In the Garden of Extracorporeal Shock Wave Therapy, Not Everything is Roses

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Review Article | Volume 3 | Issue 1 | JRS Jun – June 2023 | Page 18-21 | Achim M. Loske
DOI: 10.13107/jrs.2023.v03.i01.075

Author: Achim M. Loske 

[1] Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México.

Address of Correspondence
Dr. Achim M Loske,
Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México,
Blvd. Juriquilla 3001, Querétaro, Qro., 76230 México.
E-mail: loske@fata.unam.mx

Abstract

The popularity of extracorporeal shock wave therapy to treat a large variety of medical conditions is indisputable. Despite this, sometimes poor results are obtained, and mild to severe complications have been reported. In most cases, wrong information and lack of training are responsible for this. The objective of this article is to explain the potential danger of using shock waves and radial pressure waves, as well as the reasons why, from the point of view of physics, sometimes the outcome is not as expected.

Keywords: Extracorporeal shock wave therapy, Shock waves, Radial pressure waves, Interaction with matter, Acoustic cavitation.

References:

  1. International Society for Medical Shockwave Therapy. Introduction and Prerequisites and Minimal Standards of Performing ESWT. Available from: https://www.shockwavetherapy.org/about-eswt/indications
  2. Novak KF. Physics: F-SW and R-SW. Basic information on focused and radial shock wave physics. In: Lohrer H, Gerdesmeyer L, editors. Multisdisciplinary Medical Applications. Heilbronn, Germany: Level 10 Buchverlag Daniela Bamberg; 2014.
  3. Philipp A, Delius M, Scheffczyk C, Vogel A, Lauterborn W. Interaction of lithotripter-generated shock waves with air bubbles. J Acoust Soc Am 1993;93:2496-509.
  4. Coralic V. Simulation of Shock-induced Bubble Collapse with Application to Vascular Injury in Shockwave Lithotripsy. Dissertation. Pasadena, CA, USA: California Institute of Technology; 2014.
  5. Ueberle F, Jamshidi Rad A. Ballistic pain therapy devices: Measurement of pressure pulse parameters. Biomed Eng/Biomed Tech 2012;57:700-3.

 

How to Cite this article: Loske AM. In the Garden of Extracorporeal Shock Wave Therapy, Not Everything is Roses. | Journal of Regenerative Science | Jan – June 2023; 3(1): 18-21.

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Extracorporeal Shockwave Therapy in Greater Trochanteric Pain Syndrome

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Review Article | Volume 3 | Issue 1 | JRS Jun – June 2023 | Page 22-25 | Oyama Arruda Frei Caneca Junior , Ibrahim Afranio Willi Liu .
DOI: 10.13107/jrs.2023.v03.i01.077

Author: Oyama Arruda Frei Caneca Junior [1], Ibrahim Afranio Willi Liu [2]

[1] Director of SMBTOC, Orthopedic Surgeon at GOT Recife (Orthopedics and Traumatology Group), Brazil,
[2] Director of the Brazilian Medical Society for Shockwave Treatment-SMBTOC and Brazilian Orthopedic Society-SBOT Pain Committee.

Address of Correspondence
Dr. Oyama Arruda Frei Caneca Junior,
Director of SMBTOC, Orthopedic Physician at GOT Recife (Orthopedics and Traumatology Group), Brazil.
E-mail: oyama.arruda@gmail.com

Abstract

Peritrochanteric hip pain or great trochanter pain syndrome (GTPS) is a frequent complaint in offices and is the most common cause of pain and tenderness affecting the lateral part of the hip. Traditional conservative treatment of GTPS includes the use of anti-inflammatory drugs, physical therapy, and changing activities of daily living. In resistant cases, shockwave treatment presents satisfactory results considered good and excellent in 70 to 80% of GTPS cases treated by this technique, reducing the need for other treatments and the use of medications for long eriods. The treatment of GTPS with shock waves can be performed with focal waves or radial pressure waves, with the application of 3 initial sessions with an interval of one week, frequencies between 4 and 6 Hz, with 500 initial pulses in the region and at least 2000 pulses using energy between medium and high intensity at the point of greatest sensitivity on palpation, It is also important to treat the trigger points of the hip region. Due to the anatomical characteristics of a deep joint and the frequent presence of an associated myofascial pain, hip pathologies are a good option for the concomitant use of focal and radial pressure waves.

