Photobiomodulation and Clinical Applications
Abstract | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 24 | Josep Pous
DOI: 10.13107/jrs.2022.v02.i02.61
Author: Josep Pous [1]
[1] Medical Director, CEMATEC ( Centros de Medicina Avanzada y Tecnológica), Barcelona, Spain
Address of Correspondence
Dr. Josep Pous, (Md&PhD) Medical Director CEMATEC ( Centros de Medicina Avanzada y Tecnológica),
Barcelona, Spain Spain.
E-mail: jpous@cematec.org
Abstract
There are different denominations in the literature such as low level laser therapy (LLLT), low level light therapy (LLLT), low intensity light therapy, and high power laser, but now we must accept a scientific term “Photobiomodulation.” Membranes cells have receptors such as integrins, growth factors that cause changes in the cytoskeleton and also in the nucleus. Chromophores, such as hemoglobin and water, are photon receptors but at the level of the mitochondria the main acceptors are the cytochromes, as in photosynthesis they are the chloroplasts. The absorption of photons, eminently in cytochrome C, activates the oxidation-reduction mechanisms and the production of cellular energy as Adenosine-Triphosphate (ATP). Through mediators (AMPc, ROS, and Protein kinase) they cause changes in the nucleus, increasing cell mobility and protein synthesis, responsible for cell regeneration. The biological response to the oxidation-reduction mechanism with the release of nitric oxide and the increase in energy (ATP) is responsible for the improvement of pain and inflammation. The regenerative response to mediating cellular signals increases the organization of collagen in the vertebral discs, reduces acute inflammation (TNF alpha), improves traumatized muscle (TN kappa B), and induces osteoblast differentiation. The current musculoskeletal indications are discopathy, synovitis, arthritis, traumatized muscle, and others. Research is ongoing on the application in brain trauma, stroke, neurodegenerative diseases, anxiety, and autoimmune inflammatory processes.
| How to Cite this article: Pous J | Photobiomodulation and Clinicals Applications. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 24. |
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Tibial Stress Syndrome in Sport
Abstract | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 25 | Santiago Gómez García
DOI: 10.13107/jrs.2022.v02.i02.63
Author: Santiago Gómez García [1]
[1] Orthopaedic Surgeon and Sports Medicine Physician, Unidad Médica del Instituto Nacional de la Seguridad Social.
Dirección Provincial. A Coruña, Spain.
Address of Correspondence
Dr. Santiago Gómez García, MD
Orthopaedic Surgeon and Sports Medicine Physician, A Coruña, Spain.
E-mail: sancubacfg@yahoo.es
Abstract
Medial tibial stress syndrome (MTSS), also known as shin splints or tibial periostitis, is characterized by pain in the middle and lower end of the tibia; the pain is usually elicited by practicing sports or other physical activities. It is a common cause of leg pain in athletes and militaries. Prolonged military marching and physical activity involving excess training of the lower limbs contribute to the stress reaction of the bone, as confirmed by imaging studies. This condition has been considered a precursor stage for stress fracture.
The criteria for diagnosis of MTSS were established by Yates and White.
Although the prognosis of MTSS is usually benign, it can evolve to chronicity and be disabling.
Optimal treatment for MTSS has yet to be established.
Extracorporeal shockwave treatment (ESWT) is a tool aimed at alleviating symptoms and shortening recovery time in MTSS. Three studies have shown ESWT combined with a specific exercise program to be effective for MTSS. Regarding the recovery time, one study showed that the ESWT group recovered in 59 days while the control group did so in 91 days, another study obtained results compatible with scores 1 and 2 on the Likert scale in 76%. of the patients in the ESWT versus 37% of the control group. A third study showed 82.6% excellent or good results in the ESWT group as opposed to 36.8% in the control group to the Roles and Maudsley scale. In addition, the literature has pointed out the efficacy of 1-3 ESWT sessions in this pathology.
| How to Cite this article: García SG | Tibial Stress Syndrome in Sport. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 25. |
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Treatment of Spasticity in Patients with Brain Damage with the Association of Focused Shock Waves and Botulinum Toxin
Abstract | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 26 | Antonio Déniz Cáceres, Pedro Saavedra Santana, María Isabel Marrero Arencibia, Jaime Hernández Alemán ,Almudena Hernández
DOI: 10.13107/jrs.2022.v02.i02.65
Author: Antonio Déniz Cáceres [1], Pedro Saavedra Santana [2], María Isabel Marrero Arencibia [3], Jaime Hernández Alemán [4], Almudena Hernández [4]
[1] Rehabilitation Service, Hospital Universitario de Gran Canaria Dr. Negrín, Spain.
