendon-associated pain is not known; however, there is an increasing body of literature that suggests that it can be an effective therapy for patients who have had repeated non-surgical treatment failures.
Controversies surrounding ESWT:
There is still much debate over several issues surrounding ESWT that have not been adequately addressed by the literature: high- versus low-energy ESWT, shockwave dosage and number of sessions required for a therapeutic effect.
Further research is needed to ascertain the most beneficial protocol for patient care.
ESWT is employed in following conditions with high degree of success by physios even in fairly resistant cases.
According to a meta-analysis by Heller KD et al The advantages of ESWT are non-invasiveness and low rate of complications. Primary aim should be to evaluate adequate energy density levels and impulse rates for specific groups of indications using high quality studies according to evidence-based-medicine. Long term results need to be awaited to be able to compare ESWT with established methods. Recent inflationary use of ESWT especially in outpatient departments has no scientific indication in numerous cases as conservative methods are not used consequently.
However, ESWT is commonly used in following areas:
1. planter fascitis
2. common extensor tendinosis
3. insertional tendinopathy of achilles tendon.
4. Peyronie’s disease
5. supraspinatus tendonitis
6. patellar tendonitis
7. calcifying tendonitis of rotator cuff.
ESWT also has been experimentally used in
1. pseudoarthrosis
2. non-union
Possible complications and side effects using extracorporeal shock waves for orthopaedic diseases COULD BE AVOIDED if we know the side & adverse effects and contraindications.
Few cases may react to ESWT as follows:
1. Small superficial hematomas
2. Hyperventilations with blood pressure elevation over 200 mmHg (without other clinical symptoms & mostly transitory nature during therapy- abates within 3 hours of the therapy).
1. Application of shockwaves in the thoracic region or lung, coagulopathies or anticoagulant medicine, pregnancy and the use at nerval or vascular structures represent an absolute contraindication.
2. When using extracorporeal shock waves for bone lithotripsy, bone tumors, bone infection or infected pseudarthrosis and the application at growth plates in children and young adults represent an absolute contraindication.

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