• Dr. Timothy Mazzola

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

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



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, low-energy RADIAL shockwave treatment (like the EPAT

offered in our clinic) was supported for most treatment applications in this review. This should not be

confused with FOCUSED, high-energy shockwave, which has been linked to the rare, but unfortunate

adverse effects of osteonecrosis, bone fracture, and Achilles rupture.

At Breakthrough Regenerative Orthopedics, we are currently only using RADIAL shockwave and thus our

patients do NOT have to worry about the risks associated with FOCUSED shockwave.

For more significant injuries, we 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 EPAT 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


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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