Effect of Extracorporeal Shock Wave Therapy on Hamstring Tightness in Healthy Subjects: A Pilot Study

PURPOSE: To assess the effect of extracorporeal shock wave therapy (ESWT) for healthy participants with hamstring tightness. MATERIALS AND METHODS: This study was performed at a university rehabilitation hospital. Twenty nine healthy adults with hamstring tightness were enrolled and randomly allocated into four groups (ESWT, stretching exercise, ESWT with stretching exercise, and control). The effects of individual treatments were compared by the finger-to-floor test and popliteal angle. RESULTS: The ESWT group, stretching exercise group and ESWT with stretching exercise group had decreased finger-to-floor distances and right popliteal angles immediately after intervention, compared with the control group (p<0.05). At 4 weeks after completion of the interventions, finger-to-floor distances and the right popliteal angle in only the ESWT with stretching exercise group showed a significant improvement, compared with the control group (p=0.008 and 0.023). CONCLUSION: While ESWT and stretching both reduced hamstring tightness immediately after interventions, only ESWT with stretching exercise maintained the significantly improved relief of hamstring tightness significantly after 4 weeks.

Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

OBJECTIVE: To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. METHODS: Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. RESULTS: Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. CONCLUSION: If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US.

The Effect of Extracorporeal Shock Wave Therapy on the Scar Pain of Burn Patients: A Case Report

PURPOSE: Many burn patients are troubled with pain and paresthesia from healed wounds. Extracorporeal Shock Wave Therapy (ESWT) in various musculoskeletal disease and wounds is reported that it reduces the pain and promotes regenerating of tendon and healing of the wound. Therefore we investigated the effect of ESWT on the scar pain of burn patients. METHODS: On February 2014, three patients admitted to the department of rehabilitation medicine of Hangang Sacred Heart Hospital Burn Center underwent ESWT. One low-energy ESWT (0.05~0.12 mJ/mm2) a week was provided to them for 3 weeks in total. Numerical rating scale (NRS), Nirschl pain phase system, 70-point scoring system, Roles and Maudsley score were evaluated before ESWT, after first and third ESWT. RESULTS: In all three patients, the NRS score was decreased and total scores of Nirschl pain phase system and 70-point scoring system were improved after ESWT compared to before ESWT. Roles and Maudsley scores was poor in all three patients at before ESWT but was acceptable in two patients and good in one patient after third ESWT. CONCLUSION: Extracorporeal shockwave therapy (ESWT) is non-invasive, feasible and effective modality on the scar pain of burn patients.

Effectiveness of Initial Extracorporeal Shock Wave Therapy on the Newly Diagnosed Lateral or Medial Epicondylitis

OBJECTIVE: To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared to local steroid injection. METHOD: An analysis was conducted of twenty-two patients who were newly confirmed as lateral or medial epicondylitis through medical history and physical examination. The ESWT group (n=12) was treated once a week for 3 weeks using low energy (0.06-0.12 mJ/mm2, 2,000 shocks), while the local steroid injection group (n=10) was treated once with triamcinolone 10 mg mixed with 1% lidocaine solution. Nirschl score and 100 point score were assessed before and after the treatments of 1st, 2nd, 4th and 8th week. And Roles and Maudsley score was assessed one and eight weeks after the treatments. RESULTS: Both groups showed significant improvement in Nirschl score and 100 point score during the entire period. The local steroid injection group improved more in Nirschl score at the first week and in 100 point score at the first 2 weeks, compared to those of the ESWT group. But the proportion of excellent and good grades of Roles and Maudsley score in the ESWT group increased more than that of local steroid injection group by the final 8th week. CONCLUSION: The ESWT group improved as much as the local steroid injection group as treatment for medial and lateral epicondylitis. Therefore, ESWT can be a useful treatment option in patients for whom local steroid injection is difficult.

Combination of Intra-articular Injection of Hyaluronate and Extracorporeal Shock Wave Therapy on Knee Osteoarthritis / 中国康复理论与实践

@# Objective To investigate the therapeutic efficacy and side effect of combination of intra-articular injection of hyaluronate and extracorporeal shock wave therapy(ESWT) on patients with knee osteoarthritis.Methods50 patients with knee osteoarthritis were treated by combination of intra-articular injection of hyaluronate and ESWT(study group, n=22) or combination of intra-articular injection of hyaluronate and pain-point injection of betamethasone(control group, n=28). The parameters included pain intensity (Numeric Rating Score, NRS) at rest and at exercise, pain relief rate, the time when pain disappeared and times of betamethasone administration or ESWT. The side effects were also evaluated.ResultsNRS decreased in the two groups after treatment, while NRS was not different between the two groups(P>0.05) except 1 week after the treatment(P<0.01).ConclusionThe combination of intra-articular injection of hyaluronate and extracorporeal shock wave is a safe and effective treatment for knee osteoarthritis.

