Combinação de terapia por ondas de choque extracorpórea e agulhamento seco no tratamento de lombalgia crônica incapacitante: um relato de caso / Combination of extracorporeal shockwave therapy and dry needling as treatment of disabling chronic low back pain: a case report

Paciente do sexo masculino, 55 anos, apresentava antecedente clínico de radiculopatia lombar abordado cirurgicamente (discectomia e artrodese L5-S1) em dezembro de 2021, com resolução completa da dor associada. Iniciou com quadro de dor pós-operatória de características distintas. A primeira sessão de tratamento iniciou-se com terapia por ondas de choque extracorpóreas focal direcionada ao quadrado lombar, glúteo médio, glúteo mínimo e região peritrocantérica à direita. Posteriormente, associou-se agulhamento seco em pontos-gatilho presentes nesses mesmos 3 músculos e também no ligamento sacrotuberal direito, junto à inserção do glúteo máximo direito. Numa reavaliação uma semana depois, o paciente referiu uma redução de 70% da intensidade da dor inicial. O mesmo tratamento foi repetido, com resolução completa dos sintomas no final da sessão. Três meses depois, o doente manteve o controle álgico e recuperou totalmente a sua funcionalidade e qualidade de vida anteriores. Neste caso de limitação funcional a longo prazo devido a dor lombar crônica, a combinação da terapia por ondas de choque extracorporais e do agulhamento seco resultou num método eficaz e rápido para obter o alívio da dor e restaurar a funcionalidade anterior. No entanto, são necessários mais estudos para investigar o impacto desta combinação de terapias no controle da dor e na perda de funcionalidade devido à dor lombar crônica.

Male patient, 55 years old, had a clinical background of lumbar radiculopathy and a surgical approach (L5-S1 discectomy and arthrodesis) in December of 2021, with complete resolution of associated pain. One year later, the patient seeks medical treatment, referring a new, different pattern of low back pain, which initiated post-surgery. The first treatment session began with focused extracorporeal shockwave therapy directed at the right quadratus lumborum, gluteus medius, gluteus minimus and peritrochanteric region. Afterwards, dry needling was associated in trigger-points present in those same 3 muscles and also in the right sacrotuberal ligament, close to the insertion of the right gluteus maximus. In a reevaluation one week later, the patient reported a reduction of 70% of initial pain intensity. The same treatment was repeated, with complete resolution of symptoms at the end of the session. Three months later, the patient-maintained symptom control and fully recovered his previous functionality and quality of life. In this case of long-term functional limitation due to chronic low back pain, the combination of extracorporeal shock wave therapy and dry needling resulted in an effective and quick method to achieve pain relief and restore previous functionality. However, more studies are needed to investigate the impact of this combination of therapies in pain management and functionality loss due to chronic low back pain.

Associação de estimulação por ondas de choque a toxina botulínica e baclofeno durante a reabilitação de paciente com lesão medular e trauma cranioencefálico: relato de caso / Association of extracorporeal shockwave stimulation to botulinum toxin and baclofen during an in-patient rehabilitation in spinal cord injury and traumatic brain injury: case report

Recentemente, a terapia por ondas de choque extracorpóreas (TOCE) mostraram-se ser uma promissora tecnologia não invasiva para neuromodulação e recuperação funcional devido a melhora em brotamento neuronal, neuroproteção, controle de neuroplasticidade e reorganização neuronal, além de atuar em fatores de neurogênese. Objetivo: Descrever um caso que usa TOCE como um adjuvante na reabilitação de trauma medular. Relato de caso: LPS, 25 anos, estudante de medicina, sofreu uma queda de altura indeterminada com fratura de C5 e lesão medular associada a trauma cranioencefálico. Na fase aguda, ele se recuperou adequadamente, tendo sido submetido a descompressão e fixação de coluna e hospitalizado por 5 meses devido a disautonomias e infecções urinárias. Após esse período, ele iniciou um programa de reabilitação intensiva para tetraplegia espástica com classificação inicial segundo o ASIA (American Spinal Injury Association) nível C5 motor e C6 sensório. O tratamento incluiu 10 sessões de TOCE, realizadas com Duolith SD1 (Storz Medical, Suíça) com uma densidade de energia de 0,25mJ/mm², 5 cm e 3 cm de profundidade de foco, 2000 pulsos aplicados na linha média de coluna níveis C5 a T1 e 2000 pulsos a 5 cm de profundidade aplicados em região plantar bilateral. Bloqueio com toxina botulínica e fenol foram realizados com resposta parcial apesar da dose otimizada de baclofeno.

