Use of Focused Shock Waves in an Acute Talar Head Fracture
Case Report | Vol 4 | Issue 1 | January-June 2024 | page: 24-26 | Osvaldo Valle
DOI: https://doi.org/10.13107/jrs.2024.v04.i01.129
Author: Osvaldo Valle [1]
[1] Department of Orthopedic Surgeon Surgery, Ankle and Foot Team, MEDS Clinic, Santiago de Chile; President of ACHITOC (Chilean Association of Tissue Engineering and Shock Waves).
Address of Correspondence
Dr. Osvaldo Valle,
Department of Orthopedic Surgeon, Ankle and Foot Team, MEDS Clinic, Santiago de Chile; President of ACHITOC (Chilean Association of Tissue Engineering and Shock Waves).
E-mail: tovato@gmail.com
Abstract
Talar fractures are rare and can be difficult to manage. Even in the absence of complications, the treatment of this type of injury can be prolonged and uncomfortable for the patient. Focused shock waves have been shown to be effective in the treatment of delayed unions and non-unions. In this case report, we share our experience with the use of focused shock waves in an acute talus fracture in a patient with risk factors for healing.
Keywords: Talus, Talar fractures, Shock waves, Bone marrow edema
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| How to Cite this article: Valle O. Use of focused shock waves in an acute talar head fracture. Journal of Regenerative Science 2024;January-June;4(1):24-26.
|
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20 Years of Treatment of Bone Non-Unions and Delayed Unions with Shock Waves
??? | Vol 4 | Issue 1 | January-June 2024 | page: 27-30| Paulo F Kertzman
DOI: https://doi.org/10.13107/jrs.2024.v04.i01.131
Author: Paulo F Kertzman [1]
[1] Departamento de Ortopedia, Santa Casa de São Paulo, São Paulo, SP, Brazil.
Address of Correspondence
Dr. Paulo F Kertzman
Departamento de Ortopedia, Santa Casa de São Paulo, São Paulo, SP, Brazil.
E-mail: paulofkertzman@uol.com.br
Abstract
The treatment of bone non-unions continues to be complex and prolonged in many cases. The advent of the use of mechanical waves has made it possible, through the phenomenon of mechanotransduction, to have a non-invasive tool with a low rate of complications.
This study analyzes the experience of the last 20 years with the use of shock waves.
Keywords: Non-union, shock waves, Delayed union, Mechanotransduction
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| How to Cite this article: Kertzman PF. 20 Years of Treatment of Non-Unions and Delayed Unions with Shock Waves. Journal of Regenerative Science 2024;January-June;4(1):27-30.
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Extracorporeal Shock Wave Treatment and Multimodal Pain Management for Tarsal Tunnel Syndrome Associated with Plantar Fasciitis
Case Report | Vol 4 | Issue 1 | January-June 2024 | page: 31-34 | Ricardo Kobayashi
DOI: https://doi.org/10.13107/jrs.2024.v04.i01.133
Author: Ricardo Kobayashi [1]
[1] Department of Neurology, Pain Center, University of São Paulo, Brazil.
Address of Correspondence
Dr. Ricardo Kobayashi,
Department of Neurology, Pain Center, University of São Paulo, Brazil.
E-mail: koba@globo.com
Abstract
Introduction: Plantar fasciitis (PF) is an important cause of musculoskeletal pain and radial pressure waves (RPWs) can be used for patients not improving after 3 months of other non-operative measures. However, in refractory cases of PT, it is imperative to investigate possible differential diagnoses and one of its important differential diagnoses is tarsal tunnel syndrome (TTS). TTS is a rare but important condition which is regularly under diagnosed leading to a range of symptoms affecting the plantar aspect of the foot typically associated with a neuropathic pain pattern.
Case Report: We report a case of PF with TTS and associated neuropathic components. At first, nortriptyline 50 mg and 5% lidocaine patch were used, which improved the neuropathic pattern. After that, three RPW sessions were conducted at weekly intervals, with energy between 2 and 3 bars, frequency between 5 and 7 hertz. In addition to the area of greatest pain in the plantar fascia, treatment was also applied to the myofascial trigger points of the triceps surae and posterior tibial muscles. Three months after the last RPW session, the patient reported a 90% improvement in pain intensity, without limitations in daily activities.
