Treatment with Shockwave Therapy in a Patient with Joint Hypermobility and Temporomandibular Dysfunction

Case Report | Vol 4 | Issue 1 |  January-June 2024 | page: 09-15| Claudio Lopes Simplicio, Angélle Aragonez Essado Jácomo, Guilherme Antonio Moreira de Barros

DOI: https://doi.org/10.13107/jrs.2024.v04.i01.123

Author: Claudio Lopes Simplicio [1], Angélle Aragonez Essado Jácomo [2], Guilherme Antonio Moreira de Barros [3]

[1] Orthopedics – Physiatrist – Antalgic Therapy, RJ Brazil Ortofisio Clinic – Instdor Clinic, Sao Paulo State University (UNESP), Botucatu – SP Brazil,
[2] Physiatrist – Pain Doctor, DF, Brazil.
[3] Antalgic Therapy and Palliative Care, Faculdade de Medicina de Botucatu, UNESP-SP, Brazil.

Address of Correspondence
Dr. Cláudio Simplicio,
Orthopedics – Physiatrist – Antalgic Therapy,RJ Brazil, Ortofisio Clinic – Instdor Clinic, Sao Paulo State University (UNESP), Botucatu – SP Brazil.
E-mail: drsimplicio@terra.com.br

Abstract

The text addresses the relationship between joint hypermobility (JH), Ehlers-Danlos Syndrome (EDS), and temporomandibular dysfunction (TMD) in patients, discussing the complexity, and comorbidities associated with these conditions. A clinical case is presented, along with the treatment, including focused shockwave therapy as a non-invasive therapeutic approach. The effectiveness of shockwave therapy is discussed in relation to pain relief and musculoskeletal system regeneration, based on studies and scientific evidence.
However, despite the potential benefits, further research is still needed to fully understand the effects of these therapies in patients with specific conditions, such as JHjoint hypermobility and ehlers-danlos syndrome (EDS. The safety and efficacy of shockwave therapy are also discussed, emphasizing the importance of following rigorous protocols to avoid complications.
This summary highlights the relevance of shockwave therapy in the treatment of TMD and other musculoskeletal conditions, providing a comprehensive view of therapeutic approaches and clinical considerations involved.
Keywords: Joint Hypermobility, Ehlers-Danlos Syndrome, Temporomandibular Joint Dysfunction Syndrome, Extracorporeal Shockwave Therapy

References:

