Extracorporeal shockwave therapy (ESWT) is a non-invasive, out-patient alternative to surgery for those with many joint and tendon disorders. ESWT sends acoustic shock waves into bone or soft tissue, in effect reinjuring the area on a cellular level and breaking up the scarring that has penetrated tendons and ligaments. The controlled reinjuring of tissue allows the body to regenerate blood vessels and bone cells. The resulting revascularization leads to faster healing and often a return to pre-injury activity levels. It is a treatment using powerful acoustic pulses which is mostly used to treat kidney stones and in physical therapy and

orthopedics Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

Medical uses

The most common use of extracorporeal shockwave therapy (ESWT) is for

lithotripsy Lithotripsy is a non-invasive procedure involving the physical destruction of hardened masses like kidney stones, bezoars or gallstones. The term is derived from the Greek words meaning "breaking (or pulverizing) stones" ( litho- + τρίψω r ...

to treat

kidney stone Kidney stone disease, also known as nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material (kidney stone) develops in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine s ...

s (urinary calculosis) and biliary calculi (stones in the

gallbladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although ...

or in the

liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it ...

) 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 Plantar fasciitis or plantar heel pain (PHP) is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the fi ...

, and greater trochanteric pain syndrome. ESWT is also used to promote bone healing and treat bone necrosis. It is an effective alternative to surgical treatment of non-healing fractures. ESWT is used for wound healing and has shown positive results in short-term and long-term outcomes in diabetic patients with 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.

Procedure

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 Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), am ...

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.

History

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.

Research

In response to concerns raised by

NICE Nice ( , ; Niçard dialect, Niçard: , classical norm, or , nonstandard, ; it, Nizza ; lij, Nissa; grc, Νίκαια; la, Nicaea) is the prefecture of the Alpes-Maritimes departments of France, department in France. The Nice urban unit, agg ...

, in 2012 a study called the Assessment of the Effectiveness of ESWT for Soft Tissue Injuries was launched (ASSERT). As of 2018 use of ESWT had been studied as a potential treatment for

chronic prostatitis/chronic pelvic pain syndrome Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), previously known as chronic nonbacterial prostatitis, is long-term pelvic pain and lower urinary tract symptoms (LUTS) without evidence of a bacterial infection. It affects about 2–6% ...

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.

Veterinary use

ESWT is commonly used for treating orthopedic problems in horses, including tendon and ligament injuries,

kissing spine Baastrup's sign is an orthopedic and radiographic disorder that often occurs in elderly humans. It is characterized by enlargement of the posterior spinous processes of the lumbar spine, with normal intervertebral disc height and neuroforamina. T ...

navicular syndrome Navicular syndrome, often called navicular disease, is a syndrome of lameness problems in horses. It most commonly describes an inflammation or degeneration of the navicular bone and its surrounding tissues, usually on the front feet. It can lead t ...

, and arthritis. The evidence for these uses is weak.

Physiotherapy use

ESWT is used in physical therapy for pain reduction, increase in metabolism at the cellular level, re

vascularisation Angiogenesis is the physiological process through which new blood vessels form from pre-existing vessels, formed in the earlier stage of vasculogenesis. Angiogenesis continues the growth of the circulatory system, vasculature by processes of spr ...

, 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 achilles tendinopathy, 20 reported improvement in their condition and pain scores after ESWT; three saw no change, and none reported any worsening.

References

{{DEFAULTSORT:Extracorporeal Shockwave Therapy Medical treatments