Conclusion: This case highlights the importance of differential diagnoses of PF, especially before the indication of RPW in refractory cases. In addition to the neuropathic pattern associated with TTS, neuropathic pain associated with tendinopathies of the lower limbs is common (1/4 of cases) and needs to be identified and treated in conjunction with tendinopathy for a more effective result.
Keywords: Chronic pain, Plantar fasciitis, Tarsal tunnel syndrome, Mixed pain, Neuropathic pain, Shockwaves
References:
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8. Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res. 2013 Nov;471(11):3645-52. doi: 10.1007/s11999-013-3132-2. Epub 2013 Jun 28. PMID: 23813184; PMCID:PMC3792262.
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11. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010 Sep;17(9):1113-e88. doi: 10.1111/j.1468-1331.2010.02999.x. Epub 2010 Apr 9. PMID: 20402746.
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| How to Cite this article: Kobayashi R | Extracorporeal Shock Wave Treatment and Multimodal Pain Management for Tarsal Tunnel Syndrome Associated with Plantar Fasciitis. Journal of Regenerative Science 2024;January-June;4(1):31-34 |
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Errors in Shock Wave Theory Can Impact Clinical Outcomes
Bibliographic Analysis | Vol 4 | Issue 1 | January-June 2024 | page: 35-36 | Achim M. Loske, Daniel Moya
DOI: https://doi.org/10.13107/jrs.2024.v04.i01.135
Author: Achim M. Loske [1], Daniel Moya [2]
[1] Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México,
[2] Department of Orthopaedics, Hospital Británico de Buenos Aires, Argentina.
Address of Correspondence
Dr. Daniel Moya,
Department of Orthopaedics, Hospital Británico de Buenos Aires, Argentina.
E-mail: drdanielmoya@yahoo.com.ar
Abstract
The mechanical waves that are used therapeutically are well defined from the point of view of physics. The differences between focused and radial waves are very important, however there is enormous confusion in the literature.
In the present bibliographic analysis we make a critical comment on a publication in which a pneumatic source is illustrated and presented as generating focused shock waves.
We believe that every effort should be made to be strict in definitions, not only because science is based on the search for truth, but also because errors in shock wave theory can impact clinical outcomes.
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| How to Cite this article: Loske AM, Moya D. Errors in Shock Wave Theory Can Impact Clinical Outcomes. Journal of Regenerative Science 2024;January-June;4(1):35-36. |
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China, The Awakened Giant
Editorial | Vol 3 | Issue 2 | July-December 2023 | page: 01-02 | Daniel Moya
DOI: https://doi.org/10.13107/jrs.2023.v03.i02.85
Author: Daniel Moya [1]
[1] Department of Orthopaedics. Buenos Aires British Hospital, Argentina.
Address of Correspondence
Dr. Daniel Moya,
Department of Orthopaedics. Buenos Aires British Hospital, Argentina.
E-mail: drdanielmoya@yahoo.com.ar
Editorial:
The history of Chinese medicine is as long and legendary as that of the country itself. Its origins date back 3000 years [1]. Scientific knowledge and medical practice has gone through numerous stages.
Between the 8th and 3rd centuries BC, China went through a period of great cultural and intellectual development called the “Hundred Schools of Thought” [2]. An attempt was made to seek the explanation of the phenomena of the universe in nature itself, leaving aside explanations based on magic and myths [2]. The new ideas discussed and developed during this period have profoundly influenced philosophical views and lifestyles up to the present day in East Asian countries.
A fundamental milestone was the publication of “Huangdi Neijing“. Also known as the “Inner Canon of Huangdi“ or “Inner Canon of the Yellow Emperor“, it is the earliest surviving work on Chinese medicine[3]. Its author, Emperor Huangdi, is not only considered the initiator of Chinese Traditional Medicine but also the father of Chinese civilization.