1. Malek S, Reinhold EJ, Pearce GS. The Beighton Score as a measure of generalised joint hypermobility. Rheumatol Int. 2021 Oct;41(10):1707-1716. doi: 10.1007/s00296-021-04832-4. Epub 2021 Mar 18. PMID: 33738549; PMCID: PMC8390395
2. Martin VT, Neilson D. Joint hypermobility and headache: the glue that binds the two together–part 2. Headache. 2014 Sep;54(8):1403-11. doi: 10.1111/head.12417. Epub 2014 Jun 23. PMID: 24958300.
3. Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C Semin Med Genet. 2017 Mar;175(1):148-157. doi: 10.1002/ajmg.c.31539. Epub 2017 Feb 1. PMID: 28145606.
4. P. Beighton, L. Solomon, C. L. Soskolne. Articular mobility in an African population. Ann Rheum Dis 1973;32:413.
5. Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017 Mar;175(1):8-26. doi: 10.1002/ajmg.c.31552. PMID: 28306229.
6. Castori M, Camerota F, Celletti C, Grammatico P, Padua L. Ehlers-Danlos syndrome hypermobility type and the excess of affected females: possible mechanisms and perspectives. Am J Med Genet A. 2010 Sep;152A(9):2406-8. doi: 10.1002/ajmg.a.33585. PMID: 20684008.
7. Castori M. Ehlers-danlos syndrome, hypermobility type: an underdiagnosed hereditary connective tissue disorder with mucocutaneous, articular, and systemic manifestations. ISRN Dermatol. 2012;2012:751768. doi: 10.5402/2012/751768. Epub 2012 Nov 22. PMID: 23227356; PMCID: PMC3512326.
8. Sanches SH, Osório Fde L, Udina M, Martín-Santos R, Crippa JA. Anxiety and joint hypermobility association: a systematic review. Braz J Psychiatry. 2012 Jun;34 Suppl 1:S53-60. English, Portuguese. doi: 10.1590/s1516-44462012000500005. PMID: 22729449.
9. Bielajew BJ, Donahue RP, Espinosa MG, Arzi B, Wang D, Hatcher DC et al. Knee orthopedics as a template for the temporomandibular joint. Cell Rep Med. 2021 Apr 14;2(5):100241. doi: 10.1016/j.xcrm.2021.100241. PMID: 34095872; PMCID: PMC8149366.
10. Schmitz C, Császár NB, Milz S, Schieker M, Maffulli N, Rompe JD, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Br Med Bull. 2015;116(1):115-38. doi: 10.1093/bmb/ldv047. Epub 2015 Nov 18. PMID: 26585999; PMCID: PMC4674007.
11. Contaldo C, Högger DC, Khorrami Borozadi M, Stotz M, Platz U, Forster N et al. Radial pressure waves mediate apoptosis and functional angiogenesis during wound repair in ApoE deficient mice. Microvasc Res. 2012 Jul;84(1):24-33. doi: 10.1016/j.mvr.2012.03.006. Epub 2012 Mar 29. PMID: 22504489.
12. Simplicio C, Purita J, Murrell W, Santos GS, Dos Santos RG, Lana JF. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma 2020;11:S309-18.
13. Rompe JD, Kirkpatrick CJ, Küllmer K, Schwitalle M, Krischek O. Dose-related effects of shock waves on rabbit tendo Achillis. A sonographic and histological study. J Bone Joint Surg Br. 1998 May;80(3):546-52. doi: 10.1302/0301-620x.80b3.8434. PMID: 9619954.
14. Simplício CL, SMBTOC. Tratado de Ondas de Choque. Abu Dhabi: Sociedade Médica Brasileira de Tratamento por Ondas de Choque, Alef; 2022.
15. Gollmann-Tepeköylü C, Pölzl L, Graber M, Hirsch J, Nägele F, Lobenwein D, et al. miR-19a-3p containing exosomes improve function of ischaemic myocardium upon shock wave therapy. Cardiovasc Res. 2020 May 1;116(6):1226-1236. doi: 10.1093/cvr/cvz209. PMID: 31410448.
16. Simplicio C, Santos G, Shinzato GT, De Barros GA, Imamura M, Neto AD, et al. Extracorporeal shockwave treatment for low back pain: A descriptive of the literature. Biol Orthop J 2022;4:e96-105. DOI https://doi.org/10.22374/boj.v4iSP1.46
17. Sukubo NG, Tibalt E, Respizzi S, Locati M, d’Agostino MC. Effect of shock waves on macrophages: A possible role in tissue regeneration and remodeling. Int J Surg. 2015 Dec;24(Pt B):124-30. doi: 10.1016/j.ijsu.2015.07.719. Epub 2015 Aug 18. PMID: 26291028.
18. Kapferer-Seebacher I, Lundberg P, Malfait F, Zschocke J. Periodontal manifestations of Ehlers-Danlos syndromes: A systematic review. J Clin Periodontol. 2017 Nov;44(11):1088-1100. doi: 10.1111/jcpe.12807. Epub 2017 Sep 25. PMID: 28836281.
19. Carvalho TG. Síndrome De Ehlers-Danlos. Espondiloartrite e Manifestações Orofaciais-Um Caso Clínico. Porto: Universidade Fernando Pessoa, Faculdade de Ciências da Saúde; 2023. Available in: https://bdigital.ufp.pt/bitstream/10284/12064/1/PPG_33477.pdf
20. Kapferer-Seebacher I, Schnabl D, Zschocke J, Pope FM. Dental Manifestations of Ehlers-Danlos Syndromes: A Systematic Review. Acta Derm Venereol. 2020 Mar 25;100(7):adv00092. doi: 10.2340/00015555-3428. PMID: 32147746; PMCID: PMC9128968.
21. Buryk-Iggers S, Mittal N, Santa Mina D, Adams SC, Englesakis M, Rachinsky M, et al. Exercise and Rehabilitation in People With Ehlers-Danlos Syndrome: A Systematic Review. Arch Rehabil Res Clin Transl. 2022 Mar 4;4(2):100189. doi: 10.1016/j.arrct.2022.100189. PMID: 35756986; PMCID: PMC9214343.
22. Kapferer-Seebacher I, van Dijk FS, Zschocke J. Periodontal Ehlers-Danlos Syndrome. 2021 Jul 29. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572429/.
23. Kosho T, Mizumoto S, Watanabe T, Yoshizawa T, Miyake N, Yamada S. Recent Advances in the Pathophysiology of Musculocontractural Ehlers-Danlos Syndrome. Genes (Basel). 2019 Dec 29;11(1):43. doi: 10.3390/genes11010043. PMID: 31905796; PMCID: PMC7017038.