[2] Department of Mathematics, Universidad de Las Palmas de Gran Canaria, Spain.
[3] Department of Biochemestry and Molecular Biology, Universidad de Las Palmas de Gran Canaria, Spain.
[4] Universidad de Las Palmas de Gran Canaria, Spain.
Address of Correspondence
Dr. Antonio Déniz Cáceres, MD, PhD,
Rehabilitation Service, Hospital Universitario de Gran Canaria Dr. Negrín, Spain.
E-mail: antonio.deniz@ulpgc.es
Abstract
Introduction: Spasticity is a common complication in patients with brain damage secondary to stroke and multiple sclerosis, generating
disability and reducing the quality of life. In cases of muscles spasticity, we usually use Botulinum toxin injections (BTI) associated with
physiotherapy. Extracorporeal shock wave therapy (ESWT) is a safe, effective, and non-invasive treatment in these patients. Both methods are highly effective but currently are applied separately. Scientific evidence of the combined use of both techniques is scarce. The aim of this study is to assess the results of the association of both treatments (ESWT and BTI). On spasticity in patients secondary to stroke or multiple sclerosis.
Materials and Methods: This is a prospective study, with 6-month follow-up, including 10 adult patients with stroke or multiple sclerosis. ESWT was added to the usual treatment with BTI weekly for 3 weeks. The patients received rehabilitation during the treatment period and during the follow-up period. For statistical analysis in each of the follow-up weeks, the markers analyzed (spasticity and gait speed) were summarized in medians, which were plotted as a weekly function and the paired data were compared with the Wilcoxon test. The data were analyzed with an statistical program version 3.6.1 (R Development Core Team, 2019).
Results and Conclusions: We observed a statistically significant improvement in spasticity that was correlated with an increase in walking speed. The effectiveness of the combined treatment was superior and lasted longer than BTI alone.
Keywords: Shockwaves, Spasticity, Brain damage, Botulinum Toxin
| How to Cite this article: Deniz A, Saavedra P, Marrero I, Hernández J, Hernández A | Treatment of Spasticity in Patients with Brain Damage with the Association of Focused Shock Waves and Botulinum Toxin. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 26. |
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2022 Chinese Expert Consensus Statement on the Management of Extracorporeal Shockwave Therapy in Musculoskeletal Disorders during Novel Coronavirus Pandemic Prevention and Control
Review Article | Volume 2 | Issue 1 | JRS Jan – Jun 2022 | Page 27-31 | Fuqiang Gao , Xiangwei Ma , Wei Sun , Zirong Li , Jike Lu
DOI: 10.13107/jrs.2022.v02.i01.41
Author: Fuqiang Gao [1,2], Xiangwei Ma [3], Wei Sun [1,4], Zirong Li [1,2], Jike Lu [5]
[1] Shockwave Center, Department of Orthopedics, China-Japan Friendship Hospital, Chaoyang, Beijing, China.
[2] Beijing Key Laboratory of Immune Inflammatory Disease, China-Japan Friendship Hospital, Chaoyang, Beijing, China.
[3] Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Chaoyang, Beijing, China.
[4] Department of Orthopaedic Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
[5] Department of Orthopedics, Beijing United Family Hospital, Chaoyang, Beijing, China.
Address of Correspondence
Dr. Wei Sun, Shockwave Centers,
Department of Orthopedics, China-Japan Friendship Hospital, Chaoyang, Beijing, China.
E-mail: sun887@163.com
Abstract
Novel coronavirus pneumonia (corona virus disease 2019, [COVID-19]) is a novel respiratory infectious disease that has rapidly spread in many countries or regions around the world [1, 2, 3] . With the approval of the State Council, COVID-19 was included in the category B infectious diseases under the Law of the People’s People’s Republic of China on the Prevention and Control of Infectious Diseases, and the preventive and control measures for category A infectious diseases were adopted. Given the severity of the COVID-19 epidemic, the wide spread of transmission, and the human-to-human transmission, some patients with musculoskeletal disorders visiting hospitals and health care
workers engaged in medical shockwave technology are at potential risk of COVID-19 infection. The 2022 Chinese expert consensus statement on the Management of Musculoskeletal Disease Extracorporeal Shock Wave during the Prevention and Control of Novel Coronavirus Epidemic is formulated..