Keywords: Greater trochanteric pain syndrome; Trochanteric bursitis; hip pain; lateral hip pain; Shock waves; Radial pressure waves.

References:

  1. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013 Nov;201(5):1083-6.
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  9. 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.
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  12. Carlisi E, Cecini M, Di Natali G, Manzoni F, Tinelli C, Lisi C. Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial. Clin Rehabil. 2019 Apr;33(4):670-680. doi: 10.1177/0269215518819255.
  13. Schroeder AN, Tenforde AS, Jelsing EJ. Extracorporeal shockwave therapy in the management of sports medicine injuries. Curr Sports Med Rep. 2021 Jun 1;20(6):298-305. doi: 10.1249/JSR.0000000000000851.
  14. Mitchkash M, Robinson D, Tenforde AS. Efficacy of extracorporeal pulse-activated therapy in the management of lower-extremity running-related injuries: findings from a large case cohort. J Foot Ankle Surg. 2020 Jul-Aug;59(4):795-800. doi: 10.1053/j.jfas.2020.02.008.
  15. Congresso Brasileiro de Tratamento por Ondas de Choque, 3º, 2018, São Paulo. Consensos no Tratamento da Síndrome Trocantérica. III Brazilian Congress of Shockwave Treatment (SMBTOC).
  16. Cowan RM, Semciw AI, Pizzari T, Cook J, Rixon MK, Gupta G, Plass LM, Ganderton CL. Muscle size and quality of the gluteal muscles and tensor fasciae latae in women with greater trochanteric pain syndrome. Clin Anat. 2020 Oct;33(7):1082-1090. doi: 10.1002/ca.23510. Epub 2019 Nov 24.

 

 

How to Cite this article: Junior OAFC, Liu IAW | Extracorporeal Shockwave Therapy in Greater Trochanteric Pain Syndrome. | Journal of Regenerative Science | Jan – June 2023; 3(1): 22-25.

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Achilles Tendinopathy, Pathophysiology, Diagnosis, and Management with Shockwave Therapy

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Review Article | Volume 3 | Issue 1 | JRS Jun – June 2023 | Page 26-31 | Paul German Terán , Estefania Anabel Lozada , Alvaro Santiago LeMarie.
DOI: 10.13107/jrs.2023.v03.i01.79

Author: Paul German Terán [1], Estefania Anabel Lozada [1], Alvaro Santiago LeMarie [2]

[1] Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito, Ecuador,
[2] Anatomy Professor, Faculty of Medicine, International University of Ecuador.

Address of Correspondence
Dr. Paul German Terán,
Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito, Ecuador.
E-mail: paulteranmd@gmail.com

Abstract

The Achilles tendon is a strong structure that is frequently injured in runners and jumpers, but it can also be present in patients who do not engage in any sports. This clinical syndrome is characterized by pain, structural changes, and impairment of physical function. Achilles tendinopathy is extensively studied because it can be devastating, with slow and prolonged recovery that can take a year or more, and a high risk of re-injury. This condition is classified into insertional and non-insertional Achilles tendinopathy, depending on the affected region of the tendon. Intrinsic and extrinsic factors contribute to the intratendinous changes in vascularization and elevated pain neurotransmitters. The diagnosis is primarily based on the patient’s clinical history, and imaging techniques such as ultrasound, including sonoelastography, and magnetic resonance imaging can be useful in identifying the nature, location, and extent of the lesion. Treatment options for Achilles tendinopathy include rehabilitation, image-guided injections, shockwave therapy, ultrasound therapy, percutaneous intratissue electrolysis, orthotics, medications, and surgery. Among these options, shockwave therapy may provide the best tolerance, pain relief, and functional recovery.

Keywords: Achilles tendon, tendinopathy, insertional, non-insertional, extracorporeal shock waves.

