Antoni Morral. FCS Blanquerna. Ondas de choque: Efectos ... · FCS Blanquerna. Full thickness dorsal wounds in an impaired wound healing mouse model were treated daily (d 0-6) with

Antoni Morral Fernández Facultat de Ciències de la Salut Blanquerna. Universitat Ramon Llull. Barcelona. España.

Ondas de choque: Efectos biológicos

Antoni Morral. FCS Blanquerna.

La proliferación celular puede estimularse por:

1. Factores de crecimiento

2. Lesión (reacción inflamatoria)

3. Muerte celular

4. Deformación de los tejidos (mecanotransducción)


EFECTOS BIOLÓGICOS DE LAS

ONDAS DE CHOQUE

1. Regeneración tisular. 2. Angiogénesis. 3. Analgésia.


HUESO

SWT induces proliferation and differentiation of osteoblasts.

Hofmann A, Ritz U, Hessmann MH, Alini M, Rommens PM, Rompe JD. Extracorporeal shock wave-mediated changes in proliferation, differentiation, and gene expression of human osteoblasts. J Trauma. 2008 Dec;65(6):1402-10.


SW

Ctrl

1 wk 4 wk 8 wk

Shockwaves significantly increased bone formation than the control.

Van der Jagt OP, Piscaer TM, Schaden W, Weinans H. Unfocused extracorporeal shockwaves induce anabolic effects in rat bone.

J Bone Joint Surg Am. 2011 Jan 5;93(1):38-48.

HUESO Antoni Morral. FCS Blanquerna.

SWT heals post-operative nonunions in 70% within 6 months, and in

90% within 12 months. N= 126. 4 sesiones. No dif. Entre 3 grupos.

RCT. 3 groups 1.-0.40 mJ/mm2 2.- 0.70 mJ/mm2 . 3.-Surgery

HUESO

Cacchio A, Giordano L, Colafarina O, Rompe JD, Tavernese E, Ioppolo F, Flamini S, Spacca G, Santilli V. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg Am. 2009 Nov;91(11):2589-97.


“ESWT para el tratamiento de pseudoartrosis y retardos de consolidación de huesos largos, como terapia de 1ª elección” Kiel. Alemania. Junio 2011


Kearney CJ, Lee JY, Padera RF, Hsu HP, Spector M. Extracorporeal shock wave-induced proliferation of periosteal cells. J Orthop Res. 2011 Oct;29(10):1536-43. Baja energía en hueso: 0,15 mJ/mm2

Van der Jagt OP, Piscaer TM, Schaden W, Li J, Kops N, Jahr H, van der Linden JC, Waarsing JH, Verhaar JA, de Jong M, Weinans H. Unfocused extracorporeal Shock waves induce anabolic effects in rat bone. J Bone Joint Surg Am. 2011 Jan 5;93(1):38-48. Ondas de choque no focalizadas útiles también en hueso.

HUESO


We designed a randomized, prospective,

controlled study to compare two treatment

strategies in 30 patients with neuropathic

diabetic foot ulcers. One group was treated

with standard care and shock wave therapy.

The other group was treated with only

standard care.

After 20 weeks of treatment, 53.33% of the

SWT-treated patients had complete wound

closure compared with 33.33% of the control

patients, and the healing times were 60.8 and

82.2 days (p<0.001). Re-epithelization was

significantly accelerated in the SWT group (3

mm²/die vs. 1.3 mm²/die)

Moretti et al. 2009; BMC Musculoskelet

Disord 10:54.

• SWT accelerates wound healing by 30% compared to standard operating procedures.

PIEL Antoni Morral. FCS Blanquerna.

Larking AM, Duport S, Clinton M, Hardy M, Andrews K. Randomized control of extracorporeal shock wave therapy versus placebo for chronic decubitus ulceration. Clin Rehabil. 2010 Mar;24(3):222-9.


Ottomann C, Hartmann B, Maier H, Thiele R, Schaden W, Stojadinovic A. Prospective randomized trial of accelerated re-epithelization of skin graft donor sites using extracorporeal shock wave therapy. J Am Coll Surg. 2010 Sep;211(3):361-7.


Kamelger F, Oehlbauer M, Piza-Katzer H, Meirer R. Extracorporeal shock wave treatment in ischemic tissues: what is the appropriate number of shock wave impulses? J Reconstr Microsurg. 2010 Feb;26(2):117-21

•ESWT treatment with 200 impulses was found to be ineffective. •ESWT treatment of 5000 impulses resulted in a significant increase in the percentage of necrosis compared with other ESWT groups ( P < 0.05). •ESWT treatments between 500 and 2500 impulses at 0.11 mJ/mm2 enhanced epigastric skin flap survival significantly.