Keywords: Chinese expert consensus, Extracorporeal shockwave, Management, Musculoskeletal disorders, Novel coronavirus pandemic.
References:
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6. General Office of the National Health Commission, Office of the State Administration of Traditional Chinese Medicine. Pneumonia Diagnosis and Treatment Program for Novel Coronavirus Infection. 9th ed. New Delhi: General Office of the National Health Commission; 2022. Available from: http://www.gov.cn/zhengce/zhengceku/2022-03/15/content_5679257.htm last accessed on 2022.
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16. Wu S, Wang Y, Jin X, Tian J, Liu J, Mao Y. Environmental contamination by SARS-CoV-2 in a designated hospital for coronavirus disease 2019. Am J Infect Control 2020;48:910-4.
17. Tanaka MJ, Oh LS, Martin SD, Berkson EM. Telemedicine in the era of COVID-19: The virtual orthopaedic examination. J Bone Joint Surg Am 2020;102:e57.
18. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical coronavirus disease 2019 (COVID-19) pneumonia: Relationship to negative RT-PCR testing. Radiology 2020;296:E41-5.
19. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): Astudy of 63 patients in Wuhan, China. Eur Radiol 2020;30:3306-9.
20. Shockwave Medicine Professional Committee of China Research Hospital Association. Guidelines for extracorporeal shockwave therapy for musculoskeletal diseases in China. Chin J Med Front 2019;11:1-10.
21. Gao F, Sun W, Xing G. Interpretation of the latest diagnosis and treatment consensus of the International Society of Medical Shockwaves: Indications and contraindications of extracorporeal shockwave. Chin Med J 2017;97:2411-5.
22. Chinese Medical Association Physical Medicine and Rehabilitation Branch, Expert Consensus Group on Extracorporeal Shockwave Therapy for Musculoskeletal Diseases. Expert Consensus on Extracorporeal Shockwave Therapy for Musculoskeletal Diseases. Chin J Phys Med Rehabil 2019;41:481-7.
| How to Cite this article: Gao F, Ma X, Sun W, Li Z, Lu J | 2022 Chinese Expert Consensus Statement on the Management of Extracorporeal Shockwave Therapy in Musculoskeletal Disorders during Novel Coronavirus Pandemic Prevention and Control. | Journal of Regenerative Science | Jan – Jun 2022; 2(1): 27-31. |
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Shock Waves in Scaphoid Pseudarthrosis: A Case Series
Technical | Volume 2 | Issue 1 | JRS Jan – Jun 2022 | Page 39-42 | Paul German Terán1, Fidel Ernesto Cayon1, Estefania Anabel Lozada1, Alvaro Santiago Le Mari2
DOI: 10.13107/jrs.2022.v02.i01.47
Author: Paul German Terán [1], Fidel Ernesto Cayon [1], Estefania Anabel Lozada [1], Alvaro Santiago Le Marie [2]
[1] Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito, Ecuador.
[2] Department of General and Laparoscopic Surgery, Universidad Internacional del Ecuador, Quito, Ecuador.
Address of Correspondence
Dr. Paul German Terán,
Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito, Ecuador.
E-mail: paulteranmd@gmail.com
Abstract
Scaphoid fracture accounts for 60% of carpal fractures. The mechanism of fracture occurs after a fall with the hand extended, in pronation and radial or ulnar deviation in addition to the importance, they gain for their frequency; clinically, their problem lies in the high possibility of non-consolidation, due to the type of vascularization that it has, fractures located mainly in the waist and in the proximal pole are a high-risk factor. Most of the up-to-date papers available confirm a positive outcome of the use of focused extracorporeal shock wave therapy (ESWT-F) in pseudarthrosis. According to the literature, the success rate is between 50% and 91%. Complications when ESWT-F are performed by qualified personnel and following the standards established by international scientific organizations, are limited to petechiae and local hematomas having as a requirement, to be performed by trained personnel. This manuscript will discuss a series of cases treated in a certified center for the application of Focal Shock Waves between 2018 and 2021 to patients with scaphoid fracture with a diagnosis of Fracture Consolidation Delay and pseudarthrosis of scaphoids, which subjected to treatment with high-intensity focal shock waves under ultrasound guidance. We analyzed six male patients with an average age of 31.3 years who were treated with ESWT-F. About 33.3% were taken to osteosynthesis as initial management without achieving satisfactory bone consolidation; hence, ESWT-F was performed. About 0% complications were reported, bone consolidation occurred in 100% of patients on average of 6 weeks from the last session of ESWT-F. The results were clinically evaluated, where 100% of patients manifested a decrease in pain by an average of 75% at 2 weeks of the last session of ESWT-F and 100% at 12 weeks. In the imaging evaluation, the six patients (100%) showed signs of bone consolidation in the complete radiological assessment at 12 weeks and the Disabilities of the Arm, Shoulder, and Hand scale applied revealed improvement in their functional capacity.