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How to Cite this article: Terán PG, Lozada EA, LeMarie AS. | Achilles Tendinopathy, Pathophysiology, Diagnosis, and Management with Shockwave Therapy. | Journal of Regenerative Science | Jan – June 2023; 3(1): 26-31.

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Lateral Epicondylitis: General Concepts and Shock Wave Treatment Evidence

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Review Article | Volume 3 | Issue 1 | JRS Jun – June 2023 | Page 32-34 | Ricardo Kobayashi.
DOI: 10.13107/jrs.2023.v03.i01.81

Author: Ricardo Kobayashi [1]

[1] Pain Center, University of S£o Paulo, S£o Paulo, Brazil.

Address of Correspondence
Dr. Ricardo Kobayashi, MD, Phd,
Pain Center, University of S£o Paulo, S£o Paulo, Brazil.
E-mail: institutokobayashi@gmail.com

Abstract

Introduction:Lateral epicondylitis (LE) is one of the most common tendinopathies of the upper extremity characterized by lateral elbow pain, seriously affecting patients’ daily life and work.
Pathophysiology: Anatomically, the common extensor insertion on the lateral epicondyle of the humerus, mostly the extensor carpi radial is brevis tendon insertion, undergoes microtearing associated with a chronic repair process, but hardly any inflammation. The pathoanatomy of overuse tendinopathy is non-inflammatory angiofibroblastic tendinosis. For this reason, the term ‘‘tendinitis’’ is avoided, and ‘‘tendinosis’’ is preferred.
Diagnosis: LE is primarily a clinical diagnosis. The natural history is a gradual onset of pain in the absence of defined trauma. The most
common findings on physical examination are tenderness at the lateral epicondyle of the distal humerus and weakness or pain with resisted wrist extension (the Thomsen test).
Treatment: Non-surgical options are the mainstream treatment for LE, a small proportion of patients eventually undergoes surgery, although surgery for LE is no more effective than non-surgical treatment, based on evidence. Non-operative treatments including rest, application of ice, administration of analgesic medications, orthopedic devices, ultrasound, transcutaneous electrical nerve stimulation, eccentric training, and extracorporeal shock wave therapy (ESWT).
Shockwave Treatment of LE: There are many therapeutic options for treating LE. The existing evidence does not clearly support the efficacy of any of the available treatment methods for this clinical condition. ESWT is not the exception, although it was approved by the U.S. Food and Drug Administration for treating this disease in 2002 and much of the current evidence supports its indication for LE..

Keywords: Lateral epicondylitis, Tennis elbow, Tendinopathy, Shock waves.

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How to Cite this article: Kobayashi R. | Lateral Epicondylitis: General Concepts and Shock Wave Treatment Evidence. | Journal of Regenerative Science | Jan – June 2023; 3(1): 32-34.

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Invitation to the Presentation and Analysis of Prospective Data from a Multicenter Retrospective Study

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Editorial | Vol 2 | Issue 2 |  Jul – Dec 2022 | page: 01-02 | Di Giorno Alfonso

DOI: 10.13107/jrs.2022.v02.i02.049

Author: Di Giorno Alfonso [1]

[1] Scientific Director of Di Giorno Rehabilitation Medical Centers, Focused Shockwave Specialist.

Address of Correspondence
Dr. Di Giorno Alfonso, MD
Scientific Director of Di Giorno Rehabilitation Medical Centers, Focused Shockwave Specialist
E-mail: a.digiorno@ckf-digiorno.com

Editorial:

“FST Focused Shockwave Therapy” is a congress created to communicate the results of one of the largest Italian studies on focused shockwave therapy, carried out with the aim of evaluating the effectiveness of the aforementioned therapy in non-unions and myotendinous pathologies affecting shoulder, elbow, and hip regions.

Studies were made available by the Di Giorno Medical Rehabilitation and Sports Medicine Centers, an Italian national benchmark for focused shock wave therapy with over 35 years of experience, and 50,000 cases treated. This project was possible with the collaboration of the Orthopedic Specialty Schools of Unimore, UniRoma1 Sapienza, UniRoma2 Tor Vergata, and the Magna Graecia University of Calabria.