Qureshi AA, Ross KM, Ogawa R, Orgill DP. Shock Wave Therapy in Wound Healing. Plast Reconstr Surg. 2011 Aug 11. Review .

Una revisión (no sistemática )de los 10 últimos años. No complicaciones. Falta de consenso en los protocolos y en el tipo de heridas que pueden beneficiarse de la SW. Augura un buen futuro como coadyuvante. Futuros estudios son necesarios.


Ottomann C, Stojadinovic A, Lavin PT, Gannon FH, Heggeness MH, Thiele R, Schaden W, Hartmann B. Prospective Randomized Phase II Trial of Accelerated Reepithelialization of Superficial Second-Degree Burn Wounds Using Extracorporeal Shock Wave Therapy. Ann Surg. 2011 Aug 17.

Ensayo clínico fase II para justificar un ensayo clínico fase III. 100 impulses/cm2 at 0.1 mJ/mm2. No focalizado. 1 sola sesión. CONCLUSIONS: In this randomized phase II study, application of a single defocused shock wave treatment to the superficial second-degree burn wound after debridement/topical antiseptic therapy significantly accelerated epithelialization. This finding warrants confirmation in a larger phase III trial (ClinicalTrials.gov identifier: NCT01242423).


ANGIOGÉNESIS Antoni Morral. FCS Blanquerna.

Keil H, Mueller W, Herold-Mende C, Gebhard MM, Germann G, Engel H, Reichenberger MA. Preoperative shock wave treatment enhances ischemic tissue survival, blood flow and angiogenesis in a rat skin flap model. Int J Surg. 2011 Jan 21.

Reichenberger MA, Keil H, Mueller W, Herold-Mende C, Gebhard MM, Germann G, Engel H. Comparison of extracorporal shock wave pretreatment to classic surgical delay in a random pattern skin flap model. Plast Reconstr Surg. 2011 May;127(5):1830-7.

Mittermayr R, Hartinger J, Antonic V, Mein A, Schaden W Extracorporeal Shock Wave Therapy (ESWT) Minimizes Ischemic Tissue Necrosis Irrespective of Application Time and Promotes Tissue Revascularization by Stimulating Angiogenesis. Ann Surg. 2011 Mar 2.


Ito Y, Ito K, Shiroto T, Tsuburaya R, Yi GJ, Takeda M, Fukumoto Y, Yasuda S, Shimokawa H. Cardiac shock wave therapy ameliorates left ventricular remodeling after myocardial ischemia-reperfusion injury in pigs in vivo. Coron Artery Dis. 2010 Aug;21(5):304-11.


Kikuchi Y, Ito K, Ito Y, Shiroto T, Tsuburaya R, Aizawa K, Hao K, Fukumoto Y, Takahashi J, Takeda M, Nakayama M, Yasuda S, Kuriyama S, Tsuji I, Shimokawa H. Double-blind and placebo-controlled study of the effectiveness and safety of extracorporeal cardiac shock wave therapy for severe angina pectoris. Circ J. 2010 Mar;74(3):589-91.

“Extracorporeal cardiac SW therapy is an effective, safe and non-invasive therapeutic option for severe angina pectoris” N= 8 humans


Tao SM, Guo T, Wang Y, Cai HY, Yang C. [Extracorporeal cardiac shock wave therapy improved myocardial micro-vascular circulation after acute myocardial infarction at early stage in pigs]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2011 Mar;42(2):222-6. Chinese. En 25 cerdos domésticos. Artículo chino. No japonés Induce angiogenesis, up-regulate the expression of angiogenic factor, resulting in an improvement in micro-vascular circulation reconstruction of ischemic myocardial region.


Fu M, Sun CK, Lin YC, Wang CJ, Wu CJ, Ko SF, Chua S, Sheu JJ, Chiang CH, Shao PL, Leu S, Yip HK. Extracorporeal shock wave therapy reverses ischemia-related left ventricular dysfunction and remodeling: molecular-cellular and functional assessment. PLoS One. 2011;6(9):e24342. N=12 cerdos. 2 grupos. Valoración a 3 meses. 800 impulses at 0.09 mJ/mm2 Group SW: Higher vessel density. Lower mean fibrosis area. ECSW therapy effectively reversed ischemia-elicited LV dysfunction and remodeling through enhancing angiogenesis and attenuating inflammation and oxidative stress.


control isquemia

Isquemia +SW

Reduce la formación de fibrosis Antoni Morral. FCS Blanquerna.