Dose Related Effect of Extracorporeal Shock Wave Therapy in Lateral Epicondylitis / 대한스포츠의학회지

The aim of this study was to investigate the dose-related effects of extracorporeal shock wave therapy (ESWT) on the lateral epicondylitis of the elbow. Between March 2005 and March 2008, 66 patients who had been treated with extracorporeal shock wave therapy due to lateral epicondylitis of elbow formed the subjects. The subjects were divided into the 1st, 2nd and the 3rd treatment group and evaluated the clinical outcomes by visual analog scale (VAS) and a simple elbow test (SET) at immediate treatment, posttreatment 6 and 12 months, retrospectively. Changes in VAS score between the 2nd and 3rd treatment group and between the 1st and 3rd treatment group showed significant difference only at posttreatment 1 month group (p=0.001, 0.2, 0.1), (p=0.03, 0.08, 0.3), but Visual Analog Scale score at posttreatment 1 month showed no difference within the groups (p=1.0, 0.2, 0.07). SET within and between the groups showed significant difference at posttreatment 6 and 12 months (p<0.05).

Effect of Shock Wave Therapy on Upper Limb Spasticity in Chronic Stroke

OBJECTIVE: To investigate the effect and optimal therapeutic frequency of extracorporeal shock wave therapy (ESWT) on upper limb spasticity in chronic stroke patients. METHOD: Total 16 patients with chronic stroke were evaluated. Patients were divided into 2 groups, one group applied with 4 Hz stimulation, and the other group applied with 8 Hz stimulation. All patients were applied with sham stimulation (0 mj/cm2) at the initial time and with active stimulation (0.030 mj/cm2) 4 weeks later. Target muscles were dorsal interossei and flexor digitorum profundus. The primary outcome was the finger flexor spasticity using the modified Ashworth scale (MAS), which was serially measured before, after 1 week and after 4 week respectively. RESULTS: Before the study, the MAS of 4 Hz group was 3.90±0.87 and 8 Hz group was 3.89±0.93, which showed no significant difference. After 1 week of active stimulation, the MAS of 4 Hz group (2.90±0.81) was significantly smaller than the MAS of 8 Hz group (3.33±0.88). Treatment effects had been continued to 4 weeks. There were no complications associated with ESWT. CONCLUSION: ESWT could be used to reduce spasticity of the upper limb muscles in chronic stroke patients.

Low-energy Extracorporeal Shock Wave Therapy on Chronic Epicondylitis of the Elbow: Clinical and Sonographic Study

OBJECTIVE: To evaluate the effect of extracorporeal shock wave therapy (ESWT) and the improvement of ultrasonographic findings in refractory chronic epicondylitis of the elbow. METHOD: Twenty seven patients (7 men, 20 women, mean age 47) with minimum 1 year history of chronic epicondylitis of the elbow that was unresponsive to conventional therapy were included. Each patient was treated with 3~4 sessions of low-energy (0.06~0.12 mJ/mm2, 2000 impulses) ESWT. A 100-point scoring system, Nirschl score and Roles and Maudsley score were evaluated before treatment and at the 3- and 6-month follow-up. Ultrasonography was performed before treatment and at the 3-month follow-up. RESULTS: Total score of a 100-point scoring system and Nirschl score were significantly improved at the 3- and 6-month follow-up compared to before treatment (p<0.05). Follow up ultrasonography was performed in twenty one patients. Eighteen of 21 patients (85.7%) showed improvement of tendinosis and 4 of 6 patients (66.7%) showed improvement of tear and 3 of 10 patients (30.0%) showed improvement of calcification on ultrasonography. CONCLUSION: ESWT is safe and effective modality in the treatment of refractory chronic epicondylitis of the elbow. And ultrasonography can be a useful method to evaluate the therapeutic effect of ESWT.