The Congress will open with greetings from the from the Honorary President of the Congress Prof. Giorgio De Santis, Honorary Citizen of Cosenza and Full Professor of Plastic Surgery and Dean of the Faculty of Medicine and Surgery of UniMoRe and from the President Giorgo Gasparini, Full Professor of Orthopedics, and Traumatology and Director of the School of Specialization in Orthopedics and Traumatology of the University of Magna Graecia in Catanzaro.

The President of the Italian Society of Shock Wave Therapy (SITOD), Dr. Sergio Gigliotti, will present a report.

This will be followed by a lectio magistralis by Prof. Daniel Moya welcome guest as President of the Ibero-American Federation of Shockwaves and Tissue Engineering (Onlat) and former President of the International Society for Medical Shockwave Treatment. Dr. Moya is an orthopedic surgeon specialized in shoulder surgery with decades of experience in the field of regenerative medicine and several publications on the subject.
He will analyze the development of shock waves in Latin-American.
The event will take place in two stages. A morning session of pure scientific discussion carried out by masters of Italian orthopedics, radiology, and rehabilitation medicine, and an afternoon session focused on the study object of the Congress.
The first session will include the discussion of the main shoulder, hip, and elbow tendino-myopathies and non-unions conditions with a focus on certain fundamental aspects for understanding the use of focused shock wave therapy in their treatment.
Prof. Fabio Catani Director of the Unimore Orthopedic Clinic, world expert in hip and knee robotic surgery and Prof Giuseppe Porcellini, Director of the Unimore School of Specialties of Orthopedics and Traumatology and a prominent international figure in shoulder surgery, will take care of enunciating the classifications of the pathologies covered by the Congress.
Afterward, Prof. Gumina, Full Professor in Orthopedics and Traumatology at the Sapienza University of Rome and Director of the Complex Operative Unit in Orthopedics and Traumatology in the “Sapienza” University Department of the Polo Pontino, will deal with the biological aspects and risks.
Prof. Tarantino, Full Professor of Diseases of the Locomotor System at the University of Rome “Tor Vergata,” will address the various topics from a clinical point of view, offering ideas, and applying his experience in the search for signs and suggestive symptoms that can allow to suspect and/or make a differential diagnosis between each of these conditions.
Prof Cacchio, Associate Professor of Physical Medicine and Rehabilitation at the University of L’Aquila with proven experience in the treatment of musculotendinous pathologies with shock waves, will focus on the biomechanics and pathobiomechanics underlying the myotendinous pathologies of interest.
Prof. Elizaveta Kon, Associate Professor at Humanitas University and Humanitas Research Hospital in Milan, scientific and organizational manager for various European and national research projects, will speak about orthobiology and the role of shock waves in this regard.
The radiological aspect, crucial in characterizing and monitoring these pathologies over time, will be discussed by Prof. Monetti, radiologist with extensive experience in the sports medicine and traumatological fields, and author of over 800 publications both nationally and internationally concerning the musculoskeletal system. Professor Monetti will also clarify some aspects regarding radiological monitoring during focused shock wave application.
After the clinical-diagnostic part, the focus of the congress will move toward conservative regenerative therapy, represented by the use of focused shock waves and the topic will be presented by Dr. Maria Cristina D’Agostino former President of SIDOT. During this part of the session, there will be an opportunity to discuss and learn about the ways, in which shock waves allow the regeneration of damaged tissues and the time required to achieve it.