Recently, extracorporeal shockwaves (ESWT) have shown as a promising non-invasive technology for neuromodulation and functional recovery, due to improving neuronal budding, neuroprotection, control of neuroplasticity and neuronal reorganization, in addition to acting on neurogenesis factors. Objective: To describe a case that uses ESWT as an adjuvant to the rehabilitation of spinal cord trauma. Case Report: LPS, 25 years old, medical student, suffered a fall from an undetermined height with C5 fracture and spinal cord injury, associated with a cranioencephalic trauma. In the acute phase, he was rescued properly, performed decompression and spinal cord fixation and remained hospitalized for 5 months due to dysautonomia and urinary infections. After this period, he started an intensive in-patient rehabilitation program for spastic tetraplegia with initial classification according to ASIA C5 (motor) and C6 (sensory). The treatment included 10 sessions of ESWT, made with Duolith SD1 (Storz Medical, Switzerland) with an Energy flux density 0,25 mJ/mm2, at 5cm and 3cm depth focus, 2000 pulses each over the spinal cord at the midline of levels from C5 to T1, and 2000 pulses at 5cm depth focus applied at plantar region bilaterally.

Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction - a narrative review

ABSTRACT Objectives: To provide an overview of low-intensity extracorporeal shockwave therapy (LIEST) for erectile dysfunction (ED), pointing out which concepts are already consolidated and which paths we still need to advance. Materials and Methods: We performed a narrative review of the literature on the role of shockwave therapies in erectile dysfunction, selecting publications in PUBMED, including only relevant clinical trials, systematic reviews and meta-analyses. Results: We found 11 studies (7 clinical trials, 3 systematic review and 1 meta-analysis) that evaluated the use of LIEST for the treatment of erectile dysfunction. One clinical trial evaluated the applicability in Peyronie's Disease and one other clinical trial evaluated the applicability after radical prostatectomy. Conclusions: The literature presents little scientific evidence but suggests good results with the use of LIEST for ED. Despite a real optimism since it is a treatment modality capable of acting on the pathophysiology of ED, we must remain cautious, until a larger volume of higher quality studies allows us to establish which patient profile, type of energy and application protocol will achieve clinically satisfactory results.

Estimulação cerebral por pulsos sonoros de baixa frequência como coadjuvante nas alterações das funções corticais superiores / Non-invasive brain stimulation by low-frequency sound pulses as an adjunct to changes in higher cortical functions

Não há dúvidas sobre os prejuízos na vida humana, extensivos à família e sociedade como um todo, abrangendo todos os aspectos funcionais das pessoas envolvidas, além do indivíduo, originados dos traumatismos cranioencefálico, agudos e crônicos, externos ou internos: acidentes, atropelamentos, quedas, crimes, acidente vascular cerebral, doenças com neurodegeneração progressiva, resultando em estados demenciais. Ao longo de meio século, houve a introdução contínua de medicamentos, com resultados usualmente contraditórios e frustrantes, exigindo novas tentativas com outras classes farmacológicas. No todo, a limitação se faz sentir na impossibilidade de reversão ou mesmo de mera estabilização dos danos neurológicos, e inocuidade em termos de estimulação da neuroplasticidade. Uma exceção parece ser uma nova abordagem: a estimulação cerebral profunda por pulsos sonoros de baixa frequência (Transcranial Pulse Stimulation, ou TPS). Ainda pouco conhecida, a não ser em alguns centros de tratamento, tem se mostrado ser um acréscimo válido, por complementar os programas multidisciplinares de reabilitação

There is no doubt about the damage to human life, also extended to family and society as a whole, regarding all the functional aspects of those involved, not only the patient itself, which originates from traumatic brain injury, acute or chronic, for external or internal reasons, such as accidents, run overs, falls, crimes, stroke, progressive neurodegenerative diseases that result in dementia states. Over half a century, drugs have been continuously introduced, however their results have constantly been contradictory and frustrating, requiring new attempts with other pharmacological classes. Overall, the limitation is felt in the impossibility of reversing or even merely stabilizing the neurological damage and inefficacy regarding neuroplasticity stimulation. One exception seems to be a new approach, the non-invasive brain stimulation by low-frequency sound pulses (Transcranial Pulse Stimulation, or TPS). Except for some treatment centers, TPS is still unknown, however it has shown to be a valid adjunct in multidisciplinary rehabilitation programs