Comparison of the Clinical Results of HILT Versus ESWT in the Lateral Epicondylitis

PURPOSE: To compare the clinical results of High intensity laser therapy (HILT) versus Extracorporeal shock wave therapy (ESWT) in the lateral epicondylitis. MATERIALS AND METHODS: Fifty patients who suffer from lateral epicondylitis for more than six month duration were randomly assigned two treatment groups. Group 1 (n=25) was treated with HILT using a HIRO 3.0 laser(ASA srl, Arcugnano, Italy) and total energy was administered approximately 1200J following a standard protocol for each session; Group 2 (n=25) recieved with ESWT treatment using an EvoTron(Switech Medical AG, Kreuzlingen, Switzerland) for a total of 1000 shocks for each session. The patients were evaluated by assessment of pain using visual analog scale (VAS) and simple elbow test (SET). Comparision of overall clinical outcomes were evaluated by Roles and Maudsley score at 9 months. RESULTS: Average VAS and SET scores were significantly improved in two groups, also achieved significant improvement of symptoms at 9 months follow up according to Roles and Maudesley scores(P<0.05). The success rate in the HILT group was 76 % and in the ESWT group was 72 %. CONCLUSIONS: This study suggests that HILT could be considered as effective and noninvasive treatment modality for lateral epicondylitis.

The Effect of Shock Wave Therapy on Upper Limb Spasticityin the Patients with Stroke

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity of elbow and wrist affected by stroke. Methods: We studied 21 patients affected by stroke with spasticity in upper limbs. The neurological status of the stroke patients were evaluated by K-NIHSS and the evaluation of efficacy on the upper limb spasticity were based on modified Ashworth scale (MAS), modified Tardieu scale (MTS), and active elevation of upper limb. Treatment was performed 1 session/week, total 3 sessions in each patient. Patients were evaluated at baseline and 4 weeks after treatment using MAS of elbow flexor and active elevation of upper limb. Patients were monitored at baseline, after sham stimulation, and at 1, 4 weeks after ESWT using MTS of elbow flexor and wrist pronator. RESULTS: After ESWT, patients showed significant improvement in muscle tone of elbow flexor and wrist pronator after the 1st and 4th weeks compared with baseline and sham stimulation (p<0.001). The active elevation of hemiplegic upper limb was significantly increased (p<0.05). CONCLUSION: We suggest the ESWT could be a useful treatment method on upper limb spasticity in the patients of stroke. Further studies with a larger group of patients are warranted.

Effect of Low-energy Extracorporeal Shock Wave Therapy on Calcifying Epicondylitis: Sonographic Follow-up

OBJECTIVE: To evaluate the effect of low-energy extracorporeal shock wave therapy (ESWT) in refractory calcifying epicondylitis. METHOD: Twelve patients (1 man, 11 women, mean age 49), who suffered from refractory medial or lateral epicondylitis (mean duration 22 months) with sonographically verified calcification, were included. Subjects were classified according to radiologic and sonographic findings of calcification. Visual analogue scale (VAS) at rest and activities of daily living (ADL) as well as Nirschl score were evaluated before and 3 months after low-energy (0.06~0.12 mJ/mm2, 1,500~2,000 shocks) extracorporeal shock wave therapy (ESWT). Sonographic changes and Roles and Maudsley score were assessed 3 months after ESWT. RESULTS: VAS at rest and ADL as well as Nirschl score were significantly decreased (p<0.05) after ESWT. Roles and Maudsley score was "Good" in six patients (50%), "Acceptable" in 3 (25%) and "Poor" in 3 (25%) after 3 months. In sonographic classification, "Fragmented type" was observed in five (42%), "Nodular" in 3 (25%), "Small" in 4 (33%). All of eight radiologically positive patients (67%) showed sonographic changes of calcification including one complete resorption (8%), 3 disintegration (25%) and 4 decrease of size or number (33%). All of four radiologically negative patients (33%) were "Small type" and did not show any change of calcification on sonography. CONCLUSION: Low-energy ESWT can help the clinical improvement and resorption of calcification in refractory calcifying medial or lateral epicondylitis. Radio-opaque calcification may be a good indicator of resorption of calcification on sonography after low-energy ESWT.

Achievements and Prospects for Nonunion (review) / 中国康复理论与实践

@#Nonunion of longbones is a significant consequence in treating fractures, which is not easy to treat. Thes reviewed the basic knowledge and main progress regarding the cause, pathogenesis, pathophysiology of nonunion, and the methods that may be applied to the treatment of nonunion especially those non-operative one.

