衝擊波治療的有關研究
衝擊波的應用範圍廣泛，以下我們搜集了一些研究的摘要，只屬肌肉骨骼系統的研究。 這些文章，在國際上重要的學術會議上曾發表過。我們會將文章分類 並簡要地介紹研究的出處及其結果。您亦可點擊"顯示原文"來閱讀摘要。 為求準確，我們只能以原來的英文版本刊出摘要。 分類：足底筋膜炎(Plantar Fasciitis)
- 台灣長庚醫院對衝擊波治療足底筋膜炎的長期效果研究。
研究結果：衝擊波治療有效及安全、長期效果良好。 - 意大利Roma "La Sapienza"大學對衝擊波治療足底筋膜炎的中期效果研究。
研究結果：衝擊波乃有效的治療。 - 德國Johannes Gutenberg大學醫學院對衝擊波治療競跑運動員足底筋膜炎的研究。
研究結果：衝擊波治療安全及有效。
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Title:
Long-term Results of Extracorporeal Shockwave Treatment for Plantar Fasciitis Author:
Ching-Jen Wang, *Feng-Sheng Wang, *Kuender D. Yang, Lin-Hsiu Weng, Jih-Yang Ko Institution:
From the Department of Orthopedic Surgery and *the Department of Medical Research, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan Background:
Extracorporeal shockwave treatment has shown mixed short-term results for plantar fasciitis. However, the long-term results are not available. Hypothesis:
Long-term results of shockwave treatment are comparable with short-term results. Study Design:
Randomized controlled clinical trial; Level of evidence, 1. Methods:
This prospective study consisted of 149 patients (168 heels) with an established diagnosis of chronic plantar fasciitis, including 79 patients (85 heels) in the shockwave treatment group and 70 patients (83 heels) in the control group. In the shockwave group, patients received 1,500 shock wave impulses at 16 kV on the affected heel in a single session. Patients in the control group received conservative treatment consisting of nonsteroidal anti-inflammatory drugs, orthotics, physical therapy, an exercise program, and/or a local cortisone injection. Patients were evaluated at 60 to 72 months (shockwave group) or 34 to 64 months (control group) with a 100-point scoring system including 70 points for pain and 30 points for function. The clinical outcomes were rated as excellent, good, fair, or poor. Results:
Before treatment, the groups showed no significant differences in the scores for pain and function. After treatment, the shockwave group showed significantly better pain and function scores as compared with the control group. The overall results were 69.1% excellent, 13.6% good, 6.2% fair, and 11.1% poor for the shockwave group; and 0% excellent, 55% good, 36% fair, and 9% poor for the control group (P < .001). The recurrence rate was 12% (9/81 heels) for the shockwave group versus 55% (43/78 heels) for the control group (P < .001). There were no systemic or local complications or device-related problems. Conclusion:
Extracorporeal shockwave treatment is effective and safe for patients with plantar fasciitis, with good long-term results.
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Title:
Extracorporeal Shockwave Therapy (ESWT) in The Treatment of Plantar Fasciitis Authors:
P.Papandrea MD, M. Ciurluini MD, A. Ferretti MD Institution:
"Kirk Kilgour" Sports Injury Center, Department of Orthopaedic Surgery St. Andrea Hospital, University of Roma "La Sapienza", Italy Objectives:
evaluate medium-term clinical results of symptomatic treatment of plantar fasciitis. Methods and Measures:
From October 1998 to December 2004, 82 patients affected by plantar fasciitis, 14 of whom with a bilateral pathology, for a total of 96 cases, were treated with ESWT. On the basis of the inclusion criteria indicated by ISMST, 58 patients (67 cases) were included in the study.
44 patients (29 males and 15 females) aged between 21 and 77 years (average 56 year) were reviewed at 1 month, 4 month, 17-month follow up. 9 patients were affected by bilateral plantar fasciitis, for a total of 53 cases re-examined. 25 patients (30 cases) played sports activity. X-rays showed the presence of calcaneal spur in 34 patients.
In the pre-treatment phase, the symptomathology was classified into 5 stages according to the severity of pain and its effects on daily activities.
a) Stage 0: lack of pain;
b) Stage 1: pain only after intense physical activity or after playing sports;
c) Stage 2: pain and stiffness during intense physical activity or during sports;
d) Stage 3: pain during daily activities;
e) Stage 4: pain at rest and at night.
An average of four sessions (min 3, max 5) of shockwaves were administered (power from 0.04 to 0.250 mJ/mm2, 2000-2.500 impulses for each session). Clinical outcomes were evaluated according to the following criteria (based on the symptomathological classification mentioned above):
-Excellent: lack of pain (stage 0);
-Good: stage I with an improvement of at least two stages;
-Fair: improvement of one stage;
-Poor: no improvement.
Results:
At 1 month follow-up, 49% of patients reported satisfactory results (excellent and good results), at 4 months follow-up the percentage increased to 68%, at 17 month follow-up to were 81%. At 40 month f. up it was possible to review 15 patients (19 cases), satisfactory results were 84%. Regarding the 34 patients affected by plantar fasciitis in association with calcaneal spur, at 17 month follow-up satisfactory results were 73%, no radiological evidence of disappearing of the spur was obtained.