Clinical and electrophysiological efficacy of extracorporeal shock-wave therapy in carpal tunnel syndrome: a placebo-controlled, double-blind clinical trial

SUMMARY OBJECTIVE: The aim of this study was to evaluate the efficacy of radial extracorporeal shock wave therapy on pain, functionality, and electrophysiological measurements in carpal tunnel syndrome. METHODS: Between June 2021 and January 2022, a total of 66 wrists in 45 participants with mild-to-moderate carpal tunnel syndrome were included in this double-blind, prospective, randomized, placebo-controlled study. Patients were randomized into two groups, namely, the radial extracorporeal shock wave therapy (group 1, n=33) and the sham radial extracorporeal shock wave therapy (group 2, n=33). Night splints and tendon nerve gliding exercises were given to all participants. The participants were evaluated at baseline and the first month after treatment. Participants were evaluated using a visual analog scale, the Boston Carpal Tunnel Questionnaire, Leeds Neuropathic Symptom and Symptom Assessment, and electrophysiological examinations. RESULTS: A total of 37 participants (a total of 55 wrists, radial extracorporeal shock wave therapy n=27, and sham radial extracorporeal shock wave therapy n=28) completed the study. After the intervention, there was a significant decrease in visual analog scale values (p<0.001) and a significant increase in Boston Carpal Tunnel Questionnaire scores (p<0.001) and Leeds Neuropathic Symptom and Symptom Assessment scores (p<0.001). In electrophysiological measurements, there was a significant decrease in median nerve sensory (p=0.002) and motor (p=0.003) distal latency, and a significant increase in median nerve sensory conduction velocity (p=0.026) was found in the radial extracorporeal shock wave therapy group. CONCLUSION: This study shows that radial extracorporeal shock wave therapy has positive effects on pain, functionality, and electrophysiological measurements for mild-to-moderate carpal tunnel syndrome 1 month after application.

Complementary Ureterorenoscopy after extracorporeal Shock Wave Lithotripsy in proximal ureteral stones: success and complications

SUMMARY OBJECTIVE: The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones. METHODS: The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups. RESULTS: There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524). CONCLUSIONS: It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.

Efficacy of radial shockwave therapy for promoting healing of delayed of forearm fractures in children with ultrasonic guidance / 中华骨科杂志

Objective:To explore the clinical effect of radial extracorporeal shockwave therapy on delayed union of forearm fractures in children with ultrasonic guidance.Methods:A retrospective analysis of information on 18 children with delayed forearm fracture union who received ultrasonic guided extracorporeal shockwave therapy from February 2018 to June 2019 was conducted. Among them, there were 14 males and 4 females; Age: 9.44±3.75 years (range, 3-15 years); All the children were closed forearm fractures, including 13 cases of ulna and 5 cases of radius. Initial fixation methods: intramedullary nails fixation in 8 cases, Kirschner wire fixation in 4 cases, steel plate fixation in 2 cases, external fixation in 2 cases, conservative treatment in 2 cases; The classification of fracture nonunion were: 14 cases of hypertrophy, 4 cases of atrophy; The course of disease was 4.0 (3.0, 6.0) months. The front and lateral X-ray films of the affected side forearm were taken before treatment, 3 months and 6 months after treatment. The scores of callus condition were performed using Lane-Sandhu X-ray scoring standard and Fernandez-Esteve X-ray evaluation standard of callus grade.Results:All children completed treatment and were followed up for 6 months. The bone healing standard was the disappearance of the fracture line shown by anterior and lateral X-ray films. Within 6 months after treatment, 11 patients got bone union. The healing rate was 61.11% (11/18). The average of Lane-Sandhu X-ray scores before treatment, 3 months and 6 months after treatment were 3.0 (1.0, 4.0), 6.0 (4.0, 8.0) and 10.0 (5.0, 12.0), respectively, there were statistically significant differences in pairwise comparisons at each time point. And the average scores of Fernandez-Esteve X-ray evaluation standard for callus grade were 1.0 (1.0, 2.0), 3.0 (2.0, 4.0), and 4.0 (3.0, 4.0), respectively, there were statistically significant differences from 3 months and 6 months after treatment to preoperative group, while there was no statistically significant difference between 3 months and 6 months after treatment. The mixed effects model analysis results showed that only the Lane Sandhu X-ray score and Fernandez Esteve X-ray standard score of callus grade at different follow-up time points were significantly different. There was no statistically significant difference in age, gender, number of shockwave treatments and interval time from the first treatment after the initial fixation.Conclusion:The radial extracorporeal shockwave therapy can effectively treat the delayed healing of forearm fractures in children; the X-ray score has been significantly improved. The treatment is highly accepted by children and their parents, and can be used as one of the methods to treat delayed healing of fractures in children in the future.