Caring for the health of the population has been a priority in this country throughout the centuries. As a history lover, it is difficult for me to find another example of a nation embarking on an unequal war to defend its public health. This happened when the Western powers, led by the British Empire, sought to create opium addiction among the Chinese population in order to balance their trade balance by trafficking drugs [4]. These infamous conflicts went down in history as the “Opium Wars” and cost the lives of thousands of Chinese citizens.
In the last decades, China’s healthcare system has made great achievements in the management of medical services and public health for the Chinese people[5]. Average life expectancy at birth was 35 years before the founding of new China, and it reached 77.0 years in 2018 [6]. The projected life expectancy at birth in mainland China in 2035 is 81,3 years [7].
On April 6, 2009, China presented an action plan to undertake a radical and ambitious reform of the health system [8]. The goal is to achieve universal health coverage.
The history of shock waves in this country is a reflection of the described dynamism and historical background. The beginnings of its use in China can be traced back to the 1980s in the urological field. Prof. Xing Gengyan was the pioneer of indications in musculoskeletal pathology starting in 1993. Since that moment he has been a promoter not only of research and clinical applications, but also of medical education. In 2019, he organized in Beijing the largest international shock wave congress in history. It is a great honor that he has contributed to this issue by writing about the development of this therapeutic practice in China.
In parallel with healthcare and academic development, the Chinese industry has risen to the occasion by providing high-quality devices.
The content of this volume reflects not only the ability of our Chinese colleagues but also their openness to the world and their generosity in sharing information. Numerous universities and hospitals from different regions throughout China have collaborated selflessly. This could not have been accomplished without the monumental task of Dr. Sun Wei, our Guest Editor.
Napoleon Bonaparte is credited with the phrase “China is a sleeping giant, when she wakes she will shake the world“. Two hundred years later the giant is awake and brimming with energy.
References
[1] Reyes G Ariel E. Evolución Histórica de la Medicina Tradicional China. Comunidad y Salud [Internet]. 2008 Dic [citado 2023 Dic 27] ; 6( 2 ): 42-49. Disponible en: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S1690-32932008000200005&lng=es
[2] Orígenes de la Medicina China. Escuela Li Ping de acupuntura y Medicina Tradicional China. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://escuelaliping.com/wp-content/uploads/2013/10/Tema1.pdf
[3] Huang di nei jing su wen. Library of the congress. https://www.loc.gov/item/2021666312
[4] Travis Hanes III W, and Sanello F. The Addiction of One Empire and the Corruption of Another. Ed. Sourcebooks. 2004. ISBN-13 : 978-1402201493
[5] Chen C, Liu M. Achievements and Challenges of the Healthcare System in China. Cureus. 2023 May 15;15(5):e39030. doi: 10.7759/cureus.39030. PMID: 37378106; PMCID: PMC10292030.
[6] Yuan, X., Gao, Y. Demographic transition and economic miracles in China: an analysis based on demographic perspective. IJEPS 14, 25–45 (2020). https://doi.org/10.1007/s42495-019-00030-0
[7] Bai R, Liu Y, Zhang L, Dong W, Bai Z, Zhou M. Projections of future life expectancy in China up to 2035: a modelling study. Lancet Public Health. 2023 Dec;8(12):e915-e922. doi: 10.1016/S2468-2667(22)00338-3. Epub 2023 Mar 30. PMID: 37004714; PMCID: PMC10188127.
[8]China’s latest revolution: Basic health care for all. https://www.ilo.org/global/about-the-ilo/mission-and-objectives/features/WCMS_188582/lang–en/index.htm
| How to Cite this article: Moya D | China, The Awakened Giant. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 01-02. |
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The History of Shock Wave Medicine Development in China
Editorial | Vol 3 | Issue 2 | July-December 2023 | page: 03-04 | Shuitao Liu, Gengyan Xing
DOI: https://doi.org/10.13107/jrs.2023.v03.i02.87
Author: Shuitao Liu [1], Gengyan Xing [2]
[1] Department of Traumatic Orthopedics, Armed Police Characteristic Medical Center., Tianjin, China,
[2] Corresponding author: Gengyan Xing, Department of Orthopedic, The Third Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China.