Among the 25 sport players (30 cases) satisfactory results were 57% at 1 month, 80% at 4 month, 90% at 17 month follow-up. Conclusion:
shockwave therapy represents a valid, non-invasive symptomatic treatment for patients with plantar fasciitis.
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Title:
Shockwave Application for Chronic Plantar Fasciitis in Running Athletes. A Prospective, Randomised, Placebo-Controlled, Double-Blinded Trial. Authors:
Jan D. Rompe, Jens Decking, Carsten Schulner, Bernhard Nafe Institution:
Department of Orthopaedic Surgery, Johannes Gutenberg University School of Medicine, Mainz, Germany AIM:
To assess the efficacy of repeated low-energy shock wave application for chronic fasciitis in runners. MATERIALS AND METHODS:
Forty-five running athletes with intractable plantar heel pain were enrolled in a randomized single-blind trial with a parallel-group design and blinded independent observer, to evaluate the efficacy of three applications of 2100 impulses of low-energy shock waves (Group I) compared with placebo treatment (Group II). Followup examinations were done at six months, and at one year after extracorporeal shock wave application. Symptoms had been present from one year to six years. Each patient satisfied numerous inclusion and exclusion criteria before he or she was accepted into this study. The primary efficacy endpoint was reduction of subjects self-assessment of pain on first walking in the morning on a visual analog scale (range, 0 - 10 points) at six months after shock wave application. RESULTS:
After six months self-assessment of pain on first walking in the morning showed a significant reduction from an average seven to 2.1 points in Group I, and from an average seven to 4.7 points in Group II on the visual analog scale. The difference of 2.6 points between both groups was significant six months after the intervention (p= 0.0004, 95% CI: 1.9 - 3.3 points; power > 0.9). Twelve of nineteen patients (63%) of the treatment group versus six of twenty patients (30%) of the sham group reported a >50% improvement. After twelve months 81% of the patients of the treatment group versus 37% of the patients of the placebo group rated accordingly. Co-interventions remained on a comparable, low level in both groups. CONCLUSION:
The current study showed that three treatments with 2100 impulses of low-energy shock waves were a safe and effective nonsurgical method for treating chronic plantar fasciitis in runners.
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- 台灣長庚醫院對衝擊波治療足底筋膜炎的長期效果研究。
跟腱炎(Achilles Tendinopathy)
- 意大利Universita degli Studi di Milano大學對衝擊波治療跟腱炎的研究。
研究結果：衝擊波治療對跟腱炎是一個有效及安全的治療工具。 - 美國Bucknell大學對衝擊波治療跟腱炎的研究。
研究結果：衝擊波治療對慢性跟腱炎是一個安全及有效的治療。
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Title:
Overuse Achilles tendinopathy: ESWT vs placebo. An 18 months follow up study Authors:
F. Astore, V. Sansone, L. Spotorno Institution:
Departement of Orthopaedics, Universita degli Studi di Milano, IRCCS Humanitas, Rozzano (Milan), Italy The purpose of this study is to evaluate if Extracorporeal Shock Wave Therapy (ESWT) be considered potentially useful for overuse Achilles tendinopathy resistant to prolonged conventional non-operative treatment. METHODS
A prospective, double-blind clinical trial was performed to compare the outcomes of a standard treatment with ESWT with 2000 impulses of ESWT with energy flux density of 0.25 mJ/mm2 in the painful segment of the Achilles tendon, at weekly intervals for 3 weeks and placebo in subjects dedicated to sport and affected by non-insertional Achilles tendinopathy which failed to improve after current conservative treatments. The comparison was submitted to the chi-square test for a significance level of 95%. Of a total of 102 patients, affected by intractable Achilles tendinopathy, 51 received ESWT and 51 received Placebo. The main outcome measurement were Visual Analogical Scale and 60-point scoring system. RESULTS
87 patients concluded the study (44 ESWT and 43 Placebo). At 18 months follow-up: in the ESWT group 10 (22.8%) good, 23 (52.2%) fair and 11 (25.0%) poor; in the Placebo group 5 (11.6%) good, 12 (27.9%) fair and 26 (60.5%) poor. DISCUSSION
The management of Achilles tendinopathy is usually conservative and few therapeutic measures can be considered effective. Sometimes a slow spontaneous recovery is present. Surgery is indicated after exhausting periods of conservative treatment, but the results are controversial and frequently not satisfactory. The good results obtained with ESWT without significant risks and the controversial results of operative treatment of tendon disorders in athletes prompted us to consider ESWT for those sportsmen affected by non-insertional chronic tendinopathy of Achilles who failed to improve significantly after conventional conservative treatment. CONCLUSION
In conclusion ESWT confirmed to be an effective and safe therapeutic tool for Achilles tendinopathy resistant to conventional non-surgical management.
