Extracorporeal Shockwave Therapy – Research Articles: Summaries Only

Plantar Fascitis

“High level of efficacy and patient satisfaction.” [Wilner JM, Clin Podiatr Med Surg. 2004 Jul;21(3):441-7, viii]
“An effective form of treatment for proximal insertional plantar fascitis.” [Strash WW, Clin Podiatr Med Surg. 2002 Oct;19(4):467-76]

“A prospective randomized placebo-controlled double-blind multicenter trial shows efficiency and safety of ESWT. A single shock wave application can improve the condition significantly compared with placebo treatment (p = 0.0149). The Roles and Maudsley score also showed a significant improvement between the groups, with 61.6% good or excellent results in the verum group and 39.7% in the placebo group (p = 0.0128). Therapy-related side effects (local swelling, petechia) are rare. The data presented in this study led to FDA approval in January 2002.” [Buch M, Orthopade. 2002 Jul;31(7):637-44]

“Six months after ESWT pain decreased by 64% to 88% on the visual analog scale (VAS) and the comfortable walking time had increased significantly in both groups.” [Hammer DS, Foot Ankle Int. 2002 Apr;23(4):309-13]
”These eight published studies involved 840 patients, with success rates of as much as 88%. 12 studies had methodological variables or lack of appropriate follow-up data that would limit their validity, although the success rates were comparable to the A to C studies. This meta-analysis shows that the directed application of shockwaves to the enthesis of the plantar fascia at the inferior calcareous is a safe and effective nonsurgical method for treating chronic, recalcitrant heel pain syndrome that has been refractory to other commonly used nonoperative therapies. The results suggest that this therapeutic procedure should be considered before any surgical intervention, and may be preferable prior to cortisone injection, which has a recognized risk of rupture of the plantar fascia and a frequent recurrence of symptoms.” [ Ogden JA, Foot Ankle Int. 2002 Apr;23(4):301-8]

“The effect of shockwave therapy was investigated in 79 patients (85 heels) with plantar fascitis with one-year follow-up. The overall results were 75.3% complaint-free, 18.8% significantly better, 5.9% slightly better and none unchanged or worse. The effect of shockwave therapy seemed cumulative and was time-dependent. The recurrence rate was 5%. There were no device-related problems, systemic or local complications. Shockwave therapy is a safe and effective modality in the treatment of patients with plantar fascitis.” [Wang CJ, Foot Ankle Int. 2002 Mar;23(3):204-7]

”Fifty patients with recalcitrant heel pain and a plantar calcaneal spur on the X-ray received in a controlled, prospective and randomized study. The follow-up after 12 months showed clear improvement and relief of pain in both groups on manual pressure and while walking and an increase of the pain-free walking ability from 10 minutes before the treatment to 2 and 3 hours respectively after 12 months. We saw significantly better results after the treatment with 3 x 500 impulses. The extracorporal shock-wave therapy is an effective treatment in refractory heel pain. An amount of at least 3 x 500 impulses in the low energetic treatment is useful.” [Krischek O, Z Orthop Ihre Grenzgeb. 1998 Mar-Apr;136(2):169-74]
ESWT, High Energy (in general)

“Its effects are not well understood. Theorized that neovascularization is responsible for improvement in symptoms. Noninvasiveness and minimal complication rate are its primary advantages. The effects of shock wave therapy seem to be time dependent.” [Strash WW, Clin Podiatr Med Surg. 2002 Oct;19(4):467-76]
”Excellent results in clinical application and research led to widespread use of this noninvasive procedure. Until now the actual mode of action and biochemical pathways remain unknown. A tissue thickness of 15 mm significantly influenced focus characteristics. We found distinct spreading and slight lateral deviation of the focus. In the same way, the peak positive pressure was significantly reduced after the shock waves had passed the musculocutaneous model. The clinical application of extracorporeal shock waves should be modified in intensity and number of shock waves depending on individual anatomic conditions, indication, and location.” [Gerdesmeyer L, Orthopade. 2002 Jul;31(7):618-22]

“An ultrasound controlled treatment was applied in the low and middle energy range, using energy densities of 0.09 to 0.36 mJ/mm2. 65/409 persons in the study were competitive sportsmen. The performed examination exhibits that for conservatively treated tendinoses of the competitive sportsmen, similarly good therapy results concerning the application of ESWT can be reached compared with the classical orthopaedic shockwave therapy. Therefore, for the treatment of a tendinosis, a shock wave therapy should always be taken into account to avoid long exercise and competition breaks due to operative interventions.” [Steinacker T, Sportverletz Sportschaden. 2001 Jun;15(2):45-9]

”After 5 months 85 patients for all three indications a significant improvement of the pain situation could be reached. Patients with plantar fascitis demonstrated the highest decrease of pain, followed by tendinosis calcarea and epicondylitis radialis.” [Maier M, Z Orthop Ihre Grenzgeb. 2000 Jan-Feb;138(1):34-8]
“105 papers referring to ESWT of the locomotor system are rated. Validation was performed for each paper according to the international accepted system of the American Association of Spine Surgery in Type A-E. 4825 cases from 55 publications and abstracts that underwent ESWT were evaluated. 24 papers with 1585 cases (33%) live up to the standards of a scientific investigation. No serious complications were observed. The advantages of ESWT are non-invasiveness and low rate of complications.” [Heller KD, Z Orthop Ihre Grenzgeb. 1998 Sep-Oct;136(5):390-401]