Address of Correspondence
Dr. Gengyan Xing,
Department of Orthopedic, The Third Medical Center of Chinese People’s Liberation Army General Hospital, Beijing,
China.
E-mail: xgy1350138@163.com
Editorial
The development of shock wave medicine in China can be traced back to the 1980s. At that time, shock waves were applied to treat urinary tract stones with good results. In 1993, Professor Xing Gengyan pioneered the application of extracorporeal shock wave therapy for humeral epicondylitis, marking a significant milestone in the advancement of shock wave medicine in China. With the deepening of research on shock waves and technological advancements, the indications for shock wave medicine have been continuously expanded, achieving good results in treating bone tissue diseases such as delayed fracture healing and non-union. To further promote the experience of shock wave therapy, Professor Xing Gengyan successively held 8 national continuing education programs on “Extracorporeal Shock Wave Therapy for Bone and Muscle Disorders,” training thousands of doctors who mastered shock wave therapy techniques. With the conduct of numerous clinical studies and accumulation of data, the China National Medical Products Administration approved the domestic production of extracorporeal shock wave therapy machines for treating orthopedic diseases in August 2000, marking the official entry of shock wave medicine into a high-speed development phase in China.
As clinical applications continue to advance and expand, Chinese scholars have begun to explore the mechanisms of action of shock waves. In 2004, Professor Xing Ganyan’s research on “Osteoblast Mechanochemical Signal Transduction and Related Gene Expression Following ESWT” was funded by the National Natural Science Foundation of China, resulting in a wealth of published findings. In 2007, Professor Xing Ganyan edited and published the first monograph on shock wave medicine, <Extracorporeal Shock Wave Therapy for Bone and Muscle Diseases (First Edition)>, which consists of two parts and eight chapters. This comprehensive summary of over a decade of clinical application experience and foundational research laid the foundation for shock wave medicine in China.
With the rapid advancement of China’s medical level, Chinese scholars’ research on shock waves has gradually gained global recognition. A significant number of papers on shock waves published by Chinese scholars has been indexed, and their research achievements have been communicated at international conferences. Concurrently, as the depth of research on shock wave therapy increases and instruments advance, shock waves are no longer confined to treating urinary tract stones, non-unions, osteonecrosis, and tendinopathy [1-4]. They have also achieved promising results in treating myocardial infarction, skin ulcers, tumors, nerve injuries, and male dysfunction, among others.
In December 2013, the Chinese Shock Wave Medicine Professional Committee was established in Beijing, with Professor Xing Gengyan serving as the inaugural Chairman. Since then, shock wave medicine has had an independent academic organization. Building on past experiences, in 2014, the <Expert Consensus on Extracorporeal Shock Wave Therapy for Bone and Muscle Diseases> was released [5], significantly advancing the scientific and standardized development of shock wave medicine. In 2015, the <Extracorporeal Shock Wave Therapy for Bone and Muscle Diseases (Second Edition)> was published, expanding the volume to 5 articles and 19 chapters, with a significant addition of numerous recent research findings. In July 2016, at the annual meeting of the international society for medical shock wave treatment (ISMST) held in Malaysia, Professor Xing Gengyan was elected as the President of the ISMST. China secured the hosting rights for the 22nd annual conference in 2019, signifying that China is at the forefront of shock wave medicine development worldwide.
The year 2019 marked the most memorable year in the history of shock wave development in Chinese medicine. Building upon the previous two editions of the <Expert Consensus on Extracorporeal Shock Wave Therapy for Bone and Muscle Diseases>, Chinese scholars integrated evidence-based medical experiences and released the <Chinese Guidelines for Extracorporeal Shock Wave Therapy for Bone and Muscle Diseases (2019 Edition) [6], thereby standardizing and scientifically advancing the application of shock waves in China. In May of the same year, the ISMST 22nd International Congress on Medical Shock Waves convened in Beijing, attended by over 1,200 experts and scholars from nearly 30 countries. This was the largest-attended conference in the history of shock wave medicine, covering the broadest range of academic interests and delving into the most in-depth discussions on various research topics, significantly advancing the development of shock wave medicine in China.