Extracorporeal shockwave therapy in shoulder injuries: prospective study / Uso de terapia de ondas de choque em doenças ortopédicas do ombro: estudo prospectivo

ABSTRACT Objective: To evaluate the functional results after the use of extracorporeal shockwave therapy (ESWT) in four groups of patients: tendinopathy, partial rotator cuff injury, adhesive capsulitis and calcareous tendinopathy of the rotator cuff at one month and three months after the end of treatment. Methods: Case series in which patients were evaluated according to the VAS of pain, range of motion of the shoulder, and functional questionnaires DASH and modified UCLA. Results: There was a significant increase in the measure of flexion, lateral rotation and shoulder abduction in the evaluations after treatment in relation to the baseline measurement (p < 0.001) and no evidence of significant difference was found between the post-treatment evaluations at one month and three months follow-up (p > 0.05). There was a significant reduction in the VAS score, increase in the UCLA score and a significant reduction in the DASH score in the post-treatment evaluations in relation to the baseline score (p < 0.001) and a significant improvement in the three-month evaluation in relation to one month (p < 0.05). Conclusion: Extracorporeal shockwave therapy proved to be efficient and safe in the treatment of shoulder pathologies, improving pain, range of motion and functional scores in all groups of patients evaluated in the study. Level of Evidence IV, Case series.

RESUMO Objetivo: Avaliar os resultados funcionais após uso de terapia de ondas de choque (TOC) em quatro grupos de pacientes: tendinopatia, lesão parcial de manguito rotador, capsulite adesiva e tendinopatia calcária do manguito rotador com 1 mês e 3 meses após término do tratamento. Métodos: Série de casos, na qual os pacientes foram avaliados de acordo com a EVA da dor, amplitude de movimento do ombro, e questionários funcionais DASH e UCLA modificados. Resultados: Houve aumento significativo das medidas de flexão, rotação lateral e abdução do ombro nas avaliações após tratamento, em relação à medida basal (p < 0,001) e não houve evidências de variação significativa entre as avaliações pós-tratamento com 1 mês e 3 meses de acompanhamento (p°> 0,05). Houve redução significativa do escore EVA, aumento do escore UCLA e redução significativa do escore DASH nas avaliações após tratamento em relação ao escore basal (p < 0,001) e melhora significativa na avaliação de três meses em relação a um mês (p < 0,05). Conclusão: A terapia de ondas de choque mostrou-se uma terapia eficiente e segura no tratamento das patologias do ombro, com melhora da dor, arco de movimento e escores funcionais em todos os grupos de pacientes avaliados no estudo. Nível de Evidência IV, Série de casos.

Rotura de tendones rotulianos como complicación de mala técnica de aplicación de ondas de presión radial. Reporte de dos casos / Patellar ligament rupture as a complication of poor application technique of radial pressure wave therapy. Report of two cases

RESUMEN La tendinopatía rotuliana se caracteriza por dolor anterior de la rodilla localizado en el polo inferior de la rótula en la unión del tendón rotuliano. Esta es, a menudo, una condición discapacitante que limita la calidad de vida de los pacientes, afecta su capacidad para participar en deportes e incluso dificulta sus actividades cotidianas. El tratamiento de ondas de choque extracorpóreas (ESWT por sus siglas en inglés) ha sido reconocido como una alternativa prometedora y segura para el tratamiento de diversos trastornos musculoesqueléticos, incluida la tendinopatía rotuliana crónica. Sin embargo, existe evidencia limitada con respecto a sus efectos secundarios, en particular las lesiones de tendones asociadas con ESWT. Según el conocimiento de los autores, este es el primer artículo que demuestra evidencia clínica y radiológica de dos pacientes sin factores de riesgo que presentan desgarros parciales del tendón rotuliano después de haber recibido terapia de ondas de presión radiales, también conocida como terapia de ondas de choque radiales, como tratamiento para la tendinopatía rotuliana. El tratamiento con ondas de choque debe ser aplicada por profesionales debidamente capacitados para que se cumplan los requisitos específicos necesarios para garantizar una técnica de aplicación adecuada, minimizar los posibles efectos adversos y mejorar la seguridad del paciente.