Meglio FD, Nurzynska D, Castaldo C, Miraglia R, Romano V, De Angelis A, Piegari E, Russo S, Montagnani S. Cardiac shock wave therapy: assessment of safety and new insights into mechanisms of tissue regeneration. J Cell Mol Med. 2011 Jul 27. 344 rats . At all time points, the left ventricular ejection fraction and fractional shortening remained stable. Histological analysis revealed neither differences in the extracellular matrix collagen content nor the presence of fibrosis. In conclusion, non-invasive ECSW therapy is a safe and effective way of activating cardiac stem cells and myocardial regeneration.


TENDÓN

Berta L, Fazzari A, Ficco AM, Enrica PM, Catalano MG, Frairia R. Extracorporeal shock waves enhance normal fibroblast proliferation in vitro and activate mRNA expression for TGF-beta1 and for collagen types I and III. ActaOrthop. 2009 Oct;80(5):612-7.


Shock Waves for Tissue Repair.Wang . JBJS 87(11): 2380-7, Nov 2006

Kuo YR, Wang CT, Wang FS, Chiang YC, Wang CJ. Extracorporeal shock-wave therapy enhanced wound healing via increasing topical blood perfusion and tissue regeneration . Wound Repair Regen. Jul-Aug;17(4):522-30. 2009


Vetrano M, d'Alessandro F, Torrisi MR, Ferretti A, Vulpiani MC, Visco V. Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes. Knee Surg Sports Traumatol Arthrosc. 2011 May 27.


Combinar ESWT con PRP? Antoni Morral. FCS Blanquerna.

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Sin grupo control


CONCLUSION: Combined treatment with bone marrow-derived endothelial progenitor cells and extracorporeal shock wave is superior to either bone marrow-derived endothelial progenitor cells or extracorporeal shock wave alone in improving ischemia in rodent critical limb ischemia.

Yeh KH, Sheu JJ, Lin YC, Sun CK, Yip HK. Benefit of combined extracorporeal shock wave and bone marrow-derived endothelial progenitor cells in protection against critica limb ischemia in rats. Crit Care Med. 2011 Sep 15.


ESWT

& ANALGESIA


Neurogenic inflammation

Edvinsson L et al. Brain Res Rev. 2005;48:438–456; Goadsby PJ. Trends Mol Med. 2007;13:39–44; Levy D et al. Headache. 2006;46(suppl 1):S13–S16; Levy D et al. Pain. 2007;130:166–176; Longoni M et al. 2006;27(suppl 2):S107–S110; Moskowitz M. Neurology. 1993;43(suppl 3):S16-S20; Pietrobon D. Neuroscientist. 2005;11:373–386; Theoharides TC et al. Brain Res Rev. 2005;49:65–78.

Activated nociceptors release CGRP and substance P

NO also released

Leads to

– Vasodilation CGRP, NO, substance P

– Mast cell degranulation CGRP, substance P

– Plasma extravasation substance P

CGRP receptor

Substance P receptor

Nociceptor

CGRP Substance P NO

Mast Cell

CGRP receptor

Blood vessel

Fibras C


PORQUE ES IMPORTANTE?

Sensory neurons not only conduct afferent information to the spinal cord, but also subserve

an efferent function. Abundant evidence has accumulated supporting the notion that

activation of peripheral terminals of sensory neurons by local depolarization, axonal reflexes,

or dorsal root reflexes releases bioactive substances.

These substances, in turn, act on target cells in the periphery such as mast cells, immune

cells, and vascular smooth muscle producing inflammation, which is characterized by

redness (=flare) and warmth (secondary to vasodilation), swelling (secondary to plasma

extravasation), and hypersensitivity (secondary to alterations in the excitability of certain

sensory neurons).

We call this phenomenon “neurogenic inflammation”, that is, inflammatory symptoms that

result from the release of substances from primary sensory nerve terminals.

Richardson et al. 2002; J Pharmacol Exp Ther 302:839


Full thickness dorsal wounds in an impaired wound healing mouse model were treated daily (d

0-6) with topical SP or normal saline (NaCl). Wounds were analyzed by flow cytometry for

macrophage, leukocyte, endothelial, and dendritic cells. Healing time and wound

epithelialization were compared using analysis of variance.

