Extracorporeal shockwave therapy (ESWT) is a treatment using powerful acoustic pulses which is mostly used to treat kidney stones and in

physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...

and

orthopedics Orthopedic surgery or orthopedics (American and British English spelling differences, alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgic ...

Medical uses

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

kidney stones Kidney stone disease (known as nephrolithiasis, renal calculus disease, or urolithiasis) is a crystallopathy and occurs when there are too many minerals in the urine and not enough liquid or hydration. This imbalance causes tiny pieces of cr ...

(urinary calculosis) and biliary calculi (stones in the

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

or in the

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

) 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, and therefore 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 Tennis elbow, also known as lateral epicondylitis is an enthesopathy (attachment point disease) of the origin of the extensor carpi radialis brevis on the lateral epicondyle. It causes pain and tenderness over the bony part of the lateral epi ...

, shoulder rotator cuff pain,

Achilles tendinitis Achilles tendinitis, also known as Achilles tendinopathy, is soreness of the Achilles tendon. It is accompanied by alterations in the tendon's structure and mechanical properties. The most common symptoms are pain and swelling around the back of ...

plantar fasciitis Plantar fasciitis or plantar heel pain is a disorder of the plantar fascia, which is the connective tissue that supports the Arches of the foot, arch of the foot. It results in pain in the heel and Sole (foot), bottom of the foot that is usuall ...

, 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. Low-intensity extracorporeal shock wave therapy (LI-ESWT) has been used as a treatment for

erectile dysfunction Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a Human penis, penile erection with sufficient rigidity and durat ...

. It differs from

palliative Palliative care (from Latin root "to cloak") is an interdisciplinary medical care-giving approach aimed at optimizing quality of life and mitigating or reducing suffering among people with serious, complex, and often terminal illnesses. Man ...

options by aiming to restore natural erectile function by inducing cellular microtrauma, triggering the release of

angiogenic 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 vasculature mainly by processes of sprouting and s ...

factors and promoting

neovascularization Neovascularization is the natural formation of new blood vessels ('' neo-'' + ''vascular'' + '' -ization''), usually in the form of functional microvascular networks, capable of perfusion by red blood cells, that form to serve as collateral circu ...

in treated tissue. This mechanism is distinct from the high-intensity shock waves used in lithotripsy and medium-intensity shock waves used for anti-inflammatory purposes in orthopedics. Clinical studies, including double-blind randomized trials, have demonstrated LI-ESWT's ability to significantly improve erectile function and penile

hemodynamics Hemodynamics or haemodynamics are the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms of autoregulation, just as hydraulic circuits are controlled by control systems. The hemodynamic response continuously ...

in men with vasculogenic ED.

Procedure

The lithotripter 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.

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 shockwave lithotripsy (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 ( ; ) is a city in and the prefecture of the Alpes-Maritimes department in France. The Nice agglomeration extends far beyond the administrative city limits, with a population of nearly one million 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 the low quality of the studies.

Veterinary use

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

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 ...

, 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, 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 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