ABSTRACT Patellar tendinopathy is characterized by anterior knee pain located at the lower pole of the patella at the junction of the patellar tendon. This is often a disabling condition that limits patients' quality of life, affects their ability to participate in sports, and even hinders their normal daily activities. Extracorporeal shock wave therapy (ESWT) has been recognized as a promising and safe alternative for the treatment of various musculoskeletal disorders - including chronic patellar tendinopathy. However, there is limited evidence regarding its side effects, in particular ESWT-associated tendon injuries. To the authors' knowledge, this is the first report demonstrating clinical and radiological evidence of two patients without known risk factors for partial patellar tendon tears that developed this condition after the application of radial pressure wave therapy - also known as radial shock wave therapy - for patellar tendinopathy. ESWT must be applied by properly trained professionals so that specific requirements needed to guarantee an appropriate application technique, minimize possible adverse effects, and improve patient safety could be met.

Focused extracorporeal shock wave therapy with centrifugal exercise for the treatment of greater trochanteric pain syndrome / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of focused extracorporeal shock wave therapy with centrifugal exercise in the treatment of greater trochanteric pain syndrome.@*METHODS@#From September 2017 to June 2019, 53 eligible cases of greater trochanteric pain syndrome were randomly divided into observation group (29 cases) and control group (24 cases). In observation group, there were 8 males and 21 females, aged from 38 to 62 years old with an average of (49.96±6.39) years old; the course of disease ranged from 6 to 13 months with an average of (8.58±1.99) months;treated with focused extracorporeal shock wave therapy with centrifugal exercise. In control group, there were 5 males and 19 females, aged from 39 to 62 years old with an average of (52.79±5.86) years old;the course of disease ranged from 6 to 14 months with an average of (9.04±2.51) months;treated with centrifugal exercise alone. Visual analogue scale (VAS) and hip Harris score were measured before ESWT treatment and at 1, 2, and 6 months to evaluate relieve degree of pain and functional recovery of hip joint, respectively.@*RESULTS@#At 1 month after treatment, there were no significant differences in VAS, hip Harris score and treatment success rate (all @*CONCLUSION@#In treatment of greater trochanteric pain syndrome, focused extracorporeal shock wave therapy with centrifugal exercise could significantly relieve symptoms of lateral hip pain, improve functional recovery of hip joint with good safety. This treatment strategy is worthy of application and promotion in clinical practice.

Efficacy of penile low-intensity shockwave treatment for erectile dysfunction: correlation with the severity of cavernous artery disease / 亚洲男科学杂志(英文版)

We analyzed the efficacy of penile low-intensity extracorporeal shockwave treatment for erectile dysfunction (ED) combined with cavernous artery disease (CAD). ED was evaluated by the International Index of Erectile Function, subdividing patients into mild and moderate/severe forms. CAD was assessed using penile color Doppler ultrasonography. Patients (n = 111) with a positive outcome after treatment, based upon the minimal clinically important difference of the International Index of ED, were followed up for 3 months and 6 months. We found a significant mean increase in the index of erectile function, with an overall improvement in hemodynamic parameters of the cavernous artery. In particular, 93.9% of the patients with mild ED without CAD responded to treatment and 72.7% resumed normal erectile function. Only 31.2% of the patients with moderate/severe ED and CAD responded to treatment, and none resumed normal erectile function. All patients with mild ED and no CAD maintained the effects of therapy after 3 months, while no patients with moderate/severe ED and CAD maintained the benefits of treatment after 3 months. Thus, patients with mild ED and no CAD have better and longer lasting responses to such treatment, with a higher probability of resuming normal erectile function than patients with moderate/severe ED and CAD.

Low intensity extracorporeal shockwave therapy shifts PDE5i nonresponders to responders

ABSTRACT To evaluate the efficiency of an energy density of 0.05mj/mm2 of low intensity extracorporeal shockwave therapy (Li-ESWT) on erectile dysfunction (ED) patients.A total of 45 ED patients met the inclusion criteria, including 7 PDE5i responders and 38 nonresponders. All the patients have already been delivered 10000 shockwaves of total seven treatment points twice a week for 4 weeks. Simultaneously, questionnaires of International Index of Erectile Function-Erectile Function (IIEF-EF), Erectile Hard Score (EHS) and Minimal Clinical Important Differences (MCID) were evaluated for the efficiency and safety at 8th and 16th weeks.The changes in the IIEF-EF score by MCID suggested that Li-ESWT treatment was effective in 22 PDE5i nonresponders patients (58%) at 8th week. Then at 16th week the number of patients who were effectively treated increased to 27 (71%). Among PDE5i responders, 5 patients (71%) were effective base on MCID at 16th week. Among PDE5i nonresponders 22 patients (58%) achieved erection hard enough for vaginal penetration and increased to 27 (71%) patients at 16th week (EHS ≥3). Moreover, even 3 patients achieved EHS 4 in PDE5i nonresponders at 16th week. Among PDE5i responders, 4 of 7 patients reached EHS of 4 from EHS 3 at 16th week. Apart from this, Li-ESWT treatment was also effective in 9 patients (24%) in PDE5i nonresponders without follow-up PDE5i.Energy flux density (EFD) of 0.05 of Li-ESWT could improve the erectile function of ED patients with PDE5i response. In addition, EFD of 0.05 of Li-ESWT treatment could turn PDE5i nonresponders to responders.