SP treatment enhanced wound closure. SP increased macrophage, leukocyte, and dendritic cell

densities at d 3 and d 7 (P < 0.05). SP increased endothelial cell number

Substance P ameliorated wound healing response in an impaired wound healing model by

enhancing wound closure kinetics and epithelialization. SP increased inflammatory cell

density in the wounds supporting the essential role of inflammatory cells, especially

macrophages, in wound repair.

Muangman et al. 2009; J Surg Res, epub ahead of print

Healing after mobilization versus immobilization was assessed in a model of rat Achilles

tendon rupture.

Histological analysis confirmed a higher regenerating activity in the mobilized group, with an

increased amount of blood vessels, fibroblasts, and new collagen. The expression of sensory

neuropeptide receptors (substance P and CGRP) in the mobilized group exhibited a

significant increase from 8 to 17 days postinjury, whereas the immobilized group at 17 days

exhibited levels comparable to the intact tendon values.

Therefore, mobilization postrupture appears to boost tendon healing, a process which may

prove to be directly linked to an upregulated peripheral sensitivity to sensory

neuropeptide stimulation.

Bring et al. 2009; J Orthop Res 27:274

PORQUE ES IMPORTANTE?


Klonschinski T, Ament SJ, Schlereth T, Rompe JD, Birklein F. Application of Local Anesthesia Inhibits Effects of Low-Energy Extracorporeal Shock Wave Treatment (ESWT) on Nociceptors. Pain Med. 2011 Sep 14.


Labek G, Auersperg V, Ziernhöld M, Poulios N, Böhler N. [Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis]. Z Orthop Ihre Grenzgeb. 2005 Mar-Apr;143(2):240-6. German. N=60 Rompe JD, Meurer A, Nafe B, Hofmann A, Gerdesmeyer L. Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis. J Orthop Res. 2005 Jul;23(4):931-41. N=86

ANESTESIA Y RESULTADOS CLÍNICOS


To evaluate the effect of local anesthesia on the clinical outcome after repetitive low-energy

SWT for chronic plantar fasciitis, 86 patients were randomly assigned to receive either low-

energy SWT (2000 SW x 0.09 mJ/mm², three times, weekly intervals) without local

anesthesia (Group I) or identical SWT with local anesthesia (Group II).

No difference was found between the groups at baseline. At 3 months, the average pain score

was 2.2 points for patients of Group I, and 4.1 points for patients of Group II. Significantly

more patients of Group I achieved 50% reduction of pain compared to Group II (67% vs.

29%). ESWT as applied should be done without LA in patients suffering from chronic heel

pain. LA applied prior treatment reduced the efficiency of low-energy ESWT.

Rompe et al. 2005; J Orthop Res 23:931

ANESTESIA Y RESULTADOS CLÍNICOS


NO !!!!! Aplicar anestesia local

antes de SWT

(baja energía )


ESWT and selective nerve destruction Antoni Morral. FCS Blanquerna.

Cochrane library

Physiotherapy Evidence Database


Clasificación de la evidencia científica.

I. Adecuada: Meta-análisis de ensayos controlados y aleatorizados

II. Adecuada: Ensayo controlado y aleatorizado de muestra grande

III. Buena a regular: Ensayo controlado y aleatorizado de muestra pequeña

IV. Buena a regular: Ensayo prospectivo controlado no aleatorizado

V. Regular: Ensayos clínicos no aleatorizados

VI. Regular: Estudio de cohortes Multicéntrico. Apareamiento.

VII. Regular: Estudio de casos y controles Multicéntrico.

VIII. Pobre: Series clínicas sin grupo control. Estudios descriptivos

IX. Pobre: Anécdotas o casos clínicos

Jovell AJ, Navarro- Rubio MD.

Evaluación de la evidencia científica. Med Clin (Barc) 1995; 105: 740-743.


3 revisiones sistemáticas sobre ESWT HOMBRO


Huisstede BM, Gebremariam L, van der Sande R, Hay EM, Koes BW.

Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT)

to treat calcific and non-calcific rotator cuff tendinosis - A systematic review.

Man Ther. 2011 Mar 9.

17 RCTs (11 calcific, 6 non-calcific)

No evidence for non-calcific.


Lee SY, Cheng B, Grimmer-Somers K. The midterm effectiveness of extracorporeal shockwave therapy in the management of chronic calcific shoulder. A systematic review. tendinitis. J Shoulder Elbow Surg. 2011 Jan 11.