Keywords: Scaphoid non-union, Delayed union, Extracorporeal shockwave therapy, Extracorporeal shock wave therapy, Pseudarthrosis, Disabilities of the arm, shoulder and hand
References:
1. Reigstad O, Thorkildsen R, Grimsgaard C, Melhuus K, Rokkum M. Examination and treatment of scaphoid fractures and pseudarthrosis. Tidsskr Nor Laegeforen 2015;135:1138-42.
2. Hernández PA, Arrieta DE, Lee Ruiz LS. Generalities of scaphoid fractures. Rev Med Sin 2020;5:e595.
3. Carreño F, Osma J. Orthopedics and Traumatology. Vol. 30. Amsterdam, Netherlands: Elsevier; 2016. p . 426-8. Available from: https://www.elsevier.es/es-revista-revista-colombiana-ortopedia-traumatologia-380-articulo-manguito-rotadores-epidemiologia-factores-riesgo-S0120884516300578. Last access on 2022.
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5. Garcia AG. Fractures of the carpal scaphoid. Cir Cir 1953;21:199-206.
6. Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991;15:181-4.
7. Schleusser S, Song J, Stang FH, Mailaender P, Kraemer R, Kisch T. Blood flow in the scaphoid is improved by focused extracorporeal shock wave therapy. Clin Orthop Relat Res 2020;478:127-35.
8. Figures VJ, Azócar SC, Sanhueza FM, Cavalla AP, Liendo VR. Arthroscopic management of scaphoid pseudoarthrosis with hump deformity: Surgical technique and case series. Rev Chil Ortop Traumatol 2019;60:47-57.
9. Vázquez JM, Galindo JC. Delay of consolidation and pseudoarthrosis of the scaphoid. Medigr Artemis 2007;3:259-68.
10. Vergara EM. Vascularized bone graft for the scaphoid. Investig Orig 2011;59:281.
11. Knobloch K. Extracorporeal magnetotransduction therapy (EMTT) and high-energetic focused extracorporeal shockwave therapy (ESWT) as bone stimulation therapy for metacarpal non-union a case report. Handchir Mikrochir Plast Chir 2021;53:82-6.
12. Fallnhauser T, Wilhelm P, Priol A, Windhofer C. High-energy extracorporeal shock wave therapy in delayed healing of scaphoid fractures and non-unions: Aretrospective analysis of the consolidation rate and factors relevant to therapy decisions. Handchir Microchir Plast Chir 2019;51:164-70.
13. Terán Vela P, Abarca WI, Martínez Asnalema D. Extracorporeal shock waves as a non-surgical treatment of delay of consolidation and non-bone union in diaphyseal fracture of the humerus associated with axonotmesis of the radial nerve, clinical case and literature review. Rev Ecu Med EUGENIO ESPEJO 2019;5:52-66.
14. Moya D, Ramón S, Guiloff L, Terán P, Eid J, Serrano E. Poor results and complications in the use of focal shock waves and radial pressure waves in musculoskeletal pathology. Rehabilitation 2021;4:13-18.
15. D’Agostino MC, Craig K, Tibalt E, Respizzi S. Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg 2015;24:147-53.
16. Wang CJ, Cheng JH, Huang CC, Yip HK, Russo S. Extracorporeal shockwave therapy for avascular necrosis of femoral head. Int J Surg 2015;24:184-7.
17. Cheng JH, Wang CJ. Biological mechanism of shockwave in bone. Int J Surg 2015;24:143-6.
18. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res 2012;7:11.