Cardiac shock wave therapy for coronary heart disease: an updated meta-analysis

Abstract Introduction: The aim of this article is to study the efficacy and safety of cardiac shock wave therapy (CSWT) in the treatment of coronary heart disease (CAD). Methods: A comprehensive search of electronic databases and a manual search of conference papers and abstracts were performed until September 30, 2018. The studies using RevMan 5.3 and STATA 14.0 softwares were reviewed, and meta-analyses were performed on 13 indicators, such as a six-min walking distance test (6MWT), New York Heart Association (NYHA) functional class, Seattle Angina Questionnaire (SAQ) score, angina class (Canadian Cardiology Society [CCS]), etc. Results: A total of 26 articles were included. The total patient population was 855, of which 781 patients were treated with CSWT. Meta-analyses indicated that 6MWT (mean difference [MD] 75.64, 95% confidence interval [CI] 49.03, 102.25, P<0.00001) and NYHA (MD -0.70, 95% CI -0.92) in the CSWT group were comparable to those in the conventional revascularization group (MD -0.70, 95% CI -0.92, -0.49, P<0.00001). SAQ (MD 10.75, 95% CI 6.66, 14.83, P<0.00001), CCS (MD -0.99, 95% CI -1.13, -0.84, P<0.00001), nitrate dosage (MD -1.84, 95% CI -2.77, -1.12, P<0.00001), LVEF (MD 3.77, 95% CI 2.17, 5.37, P<0.00001), and SSS (MD -4.29, 95% CI -5.61, -2.96, P<0.00001), SRS (MD -2.90, 95% CI -4.85, -0.95, P=0.004), and the exercise test (standard mean difference 0.57, 95% CI 0.12, 1.02, P=0.01) all showed significant differences. Conclusion: CSWT may offer beneficial effects to patients with CAD, but more large-scale clinical studies are needed to further verify its therapeutic effect.

Lesión del nervio cubital secundario a terapia de ondas de choque extracorpóreas radiales identificada con ultrasonografía de alta resolución: Reporte de caso / Ulnar Nerve Injury After Radial Extracorporeal Shock Wave Therapy Identified With High­Resolution Ultrasonography: Case Report

Mujer de 49 años fue evaluada por desarrollar dolor súbito a nivel de los epicóndilos mediales conjuntamente con entumecimiento y sensación de hormigueo en el cuarto y quinto dedos después de recibir terapia de ondas de choque extracorpóreas radiales (rESWT) como tratamiento para epicondilitis medial bilateral. El examen neurológico reveló signo de Tinel positivo, parestesia y una prueba de discriminación de dos puntos alterada sobre la región cubital del cuarto y quinto dedos. La ultrasonografía de alta resolución demostró hallazgos de lesión nerviosa periférica tales como hipoecogenicidad y aumento del diámetro de ambos nervios cubitales. La paciente mejoró únicamente tras recibir tratamiento conservador, demostrando así una aparente neuropatía compresiva bilateral aguda como resultado de la terapia. ESWT se utiliza como una alternativa prometedora para el tratamiento de diversos trastornos musculoesqueléticos; sin embargo, existe evidencia limitada con respecto a sus efectos secundarios, en particular la mononeuropatía periférica. Según el conocimiento de los autores, este es el primer reporte que demuestra un daño nervioso estructural después de rESWT con el uso de ultrasonografía de alta resolución.