Currently, over 3,000 hospitals in China possess extracorporeal shock wave therapy systems, covering treatment fields such as orthopedics, urology, plastic surgery, cardiology, stomatology, oncology, and rehabilitation, treating millions of patients annually [7-9]. Concurrently, Chinese scholars in the field of shock wave therapy are continually innovating, integrating extracorporeal shock waves with techniques such as arthroscopy, stem cells, and nanomaterials to achieve synergistic therapeutic effects, resulting in favorable outcomes [10-12]. Each year, over 500 related research papers are published.
Further, elucidating the biological mechanisms of shock waves in clinical efficacy at the organizational, cellular, and molecular levels will continuously expand the application scope of shock waves. In response to the relative lack of high-level evidence for shock wave research, the China Shock Wave Medical Association is organizing multi-center, large-sample clinical studies; standardized training for practitioners and accreditation of treatment institutions have also been put on the agenda. It is believed that in the near future, China’s shock wave medicine will witness a richer array of research achievements, bringing blessings to more patients.
References:
1. Xing G. The past, present and future of shockwave medicine. Chin J Front Med Sci 2014;6:1-2.
2. Wang Y, Guo T, Cai HY, Ma TK, Tao SM, Sun S, et al. Cardiac shock wave therapy reduces angina and improves myocardial function in patients with refractory coronary artery disease. Clin Cardiol 2010;33:693-9.
3. Liu J, Zhou F, Li GY, Wang L, Li HX, Bai GY, et al. Evaluation of the effect of different doses of low energy shock wave therapy on the erectile function of streptozotocin (STZ)-induced diabetic rats. Int J Mol Sci 2013;14:10661-73.
4. Yan X, Yang G, Cheng L, Chen M, Cheng X, Chai Y, et al. Effect of extracorporeal shock wave therapy on diabetic chronic wound healing and its histological features. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2012;26:961-7.
5. Xing G, Huang C, Huang Z, Li Y, Li Z, Liu Y, et al. Professional Committee of Shock Wave Medicine of Chinese Research Hospital Association. Expert consensus of extracorporeal shock wave therapy for bone and muscle diseases. Chin J Front Med Sci 2014;6:170-7.
6. Xing G, Zhang H, Liu S, Zhao Z. Chinese guidelines for extracorporeal shockwave therapy for bone and muscle diseases (2019 Edition). Chin J Front Med Sci 2019;11:1-10.
7. Xu Y, Wu K, Liu Y, Geng H, Zhang H, Liu S, et al. The effect of extracorporeal shock wave therapy on the treatment of moderate to severe knee osteoarthritis and cartilage lesion. Medicine (Baltimore) 2019;98:e15523.
8. Li F, Zhen Z, Sun SJ, Jiang Y, Liang WH, Belau M, et al. Attenuation of myocardial dysfunction in hypertensive cardiomyopathy using non-R-wave-synchronized cardiac shock wave therapy. Int J Mol Sci 2022;23:13274.
9. Huang Q, Yan P, Xiong H, Shuai T, Liu J, Zhu L, et al. Extracorporeal shock wave therapy for treating foot ulcers in adults with type 1 and type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Can J Diabetes 2020;44:196-204.e3.
10. Liang H, Chen K, Xie J, Yao L, Liu Y, Hu F, et al. A bone-penetrating precise controllable drug release system enables localized treatment of osteoporotic fracture prevention via modulating osteoblast-osteoclast communication. Small 2023;19:e2207195.
11. Bai X, Gao Y, Zhang M, Chang YN, Chen K, Li J, et al. Carboxylated gold nanoparticles inhibit bone erosion by disturbing the acidification of an osteoclast absorption microenvironment. Nanoscale 2020;12:3871-8.
12. Zeng L, Geng H, Gu W, Ma S, Qin Y, Xia S, et al. Au nanoparticles attenuate RANKL-induced osteoclastogenesis by suppressing pre-osteoclast fusion. J Nanosci Nanotechnol 2019;19:2166-73.
| How to Cite this article: Liu S, Xing G | The History of Shock Wave Medicine Development in China. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 03-04. |