”On the basis of the results achieved, it may be concluded that, for specific indications, extracorporeal shock wave therapy may now be taken out of the clinical testing stage and introduced into routine practice.” [Rompe JD, Fortschr Med. 1997 Jun 30;115(18):26, 29-33]
”The results show the benefit of ESWA in the treatment of chronic soft-tissue disorders without severe side effects. Some patients showed small subcutaneous hematomas and erosion of the skin when energies about 20 mJ were used. Forty-seven of 84 of the patients obtained complete relief; 24 patients showed a marked reduction in their complaints. In only 13 of 84 cases was the treatment unsuccessful.” [Boxberg W, Chirurg. 1996 Nov;67(11):1174-8]

Chronic Calcific Tendinitis of the Shoulder

“4-year outcome was determined in a prospective study of 115 patients. By 4 years after shockwave therapy, 20% of the entire patient population had undergone surgery on the involved shoulder. Subjectively, 78% of patients in group A and 87% in group B thought the shockwave treatment had been successful. Radiologic changes were found in 93% of patients in each group. The failure rate after ESWT is high, but for 70% of the patients in this study, the treatment was successful and no long-term complications were seen.” [Daecke W, J Shoulder Elbow Surg. 2002 Sep-Oct;11(5):476-80]

“The aim of the study was to verify the hypothesis that either high-dose or low-dose ESWT could be effective if the total amount of applied energy was similar. METHOD: Fifty patients were assigned at random to 2 groups. The treatment consisted of 3 x 5000 low-dose impulses without anesthesia (group 1) and 1 x 5000 high-dose impulses with intravenous analgesia (group 2). Extracorporeal shock wave therapy may be an alternative treatment of calcifying tendinitis of the shoulder. Both treatment protocols gave equivalent results.” [Seil R, Z Orthop Ihre Grenzgeb. 1999 Jul-Aug;137(4):310-5]

“In part A 80 patients with chronic symptoms were randomly assigned to a control and three subgroups which had different treatment by low-energy and high-energy shock waves. In part B 115 patients had either one or two high-energy sessions. The results after six months showed energy-dependent success, with relief of pain ranging from 5% in our control group up to 58% after two high-energy sessions. Shockwave therapy should be considered for chronic pain due to calcific tendinitis which is resistant to conservative treatment.” [Loew M, J Bone Joint Surg Br. 1999 Sep;81(5):863-7]

”After 12 weeks 14/20 patients showed a marked improvement of symptoms. The x-rays of 7/20 patients showed a complete resorption of the calcifications, in 5/20 cases partial disintegration of the calcium deposits was seen. The overall morbidity was low with 14/20 patients developing transient hematomas; MRI imaging showed no severe damages of bone and soft tissue.” [Loew M, Urologe A. 1995 Jan;34(1):49-53]

“In a pilot group of 5 patients the deposits were localized by sonography. Immediately after treatment 1 patient felt complete release of pain, the calcium deposit had disappeared on the x-ray control one day after treatment. In 3 cases pain release and elimination of the calcification appeared during 6 weeks after treatment. One patient showed only radiological disintegration of the calcification with no release of pain.” [Loew M, Z Orthop Ihre Grenzgeb. 1993 Sep-Oct;131(5):470-3]

Lateral Epicondylitis (LE)

”Complications such as small hematomas were only found in four patients. After a mean follow-up of 30.7 months, 78 patients could be evaluated with the Roles and Maudsley score. Of these 30.8% had an excellent and 42.3% a good result, while 11.5% had a fair and 15.4% a distinctly poor outcome. Sixty-two patients declared their satisfaction with the ESWT and would agree to have the therapy repeated.” [Decker T, Orthopade. 2002 Jul;31(7):633-6]

”Clinically examined before and after repetitive low-energy ESWT. After a follow-up of 18.6 months clinical evaluation showed a significantly better mean clinical performance than before treatment. Interestingly, male patients showed a significantly better mean clinical performance than female patients, and male and female patients differed significantly in the signal intensity of the common extension tendon cross-section and tendon thickening on MRI. This study reports the first indication of predictability of positive clinical outcome of the treatment of chronic lateral tennis elbow by ESWT using imaging prior to treatment.” [Maier M, Arch Orthop Trauma Surg. 2001 Jul;121(7):379-84]

” Follow-ups were performed at 3, 6, 12, 24 weeks. Statistical analysis showed significant improvement both of subjective and objective criteria. 41/75 patients became painfree. Only 7 patients decided to have an operation after the 24-weeks-follow-up. Ambulatory shock wave therapy is a considerable alternative before surgical intervention in chronic tennis elbow.” [ Rompe JD, Z Orthop Ihre Grenzgeb. 1996 Jan-Feb;134(1):63-6]

Supraspinatus Tendon Syndrome

”No statistically significant differences were proven between ESWT and radiotherapy. “ESWT appears to be at least equivalent to radiotherapy in treating chronic supraspinatus tendinitis syndrome and can avoid a dose of radiation for patients and staff.” [Haake M, Z Orthop Ihre Grenzgeb. 2001 Sep-Oct;139(5):397-402]
”We found functional improvement and pain reduction in both groups 12 weeks after treatment. For the treatment of calcific tendinitis affecting the supraspinatus, we recommend accurate fluoroscopy-controlled focusing of ESWT on the calcification. Focusing on the calcification rather than on the insertion of the supraspinatus tendon is significantly more effective. On the basis of our results, ESWT requires the use of suitable shockwave generators that permit accurate focusing.” [Haake M, Biomed Tech (Berl). 2001 Mar;46(3):69-74]