There was consistent evidence of midterm effectiveness of ESWT in reducing pain and improving shoulder function for patients with chronic calcified tendinitis. ESWT is a potential alternative to surgery with minimal side effects. 9 RCTs


Storheim K, Gjersing L, Bølstad K, Risberg MA.

[Extracorporeal shock wavetherapy (ESWT) and radial extracorporeal

shock wave therapy (rESWT) in chronic musculoskeletal pain].

Tidsskr Nor Laegeforen. 2010 Dec 2;130(23):2360-4.

Systematic Review. Norwegian.

N= 49 RCT. ESWT-Focal: only had a positive effect in chronic rotator cuff

syndrome with calcium deposits and was not effective in the absence of calcium

deposits and chronic lateral epicondylitis

N= 5 RCT. rESWT-Radial: Positive results in chronic rotator cuff

syndrome with calcium deposits and chronic lateral epicondylitis


CONCLUSION: The RSWT is safe and effective and must be considered as possible therapy for the treatment of patients with tennis elbow.

Spacca G, Necozione S, Cacchio A. Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study. Eura Medicophys. 2005 Mar;41(1):17-25.


CONCLUSION: Our study found little evidence to support the use of ESWT for the treatment of lateral epicondylitis

Staples MP, Forbes A, Ptasznik R, Gordon J, Buchbinder R. A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). J Rheumatol. 2008 Oct;35(10):2038-46.


Corticosteroid injection provided a high success rate in the short term. Autologous blood injection and extracorporeal shock wave therapy gave better long-term results. (52 weeks)

Ozturan KE, Yucel I, Cakici H, Guven M, Sungur I. Autologous blood and corticosteroid injection and extracoporeal shock wave therapy in the treatment of lateral epicondylitis. Orthopedics. 2010 Feb;33(2):84-91.


Engebretsen K, Grotle M, Bautz-Holter E, Sandvik L, Brox JI. Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study. BMJ. 2009 Sep 15;339

Supervised exercises were more effective than rESWT for short term (18 weeks) improvement in patients with subacromial shoulder pain.(+3m.)

N=104


N=104

Engebretsen K, Grotle M, Bautz-Holter E, Ekeberg OM, Juel NG, Brox JI. Supervised exercises compared with radial extracorporeal shock-wave therapy for subacromial shoulder pain: 1-year results of a single-blind randomized controlled trial. Phys Ther. 2011 Jan;91(1):37-47.

CONCLUSION: No significant difference was found between the SE and rESWT groups at the 1-year follow-up. More participants in the SE group had returned to work.


1 revisión sistemática sobre ESWT FASCIOPATÍA PLANTAR


Storheim K, Gjersing L, Bølstad K, Risberg MA. [Extracorporeal shock wave therapy (ESWT) and radial extracorporeal shock wave therapy (rESWT) in chronic musculoskeletal pain]. Tidsskr Nor Laegeforen. 2010 Dec 2;130(23):2360-4. Review. Norwegian.

“The effect in chronic plantar fasciitis was variable” 10 RCT Focal 2 RCT Radial


Crawford F, Thomson CE. WITHDRAWN. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD000416.

WITHDRAWN Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;(3):CD000416. Review. Update in: Cochrane Database Syst Rev. 2010;(1):CD000416.


Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L,Gollwitzer H.

Radial extracorporeal shock wave therapy is safe and effective in the treatment

of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized

placebo-controlled multicenter study. Am J Sports Med. 2008 Nov;36(11):2100-9.


2 revisiones sistemáticas sobre ESWT TENDINOPATÍA AQUÍLEA


Tendinopatía aquílea (inserción)

1 Revisión sistemática.

Kearney R, Costa ML. Insertional achilles tendinopathy management: a systematic review. Foot Ankle Int. 2010 Aug;31(8):689-94.

CONCLUSION: There is a consensus that conservative methods should be used before operative interventions. Current evidence for conservative treatment favors eccentric loading and shock wave therapy, although there is limited evidence by which to judge their effectiveness


Tendinopatía aquílea (cuerpo) 1 Revisión sistemática.

Magnussen RA, Dunn WR, Thomson AB. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med. 2009 Jan;19(1):54-64.

Eccentric exercises have the most evidence of effectiveness in treatment of midportion Achilles tendinopathy. More investigation is needed into the utility of ESWT


Rompe JD, Nafe B, Furia JP and Maffulli N.

Eccentric loading, shock-wave treatment, or a wait and-see policy for tendinopathy of the main body of tendon Achilles: a randomized controlled trial.American Journal of Sports Medicine 2007. 35: 374-383.