Extracorporeal Shock Wave Therapy for the Treatment of Refractory Plantar Fasciitis / 대한족부족관절학회지

PURPOSE: The objective of this study was to report the outcomes of patients treated with extracorporeal shock wave therapy (ESWT) for refractory plantar fasciitis of the foot. MATERIALS AND METHODS: From November 2005 to October 2006, a total of sixty-two patients with refractory plantar fasciitis were treated with extracorporeal shock wave therapy. The main outcome measurements were visual analogue scale (VAS) and Roles and Maudsley score evaluated before treatment and at one and six months after treatment. RESULTS: Roles and Maudsley score was excellent (0%), good (6.4%), fair (35.4%) and poor (58.2%) before treatment which improved to excellent (56.5%), good (38.7%), fair (4.8%) and poor (0%) at final follow-up. VAS scores also significantly improved after ESWT (p<0.05). There was no statistically significant correlation between clinical results and body mass index (BMI) (p=0.102). CONCLUSION: Extracorporeal shock wave therapy appears to be an effective and safe treatment modality for refractory plantar fasciitis and may help the patient to avoid surgery for refractory heel pain.

Extracorporeal Shock Wave Therapy (ESWT) in Patients with Chronic Proximal Plantar Fasciitis / 대한족부족관절학회지

PURPOSE: To evaluate the results of extracorporeal shock wave therapy (ESWT) for patients with chronic proximal plantar fascitis. MATERIALS AND METHODS: Between April 2005 and April 2006, 35 cases (24 patients) who were followed more than 6 months were evaluated. By EvoTron(R), 2 sessions of ESWT (Group 1: 1200 and Group 2: 1500 shock waves/session of 0.12 mJ/mm2) were performed at 2 weeks interval. The mean age was 40.0 (range, 15-59) years. 13 patients were male and 11 patients were female. Visual analogue scale (VAS) on daily activity and a 100-point scoring system including 70 points for pain and 30 points for function were used. The clinical outcomes were rated as follows: excellent, no pain on daily activity; good, less than 50% of previous VAS; fair, 50-75% of previous VAS; or poor, more than 75% of previous VAS. Excellent and good were graded as satisfactory results. We compare clinical results between groups and evaluate the relationships between clinical results and duration of symptom, fascial thickening and previous steroid injection were evaluated. RESULTS: Overall satisfactory rate were 71.4%. There was no significant difference of clinical results between groups. And there were no significant difference between clinical results and duration of symtom, preoperative fascial thickening and previous steroid injection. CONCLUSIONS: ESWT for recalcitrant chronic proximal plantar fascitis is useful treatment method with high patient satisfaction and pain relief, but more long-term study must be needed.

Shockwave Therapy for Tennis Elbow / 대한정형외과학회잡지

PURPOSE: The aim of this study was to investigate the effects of extracorporeal shock wave therapy (ESWT) an lateral epicondylitis of the elbow. MATERIALS AND METHODS: Twenty-four patients with refractory lateral epicondylitis were treated with shock waves. The patients were evaluated by assessing of pain using visual analog scale (VAS) and a simple elbow test (SET). Overall clinical outcomes were evaluated using Roles and Maudsley scores at 12 months after ESWT. RESULTS: Significant symptom improvement were observed in 20 (83%) patients at the 12 months follow up according to the Roles and Maudesley scores. Average SET and VAS scores were also significantly improved after ESWT (p<0.05). CONCLUSION: This study suggests that shock waves therapy could be considered as an effective and noninvasive treatment modality for refractory lateral epicondylitis of the elbow.

Effect of extracorporeal shock wave therapy on managing heel pain / 中国康复理论与实践

@# ObjectiveTo observe the effect of extracorporeal shock wave therapy (ESWT) on managing heel pain. Methods22 patients were divided into 2 groups,12 cases in treatment group who accepted ESWT, 10 cases in control group.The intensity of morning pain on weight bearing, pain triggered by prolonged walking/standing, pain on tension and palpation tests were assessed by Visual Analogue Scale (VAS) before and after each treatment session, including the follow-up session,3 weeks after treatment. In addition, Mayo Clinical Scoring System (MCSS) was used to evaluate the treatment outcomes. ResultsAfter 3 weeks of treatment and 3 weeks' follow-up, the intensity of pain on tension test(P<0.05)as well as that on palpation test (P<0.01)decreased, the maximum duration of prolonged walking or standing (P<0.05)and MCSS scores (P<0.05)improved. Conclusions ESWT seems to be a more effective treatment modality for managing heel pain.