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Treatment of Morton’s neuroma with focused shock waves Comparison between shock waves and surgery

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Clinical Study | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 13-16 | Bernard Meyer , Daniel Moya
DOI: 10.13107/jrs.2022.v02.i02.055

Author: Bernard Meyer [1], Daniel Moya [2]

[1] Orthopaedic Surgeon. Moinhos de Vento Hospital, Porto Alegre, RS, Brasil,
[2] Orthopaedic Surgeon. Hospital Británico de Buenos Aires, Argentina.

Address of Correspondence
Dr. Bernard Meyer, MD,
Orthopaedic Surgeon. Moinhos de Vento Hospital, Porto Alegre, RS, Brasil.
E-mail: bernardfabiomeyer@gmail.com

Abstract

Various treatments have been described for Morton’s neuroma. We compare the results of shock wave treatment with surgical neurectomy in a prospective series of 32 cases randomly assigned. In the group of patients treated with focused waves (17 cases), the percentage of good results was 70.6%, while in the operated patients (15 cases) it amounted to 93.2%. Poor results were found in 29.4% in shockwave group and 6.8 % in surgical group. Focused shock waves have a high, but lower success rate than surgery in the treatment of Morton’s neuromas. Nevertheless, due to their non-invasiveness and low chance of complications, they can be considered an option prior to minimally invasive and surgical techniques.

Keywords: Morton neuroma, shockwaves, neurectomy.

References:

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How to Cite this article: Meyer B, Moya D | Treatment of Morton’s neuroma with focused shock waves Comparison between shock waves and surgery. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 13-16.

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Extracorporeal shock wave treatment in plantar fasciitis with an associated neuropathic component. How to optimize the result?

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Case Report | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 21-23 | Lauro Schledorn de Camargo , Ricardo Kobayashi
DOI: 10.13107/jrs.2022.v02.i02.59

Author: Lauro Schledorn de Camargo [1], Ricardo Kobayashi [2]

[1] Orthopedic Surgeon at LC Clinic, Jundiai-SP Brazil, Brazil,
[2] Pain Center, Department of Neurology, University of São Paulo, Brazil.

Address of Correspondence
Dr. Lauro Schledorn de Camargo, MD,
Orthopedic Surgeon at LC Clinic, Jundiai-SP Brazil, Brazil.
E-mail: laurosch@hotmail.com

Abstract

Introduction: Current evidence supports the use of radial pressure wave and focused extracorporeal shock wave treatment (ESWT) for the treatment of chronic plantar fasciitis that does not improve with conservative treatment. Studies show that a quarter of plantar fasciitis may have an associated neuropathic component and the literature shows that neuropathic pain causes more intense pain and greater functional disability. However, there is a lack of literature on the results of ESWT in tendinopathies associated with the neuropathic pattern.
Case report: We report a case of plantar fasciitis with central sensitization and associated neuropathic component. At first, pregabalin 75mg twice a day was used, which improved the neuropathic pattern. After that, 3 sessions were performed with piezoelectric ESWT with energy of 0.12 mJ/mm2, 2000 impulses at a frequency of 8 Hz, once a week for three weeks. The patient was followed up for 3 months and had complete improvement of symptoms without functional limitation for activities of daily living.
Conclusion: This case report serves to draw attention to the importance of evaluating and treating the neuropathic pattern associated with tendinopathies in order to optimize the therapeutic result. However, randomized clinical trials are lacking to determine the real difference in results between using ESWT in nociceptive pain or in mixed pain with an associated neuropathic component.

Keywords: Chronic pain, plantar fasciitis, mixed pain, neuropathic pain, shockwaves.

References:

1. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. J Bone Joint Surg Am. 2018 Feb 7 ; 100 (3):251-263. doi:10.2106/JBJS.17.00661.
2. Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD. American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg. 2018 Mar-Apr;57(2):370-381. doi: 10.1053/j.jfas.2017.10.018.
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10. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015 Feb;14(2):162-73. doi: 10.1016/S1474-4422(14)70251-0.
11. Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, 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. doi: 10.1177/0363546508324176.
12. Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouché RT, Caminear DS, Fullem B, Vester JC, Horn C, Banke IJ, Burgkart R, Gerdesmeyer L. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am. 2015 May 6;97(9):701-8. doi: 10.2106/JBJS.M.01331.
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How to Cite this article: Camargo Lsd, Kobayashi R |Extracorporeal shock wave treatment in plantar fasciitis with an associated neuropathic component. How to optimize the result?. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 21-23.

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Treatment of Spasticity in Patients with Brain Damage with the Association of Focused Shock Waves and Botulinum Toxin

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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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