19. Balius R, Jimenez F. Interventional Ultrasound in Sports Traumatology. I. Madrid; 2015. p. 2-4.
| How to Cite this article: Teran PG, Cayon FE, Lozada EA, Le Marie AS | Shock Waves in Scaphoid Pseudarthrosis: A Case Series. | Journal of Regenerative Science | Jan – Jun 2022; 2(1): 39-42. |
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Treatment of a Femoral Shaft Non-union in a Pediatric Patient with Focused Shock Waves
Case Report | Volume 2 | Issue 1 | JRS Jan – Jun 2022 | Page 36-38 | Sebastián Senes1, Gerardo Staudacher2, Santiago Iglesias1, Daniel Moya1, Rodolfo Goyeneche2
DOI: 10.13107/jrs.2022.v02.i01.45
Author: Sebastián Senes [1], Gerardo Staudacher [2], Santiago Iglesias [1], Daniel Moya[1], Rodolfo Goyeneche [2]
[1] Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires, Argentina.
[2] Servicio de Ortopedia y Traumatología Infantil, Hospital de Pediatría Garrahan, Buenos Aires, Argentina.
Address of Correspondence
Dr. Daniel Moya, MD,
Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, CABA, Argentina.
E-mail: drdanielmoya@yahoo.com.ar
Abstract
Non-unions of the femur in children are not frequent, but when they do occur they can be very difficult to manage. Shock wave therapy has emerged as an effective option for well-chosen pseudoarthrosis cases, however there are no reports of pediatric cases. We report a 12-year-old male patient with a history of pathological fracture due to mid-diaphyseal osteomyelitis of the right femur at 8 years of age. After several surgical procedures the integrity of the femur was restored but an area of non-unions persisted at mid-diaphyseal level. He was treated with 3 sessions of focused shock waves with an electrohydraulic generator. He presented a rapid consolidation, avoiding a new endomedullary nailing surgery with bone graft.
Focused shock waves may be a useful therapeutic option in children with nonunions in well-selected cases.
Keywords: Pediatric, Fracture non-unions, Shock Waves
References:
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2. Rockwood, Charles A., Kaye E. Wilkins, James H. Beaty, and James R. Kasser. Rockwood and Wilkins’ Fractures in Children. Philadelphia: Lippincott Williams & Wilkins, 2001
3. Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop. 1991;15(3):181-4. doi: 10.1007/BF00192289. PMID: 1743828.
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9. Schaden W, Fischer A, Sailler A. Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop Relat Res. 2001 Jun;(387):90-4. doi: 10.1097/00003086-200106000-00012. PMID: 11400900.
10. Elster EA, Stojadinovic A, Forsberg J, Shawen S, Andersen RC, Schaden W. Extracorporeal shock wave therapy for nonunion of the tibia. JOrthop Trauma. 2010 Mar; 24(3):133-41.doi: 10.1097/BOT.0b013e3181b26470. PMID: 20182248.
11. Kuo SJ, Su IC, Wang CJ, Ko JY. Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions of femoral shaft fractures. Int J Surg. 2015 Dec;24(Pt B):131-4. doi: 10.1016/j.ijsu.2015.06.075. Epub 2015 Jul 9. PMID: 26166737.
12. 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. doi: 10.2106/JBJS.H.00841. Erratum in: J Bone Joint Surg Am. 2010 May;92(5):1241. PMID: 19884432.
13. Notarnicola A, Moretti L, Tafuri S, Gigliotti S, Russo S, Musci L, Moretti B. Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid. Ultrasound Med Biol. 2010 Aug;36(8):1306-13. doi: 10.1016/j.ultrasmedbio.2010.05.004. PMID: 20691920.
14. Furia JP, Juliano PJ, Wade AM, Schaden W, Mittermayr R. Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures. J Bone Joint Surg Am. 2010 Apr;92(4):846-54. doi: 10.2106/JBJS.I.00653. PMID: 20360507.
15. W. Schaden, M. Pusch, C. Schwab, R. Mittermayr, H. Kuderna. Grundlagen der extrakorporalen Stoßwellentherapie (ESWT) bei Pseudarthrosen. Quality for the treated and practitioners. 47th Annual Meeting, Salzburg, Austria, 2011.
16. International Society for Medical Shockwave Treatment. Indications. https://www.shockwavetherapy.org/about-eswt/indications/ Last Access, June 15th,2022.
| How to Cite this article: Senes S, Staudacher G, Iglesias S, Moya D, Goyeneche R | Treatment of a femoral shaft non-union in a pediatric patient with focused shock waves | Journal of Regenerative Science | Jan – Jun 2022; 2(1): 36-38. |