A discussion will then follow on the surgical approaches to the aforementioned pathologies, presented to the public by nationally and internationally renowned experts, with the moderation of Prof. Catani, an expert in biomechanics and physiology of major joints, joint prosthetics, computer-assisted surgery, and robotics in knee and hip joint prosthetics and experience in the orthopedic-regenerative field; together with their experience regarding shock wave therapy. Prof. Cattani will discuss about how orthopedic surgery is currently leaning toward the regenerative rather than the reconstructive area.
The Directors of Orthopedic Clinics and Schools of Specialization in Orthopedics and Traumatology Fabio Catani, Giorgio Gasparini, Umberto Tarantino, Giuseppe Porcellini and Stefano Gumina, with their clinical experience, will also clarify the importance of carrying out appropriate rehabilitative exercises for functional recovery, the correct execution timing and the correct way to perform this regenerative treatment to obtain the maximum benefit for the patient.
During the break, the guests will be entertained with a standing lunch offered by the Congress organization to encourage knowledge and allow dialogue between the various participants.
A workshop on focused shock waves which will have the aim of showing the use of the method according to the Italian school, describing its functioning and correct execution, highlighting the mistakes not to be made to achieve a satisfactory result, and will take place for the whole day in the Medical Center.
The afternoon will focus on the presentation of 300 clinical cases treated with shock waves with stable positive results even 12 months after the start of treatment. The discussion of these cases will be moderated by leading figures of national orthopedics and will have the aim of involving all those present in a constructive way.
The program will be completed by the experience brought by the Spanish-Latin American School, headed by Prof. Daniel Moya, which will be interesting for comparison and growth for those who use the method and for those who want to start using it in the treatment of musculoskeletal pathologies.
Dr. Raffaele Scalpone, diabetologist and President of Dela Aid, will expose about the usefulness of the method in orthopedic pathologies of the diabetic and diabesity.

Finally, the entry of four other pathological conditions will be announced within a new multicenter study with prospective collection of retrospective data in the Medical Rehabilitation and Daytime Sports Medicine Centers located in Bologna, Rome, Cosenza, Lamezia Terme, organized by the four Orthopedics Specialty Schools of UniMoRe UMG Sapienza and Tor Vergata.
The Curia of Cosenza with its auditorium, the museum, the historic cathedral with the Madonna del Pilerio patroness of Cosenza will host us on this day of discussion, on this method, between the schools overlooking the two shores of the ocean. Participants will also have the opportunity to visit the historic center of Cosenza, the 750 km between the Tyrrhenian and the Ionian with the suggestive seaside villages, the beaches, the cliffs and the seabed and the typical products such as the cedars, the citrus plantations, the citrus plantations, the Olive groves and bergamot and then the Sila, the greenhouses, and still the most beautiful kilometer in Italy, the Reggio Calabria seafront, as D’Annunzio defined it, to then go to Aspromonte passing through the Costa Viola, not forgetting Isola Capo Rizzuto, Sibari with its plain and the Albanian countries and the Pollino with its national park, the second park of Europe.

Calabria 1000 before Christ was inhabited by the Italians, now it represents well a miniature Italy, Italy has everything, history, traditions, culture, seas, mountains, plains and many other things.

 

Dr. Di Giorno Alfonso

 

How to Cite this article: Invitation to the Presentation and Analysis of Prospective Data from a Multicenter Retrospective Study.  | Journal of Regenerative Science | Jul – Dec 2022; 2(2):01-02.

 

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Piezoelectric Shock Wave Sources: Are they Still the Cinderella to Treat Musculoskeletal Disorders?

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Technical Notes | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 03-06 | Daniel Moya, Achim M. Loske
DOI: 10.13107/jrs.2022.v02.i02.51

Author: Daniel Moya [1], Achim M. Loske [2]

[1] Department of Orthopaedics, Hospital Británico de Buenos Aires, Argentina,
[2] Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México,
Blvd. Juriquilla 3001, Querétaro, México.

Address of Correspondence
Dr. Daniel Moya, MD
Department of Orthopaedics, Hospital Británico de Buenos Aires, Argentina.
E-mail: drdanielmoya@yahoo.com.ar

Abstract

There are three types of focused shock wave generators: electrohydraulic, electromagnetic and piezoelectric. Although it has been postulated that there are no differences in clinical efficacy between the three, the information available on the results of the use of piezoelectric generators to treat musculoskeletal disorders is very limited.
The objective of this publication is to demonstrate the little existing evidence on piezoelectric generators and to highlight their versatility and promising future.

Keywords: Musculoskeletal disorders, Shock waves, ESWT, Piezoelectric.

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How to Cite this article: Moya D, Loske AM |Piezoelectric Shock Wave Sources: Are they Still the Cinderella to Treat Musculoskeletal Disorders?. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 03-06.

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