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  • Dr. Timothy Mazzola

Shockwave Therapy for Orthopedic Injuries: Non-invasive, non-surgical treatment.

Updated: Dec 12, 2022

Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal

Conditions:


Summary:

Extracorporeal shock wave therapy can result in beneficial effects for treatment of numerous

refractory/chronic musculoskeletal conditions of tendons and fascia. This review outlines the numerous

studies that have reviewed outcomes for both upper and lower extremity pathology, including but not

limited to plantar fasciitis, Achilles tendonitis, patellar tendonitis, greater trochanteric pain syndrome,

lateral epicondylitis and rotator cuff tendinopathy. For patients who have failed to heal adequately with

conservative treatment options and are presented with surgery as the next choice, ESWT may be a

reasonable alternative.


Of the two forms of shockwave treatment, clinical studies on low-energy RADIAL shockwave treatment have shown essentially no negative effects. Rare individual cases of adverse effects of osteonecrosis, bone fracture, and Achilles rupture have occurred with FOCUSED, high-energy shockwave. We thus have employed the latest, most cautious approach to safely employ this VERY STRONG and POWERFUL treatment.


At Breakthrough Regenerative Orthopedics, we now use BOTH RADIAL and FOCUSED shockwave and treatments to optimize the outcomes of various conditions. RADIAL shockwave is particularly useful in the muscle and fascial systems, while FOCUSED shockwave has shown great healing capacity in tendons, ligaments, and even bone injuries.


For more significant injuries, we also have the ability to provide more aggressive treatments such as

Ultrasound guided Regenerative injections with Platelet Rich Plasma or Bone Marrow aspiration alone or

combined with RADIAL shockwave (EPAT).


Please see the abstracts below to two scientific studies of ESWT and follow the links to the full article if desired.



PM R 10 (2018) 1385-1403 www.pmrjournal.org


Narrative Review


Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: A Narrative Review

Julia M. Reilly, MD, Eric Bluman, MD, PhD, Adam S. Tenforde, MD


Abstract

Extracorporeal shockwave therapy (ESWT) is a technology that was first introduced into clinical practice in 1982 for urologic conditions. Subsequent clinical applications in musculoskeletal conditions have been described in treatment of plantar fasciopathy, both upper and lower extremity tendinopathies, greater trochanteric pain syndrome, medial tibial stress syndrome, management of nonunion fractures, and joint disease including avascular necrosis. The aim of this review is to summarize the current understanding of treatment of musculoskeletal conditions with ESWT, accounting for differences in treatment protocol and energy levels. Complications from ESWT are rare but include 2 reported cases of injury to bone and Achilles tendon rupture in older adults using focused shockwave. Collectively, studies suggest ESWT is generally well-tolerated treatment strategy for multiple musculoskeletal conditions commonly seen in clinical practice.

Level of Evidence: III


Follow this link for the full article to the above abstract: https://f.hubspotusercontent40.net/hubfs/4232994/FINAL_PM%26R%202018-Effect%20of%20Shockwave%20Treatment%20for%20Management%20of%20Upper%20and%20Lower%20Extremity%20Musculoskeletal%20Conditions%20(3).pdf





J Am Acad Orthop Surg 2006;14:195- 204 Copyright 2006 by the American Academy of Orthopaedic Surgeons.Volume 14, Number 4, April 2006


Perspectives on Modern Orthopaedics: Extracorporeal Shock Wave Therapy in the Treatment of Chronic Tendinopathies

Andrew Sems, MD, Robert Dimeff, MD, Joseph P. Iannotti, MD, PhD


Abstract Many clinical trials have evaluated the use of extracorporeal shock wave therapy for treating patients with chronic tendinosis of the supraspinatus, lateral epicondylitis, and plantar fasciitis. Although extracorporeal shock wave therapy has been reported to be effective in some trials, in others it was no more effective than placebo. The multiple variables associated with this therapy, such as the amount of energy delivered, the method of focusing the shock waves, frequency and timing of delivery, and whether or not anesthetics are used, makes comparing clinical trials difficult. Calcific tendinosis of the supraspinatus and plantar fasciitis have been successfully managed with extracorporeal shock wave therapy when nonsurgical management has failed. Results have been mixed in the management of lateral epicondylitis, however, and this therapy has not been effective in managing noncalcific tendinosis of the supraspinatus. Extracorporeal shock wave therapy has consistently been more effective with patient feedback, which enables directing the shock waves to the most painful area (clinical focusing), rather than with anatomic or image-guided focusing, which are used to direct the shock wave to an anatomic landmark or structure.


Follow this link for the full article of the above abstract: https://shockwavemd.files.wordpress.com/2013/04/extracorporeal-shock-wave.pdf






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