A 49-year old woman was evaluated for developing bilateral acute medial elbow pain, numbness, and tingling sensation in the fourth and fifth fingers after receiving radial extracorporeal shock wave therapy (rESWT) for bilateral medial epicondylitis. Neurologic examination revealed the presence of Tinel's sign, paresthesia and impaired two-point discrimination testing over the ulnar side of the fourth and fifth fingers bilaterally. High-resolution ultrasonography demonstrated findings of nerve injury, such as hypoechogenicity and increased diameter of both ulnar nerves. After conservative treatment, the patient improved her condition demonstrating an apparently acute compressive nerve injury as a result of the therapy. ESWT is used as a promising alternative for the treatment of various musculoskeletal disorders; however, there is limited evidence regarding its side effects, in particular peripheral mononeuropathy. To the authors' knowledge, this is the first report demonstrating structural damage of a nerve after rESWT with the use of high-resolution ultrasonography.

Extracorporeal Shock-Wave Lithotripsy in Renal and Ureteric Calculi: Role in Resource Poor Developing Countries in Modern Era

Introduction: Extracorporeal shock-wave lithotripsy (ESWL)is an established non-invasive treatment modality for renaland ureteric stones. However, treatment outcome and efficacydepends on multiple factors like stone size, location and typeof machine used. We aimed to assess efficacy of ESWL asa primary treatment modality in renal and ureteric stones ina busy hospital setting having significant renal stone diseaseburden.Material and methods:1187 patients who underwent ESWLbetween January 2015 to December 2016 in our departmentwere included in the study. Patients with nephrolithiasis andureterolithiasis having functional kidney, without any absolutecontraindication to ESWL were included. Dornier Med TechCompact Delta 2 machines were used for all the patients.Stone localization was done using both fluoroscopic andultrasound- guided methods by same expert.Results: Out of 1187 patients,887 patients had solitary renalstones,170 had solitary ureteral calculus and 130 patients hadmultiple renal calculi. Stone size ranged from 8mm–20mm.Renal pelvic stones, upper calycial stones and proximalureteric stones had stone free rate of 84%,86% and 82.5%respectively. 89% and 84% of patients were stone free whensize of stone was between 8-12mm, it decreased to 77% and73% when size increased between 13-16mm for kidney andureteric stones respectively.Conclusions: ESWL is an effective primary treatmentmodality for appropriately selected patients with stone sizeless than 2 cm in favorable location with a normal functioningkidney. Use of both fluoroscopic and ultrasound imagingimproves localization of stones thus improving success. Itis an important modality in hands of urologist treating hugevolume of urolithiasis patients in busy hospitals with longwaiting list and with limited resources.

Chronic Intractable Calcific Lateral Epicondylopathy Treated with Ultrasound-Guided Barbotage Combined with Extracorporeal Shock-Wave Therapy

Lateral epicondylopathy represents pain in the lateral (radial aspect) of the elbow caused by degeneration in the common extensor tendon. Calcium deposit frequently developes in lateral epicondylopathy, with the prevalence up to 46%. There are considerable debates on its treatment protocols for lateral epicondylopathy so far, likewise, the effective treatment method for calcific lateral epicondylopathy has not been established. We report here a case of chronic intractable calcific lateral epicondylopathy treated with ultrasound-guided barbotage and focused type extracorporeal shock wave therapy (ESWT). To our knowledge, this is the first report of calcific lateral epicondylopathy treated by ultrasound-guided barbotage combined with ESWT.

Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-Analysis

OBJECTIVE: To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. METHODS: PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria.

Extracorporeal Shock Wave Therapy in Peyronie's Disease: Clinical Efficacy and Safety from a Single-Arm Observational Study

PURPOSE: In this study, we aimed to determine the role of extracorporeal shockwave therapy (ESWT) in the management of Peyronie's disease (PD). MATERIALS AND METHODS: A total of 325 patients suffering from PD were enrolled in this single-arm clinical study. All patients were received ESWT using a schedule of 1 treatment/wk. Penile curvature was measured by a goniometer after intracavernosal drug-induced erection using Alprostadil. Plaque size was measured with a ruler and sexual function assessed by the international index of erectile function (IIEF)-15 score. Severity of erectile dysfunction was classified as severe (IIEF-15 ≤10), moderate (IIEF-15 between 11 and 16), or mild (IIEF-15 between 17 and 25). Results were evaluated at baseline and 3 months after the treatment. RESULTS: All the patients completed the study protocol. Median age was 59.0 years (55.0–64.0 years). After treatment, the median (interquartile range, IQR) plaque size reduced from 1.78 cm2 (1.43–2.17 cm2) to 1.53 cm2 (1.31–1.96 cm2) (p<0.001); the median (IQR) penile length in erection increased from 13.0 cm (12.0–14.0 cm) to 14 cm (13.0–15.0 cm) (p<0.001) and the median (IQR) penile curvature from 30.4° (22.2°–35.4°) to 25.0° (20.2°–30.4°) (p<0.001). We also observed a decrease in pain assessed by visual analogue scale (7 vs. 3; p<0.001), an improvement in each of the IIEF sub-domains (p<0.001) and an improvement in all three PD questionnaire domains (p<0.001). CONCLUSIONS: Based on our findings, ESWT could be considered a safe and efficient minimally invasive option for the management of the patients suffering from PD.