Rompe JD, Furia J, Maffulli N,

Eccentric Loading Compared with Shock Wave Treatment for Chronic Insertional Achilles Tendinopathy. A Randomized, Controlled Trial J Bone Joint Surg Am. 2008;90:52-61.


Rompe JD, Furia JP and Maffulli N.

Eccentric loading versus eccentric loading plus shock wave treatment for midportion achilles tendinopathy: a randomized controlled trial.

Am J Sports Med. 2009 Mar;37(3):463-70.


Rees JD, Maffulli N, Cook J. Management of tendinopathy. Am J Sports Med. 2009 Sep;37(9):1855-67


Moen MH, Rayer S, Schipper M, Schmikli S, Weir A, Tol JL, Backx FJ.

Shockwave treatment for medial tibial stress syndrome in athletes;

a prospective controlled study. Br J Sports Med. 2011 Mar 9.

Rompe JD, Cacchio A, Furia JP, Maffulli N. Low-energy extracorporeal shock

wave therapy as a treatment for medial tibial stress syndrome. Am J Sports Med.

2010 Jan;38(1):125-32.


Cacchio A, Rompe JD, Furia JP, Susi P, Santilli V, De Paulis F. Shockwave

therapy for the treatment of chronic proximal hamstring tendinopathy in

professional athletes. Am J Sports Med. 2011 Jan;39(1):146-53.


Wang CJ, Ko JY, Chan YS, Weng LH, Hsu SL. Extracorporeal shockwave for chronic patellar tendinopathy. Am J Sports Med. 2007 Jun;35(6):972-8. RCT

CONCLUSION: Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.


SW as a solitary treatment during the competitive season has no benefit over

placebo treatment in the management of actively competing jumping athletes with

patellar tendinopathy who have symptoms for less than 12 months.

Zwerver J, Hartgens F, Verhagen E, van der Worp H, Diercks RL.

No Effect of Extracorporeal Shockwave Therapy on Patellar

Tendinopathy in Jumping Athletes During the Competitive Season: A Randomized

Clinical Trial. Am J Sports Med. 2011 Feb 1.



0

1

2

3

4

5

6

7

8

9

10

0 1 Mo 4 Mo 15 Mo

Home Tr.

Corticoid Inj.

Shock Wave

6.2 5.8

N.S.

6.3

N.S.

N.S.

from baseline

5.9 5.6

2.2

4.5

5.3 5.2

3.2

2.7 2.4

N.S.

<.001.

<.001

N.S.

<.01.

<.001

<.001

<.001. N.S.

PA

IN R

AT

ING

Main Outcome Measure

Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. 2009 Oct;37(10):1981-90.


Complicaciones

• Liu HM et al. Humeral head osteonecrosis after ESWT for the treatment for rotator cuff tendinopathy. A case report. J Bone Joint Surg Am. 2006 Jun 88 (6): 1353-6

• Durst et al. Osteonecrosis of the humeral head after ESWT. J Bone Joint Surg Am. 2002 Jul; 84 (5): 744-6


Haake M, Böddeker IR, Decker T, Buch M, Vogel M, Labek G, Maier M, Loew M, Gerdesmeyer L, Rompe JD. Side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of tennis elbow. Arch Orthop Trauma Surg. 2002 May;122(4):222-8.

Most frequently, transitory reddening of the skin (21.1%), pain (4.8%) and small haematomas (3.0%) were found. Migraine was registered in four and syncopes in three instances after ESWT. ESWT for LE with an energy flux density of ED(+) 0.04 to 0.22 mJ/mm(2) is a treatment method which has very few side-effects.


Malay DS, Pressman MM, Assili A, et al. Extracorporeal Shockwave Therapy Versus Placebo for the Treatment of Chronic Proximal Plantar Fasciitis: Results of a Randomized, Placebo-Controlled, Double-Blinded, Multicenter Intervention Trial. J Foot Ankle Surg 2006;45:196–210.

Adverse effects included skin reddening, pain and local swelling, sleep disturbance, haematoma, nausea, and No serious adverse effects reported


Medicus curat, natura sanat The physician treats, nature cures

Honestidad: ESWT 2ª línea

Paciencia: 3-4 meses


[email protected]

Moltes gràcies!!


Documents

Antoni Morral. FCS Blanquerna. Ondas de choque: Efectos ... · FCS Blanquerna. Full thickness dorsal wounds in an impaired wound healing mouse model were treated daily (d 0-6) with