24. Lepperdinger U, Zschocke J, Kapferer-Seebacher I. Oral manifestations of Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2021 Dec;187(4):520-526. doi: 10.1002/ajmg.c.31941. Epub 2021 Nov 6. PMID: 34741498; PMCID: PMC9298068.
25. Song B, Yeh P, Nguyen D, Ikpeama U, Epstein M, Harrell J. Ehlers-Danlos Syndrome: An Analysis of the Current Treatment Options. Pain Physician. 2020 Jul;23(4):429-438. PMID: 32709178.
26. Yoshizawa T, Kosho T. Mouse Models of Musculocontractural Ehlers-Danlos Syndrome. Genes (Basel). 2023 Feb 8;14(2):436. doi: 10.3390/genes14020436. PMID: 36833362; PMCID: PMC9957544.
27. Tian Y, Cui S, Guo Y, Zhao N, Gan Y, Zhou Y, et al. Similarities and differences of estrogen in the regulation of temporomandibular joint osteoarthritis and knee osteoarthritis. Histol Histopathol. 2022 May;37(5):415-422. doi: 10.14670/HH-18-442. Epub 2022 Feb 23. PMID: 35194774.
28. Urits I, Charipova K, Gress K, Schaaf AL, Gupta S, Kiernan HC, et al.. Treatment and management of myofascial pain syndrome. Best Pract Res Clin Anaesthesiol. 2020 Sep;34(3):427-448. doi: 10.1016/j.bpa.2020.08.003. Epub 2020 Aug 8. PMID: 33004157.
29. Ba S, Zhou P, Yu M. Ultrasound is Effective to Treat Temporomandibular Joint Disorder. J Pain Res. 2021 Jun 10;14:1667-1673. doi: 10.2147/JPR.S314342. PMID: 34140803; PMCID: PMC8203600.
30. Sabeti-Aschraf M, Dorotka R, Goll A, Trieb K. Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff. Am J Sports Med. 2005 Sep;33(9):1365-8. doi: 10.1177/0363546504273052. Epub 2005 Jul 7. PMID: 16002492.
31. Li W, Wu J. Treatment of Temporomandibular Joint Disorders by Ultrashort Wave and Extracorporeal Shock Wave: A Comparative Study. Med Sci Monit. 2020 Jun 21;26:e923461. doi: 10.12659/MSM.923461. PMID: 32564051; PMCID: PMC7328499.
32. Kim YH, Bang JI, Son HJ, Kim Y, Kim JH, Bae H, et al. Protective effects of extracorporeal shockwave on rat chondrocytes and temporomandibular joint osteoarthritis; preclinical evaluation with in vivo99mTc-HDP SPECT ex vivo micro-CT. Osteoarthritis Cartilage 2019;27:1692-701. DOI: 10.1016/j.joca.2019.07.008
33. Hazan-Molina H, Reznick AZ, Kaufman H, Aizenbud D. Assessment of IL-1β and VEGF concentration in a rat model during orthodontic tooth movement and extracorporeal shock wave therapy. Arch Oral Biol. 2013 Feb;58(2):142-50. doi: 10.1016/j.archoralbio.2012.09.012. Epub 2012 Oct 22. PMID: 23088789.
34. Manafnezhad J, Salahzadeh Z, Salimi M, Ghaderi F, Ghojazadeh M. The effects of shock wave and dry needling on active trigger points of upper trapezius muscle in patients with non-specific neck pain: A randomized clinical trial. J Back Musculoskelet Rehabil. 2019;32(5):811-818. doi: 10.3233/BMR-181289. PMID: 30883334.
35. Zhang X, Yan X, Wang C, Tang T, Chai Y. The dose-effect relationship in extracorporeal shock wave therapy: the optimal parameter for extracorporeal shock wave therapy. J Surg Res. 2014 Jan;186(1):484-92. doi: 10.1016/j.jss.2013.08.013. Epub 2013 Sep 3. PMID: 24035231.
36. Al-Moraissi EA, Farea R, Qasem KA, Al-Wadeai MS, Al-Sabahi ME, Al-Iryani GM. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2020 Aug;49(8):1042-1056. doi: 10.1016/j.ijom.2020.01.004. Epub 2020 Jan 22. PMID: 31982236.
37. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res. 2003 Nov;21(6):984-9. doi: 10.1016/S0736-0266(03)00104-9. PMID: 14554209.
38. 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. PMID: 29406349.
39. Király, M., Bender, T., & Hodosi, K. (2018). Comparative study of shockwave therapy and low-level laser therapy effects in patients with myofascial pain syndrome of the trapezius. Rheumatology International. doi:10.1007/s00296-018-4134-x 10.1007/s00296-018-4134-x
40. Poenaru D, Sandulescu MI, Cinteza D. Biological effects of extracorporeal shockwave therapy in tendons: A systematic review. Biomed Rep. 2022 Dec 29;18(2):15. doi: 10.3892/br.2022.1597. PMID: 36684664; PMCID: PMC9845689..
41. Moya D, Ramón S, Guiloff L, Terán P, Eid J, Serrano E. Malos resultados y complicaciones en el uso de ondas de choque focales y ondas de presión radial en patología musculoesquelética [Poor results and complications in the use of focused shockwaves and radial pressure waves in musculoskeletal pathology]. Rehabilitacion (Madr). 2022 Jan-Mar;56(1):64-73. Spanish. doi: 10.1016/j.rh.2021.02.007. Epub 2021 Apr 5. PMID: 33832759.
42. Zhang X, Yan X, Wang C, Tang T, Chai Y. The dose-effect relationship in extracorporeal shock wave therapy: the optimal parameter for extracorporeal shock wave therapy. J Surg Res. 2014 Jan;186(1):484-92. doi: 10.1016/j.jss.2013.08.013. Epub 2013 Sep 3. PMID: 24035231.
43. Lu CC, Chou SH, Shen PC, Chou PH, Ho ML, Tien YC. Extracorporeal shock wave promotes activation of anterior cruciate ligament remnant cells and their paracrine regulation of bone marrow stromal cells’ proliferation, migration, collagen synthesis, and differentiation. Bone Joint Res. 2020 Aug 11;9(8):458-468. doi: 10.1302/2046-3758.98.BJR-2019-0365.R1. PMID: 32832074; PMCID: PMC7418778.

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