Clinical study of Xiere-Zhuyu-Paishi decoction and auxiliary lithotripsy for the patients withupper ureteral calculi on the effect of stone removal and renal colic relief / 国际中医中药杂志

Objective To observe the effect of stone removal and relieving renal colic with Xiere-Zhuyu-Paishi decoction and auxiliary lithotripsy in patients with upper ureteral calculi. Methods A total of 80 patients with upper ureteral calculi were divided into the observation group and the control group according to the random number table method, with 40 in each group. Both groups were treated with extracorporeal shock wave lithotripsy (ESWL) as the basic treatment. Besides, the control group added the western medicine, such as pain relieving, spasmodic and anti-infection while, the observation group with Xiere-Zhuyu-Paishi decoction. Both groups were treated for 4 weeks. After 1 courses of treatment, the curative effect was evaluated. The effect of lithotripsy (lithotripsy success rate, stone clearance rate, stone expulsion time), renal colic improvement (renal colic rate, analgesic drug usage rate, pain visual analogue VAS score) and WHOQOL-BREF scores were compared. Results After treatment, the total efficiency of observation group was 92.5％ (37/40), while the control group was 75％ (25/40), and the difference was statistically significant (Z=-3.082, P=0.004). After treatment, the observation group stone clearance rate was 92％ (36/40), while the control group was 72.5％ (29/40), and the difference was statistically significant (χ2=3.986, P=0.031). After treatment, the incidence of renal colic of the observation group was 12.5％ (5/40), while the control group was 32.5％ (13/40), and the difference was statistically significant (χ2=3.146, P=0.037). The analgesic drug usage rate in the observation group was 5％ (2/40), while the the control group was 25％ (10/40), and the difference was statistically significant (χ2=4.021, P=0.019). After treatment, the observation group lithecbole time, pain VAS score levels in the observation group was significantly lower than those in the control group (t=6.261,5.743, all Ps<0.01). After treatment, the WHOQL-BREF score, the physiological domain score, psychological field score, social relationship domain score, environment the field score in the observation group were significantly higher than those of control group (t values were 6.731, 4.342, 5.064, 4.521, 5.128, all Ps<0.01).Conclusions The application of Xiere-Zhuyu-Paishi decoction and auxiliary lithotripsy in patients with upper ureteral calculi can promote stone removal in upper ureteral stones, alleviate renal colic and improve the quality of life of the patients.

Treatment of nonunion with autologous bone transplantation combined with platelet-rich plasma and extracorporeal shock wave / 中国骨伤

OBJECTIVE@#To investigate the methods and clinical effects of autologous iliac bone transplantation, platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) in the treatment of nonunion.@*METHODS@#From January 2015 to December 2016, 60 patients with nonunion were treated, including 41 males and 19 females, aged 18 to 42 years old with an average age of 29 years old. Patients with nonunion were divided into autologous bone transplantation treatment group(control group), autologous bone transplantation and platelet-rich plasma(PRP) combined with extracorporeal shock wave(ESW) treatment group(experimental group). The callus formation, local complications, final growth of fracture and Johner-Wruhs functional classification of operative limbs of the two groups were compared 3 months after operation.@*RESULTS@#Fifty-five patients were followed up, 27 in the control group and 28 in the experimental group, 5 patients were lost. The follow-up period ranged from 8 to 24 months. The callus score in the control group was significantly lower than that in the experimental group at 3 months after operation(<0.05). There was no swelling and infection in the skin of the iliac bone acquisition site and non-union operation site in both groups. The clinical and bone healing time of the control group was significantly longer than that of the experimental group(<0.05). In the experimental group, 28 patients achieved bone union; in the control group, 24 patients achieved bone union, and 3 patients had bone nonunion again. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the control group was significantly lower than that in the experimental group(<0.05).@*CONCLUSIONS@#Autologous iliac bone transplantation combined with platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) has a certain effect in the treatment of bone nonunion after fracture surgery. It can significantly improve the formation of new bone. It is a comprehensive and useful way to treat bone nonunion after fracture surgery in clinical work.