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Title:
ESWT as a treatment for chronic insertional Achilles tendinosis Authors:
J Furia Institution:
Bucknell University, SUN Orthopedics and Sports Medicine Lewisburg, PA USA Purpose:
The purpose of this study was to determine the efficacy of high energy extracorporeal shockwave therapy (ESWT) for the treatment of adults with chronic insertional Achilles tendinosis and to determine if use of a local anaesthesia field block has an adverse effect on outcome. Type of Study:
Retrospective case-control. Methods:
Between June 1 2003 and January 31 2004, 68 patients with chronic insertional Achilles tendinosis were enrolled in this study. Each patient had failed to respond to a minimum of six months of traditional non-operative treatments. Thirty-five patients were treated with a single dose of high energy shock wave therapy (ESWT group). Thirty-three patients were treated with additional forms of traditional non-operative measures (control group). All procedures were performed by a physician using either a local anaesthesia field block (12 patients) or an anesthesia other than local (23 patients). Each of the ESWT patients received a total of 3000 shocks for a total energy flux density of 604mJ/mm2. T-tests and analysis of variance (ANOVA) were used to test for differences in visual analog scores (VAS) between the ESWT and control groups. Results:
Four weeks post treatment, the mean visual analog score (VAS) for the control and ESWT groups were 8.2 (range, 6-10; SD=1.1) and 4.2 (range, 1-10; SD=2.4) respectively (t=8.7, P < .001). Twelve weeks post treatment, the mean VAS for the control and ESWT groups were 7.2 (range, 5-9; SD=1.3) and 2.9 (range, 1-10; SD=2.1) respectively (t=10.1, P < .001). Fifty-two weeks post treatment, the mean VAS for the control and ESWT groups were 7.0 (range, 4-9; SD=1.2) and 2.8 (range, 1-10; SD=2.2) respectively (t=9.7, P < .001). Using the Roles and Maudsley scale, 2 of the control patients (6.1%) and 6 of the ESWT patients (17.1%) were assigned an excellent result and 11 of the control patients (33.3%) and 23 of the ESWT patients (65.7%) had a good result at the final endpoint. ANOVA testing at 52 weeks post treatment revealed that the mean improvement in VAS score for the local anaesthesia subgroup was significantly less than the corresponding gain in the anaesthesia other than local subgroup ( F=16.77 verses F=53.95, P<.001). There were no significant complications. Conclusions:
ESWT is a safe and effective treatment for chronic insertional Achilles tendinosis. Local field block anaesthesia appears to decrease the effectiveness of this procedure.
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- 意大利Universita degli Studi di Milano大學對衝擊波治療跟腱炎的研究。
膝蓋腱炎(Patellar Tendinopathy)
- 意大利Roma "La Sapienza"大學對衝擊波治療膝蓋腱炎的研究。(文中Jumper's Knee即膝蓋腱炎)
研究結果：衝擊波對膝蓋腱炎是一有效的療法。
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Title:
Treatment of Jumper's Knee with Extracorporeal Shock Wave Therapy Author:
M.C. Vulpiani, D. Trischitta, M. Vetrano, V. Savoia, E.Di Pangrazio, A. Ferretti Institution:
St. Andrea Hospital, University "La Sapienza" Rome, Italy Jumper’s knee affects mostly individuals who play sports particularly jumping athletes. In this study we have included 73 sports patients, 54 male and 19 female, age range between 15 and 69 (mean age: 32). Since 10 patients were affected by bilateral tendinopathy, a total of 83 tendons were treated. All patients underwent clinical and instrumental diagnosis in order to recognize the presence, the location and the seriousness of the specific tendinopathy associated or not with calcific areas of metaplasia in the tendon to be diagnosed. The pain symptomathology was classified using VAS and according to a 5 stage clinical evaluation range. The treatment was performed using 2 different devices, produced by STORZ, both equipped with electromagnetic generators with cylindrical coil and providing ultrasonography capability. The protocol, identical for both generators, called for an average of 4 sessions (min. 3 - max. 5), administered in 2 to 7-day time intervals with 1,500-2,500 shocks applied with an EDF between 0.08 and 0.44 mJ/mm2.
The evaluation of the post-treatment results was assessed on the basis of the average VAS score and on the subjective clinical evaluation range. In conclusion, we obtained satisfactory results in 73.5% of cases (Excellent in 54.2% and Good in 19.3%). The successful treatment in performing athletes (16 tendons) was satisfactory in 87.5% with an average time of resuming sport at approximately 6 weeks. In our opinion, shock waves are a valid conservative therapy for the treatment of jumper’s knee, in accordance with what is found in literature.
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- 意大利Roma "La Sapienza"大學對衝擊波治療膝蓋腱炎的研究。(文中Jumper's Knee即膝蓋腱炎)
肩關節炎
- 德國Technical University of Munich大學對衝擊波治療肩鈣化性筋腱炎的研究。
研究結果：衝擊波對肩鈣化性筋腱炎是最佳的療法。 - 意大利Universita egli studi del Piemonte Orientale大學對衝擊波治療肩鈣化性筋腱炎的研究。
研究結果：衝擊波對肩鈣化性筋腱炎是有效的療法。 - 意大利University of Rome "La Sapienza"大學對衝擊波治療肩Impingement Syndrome的研究。
研究結果：衝擊波對肩Impingement Syndrome是有價值的療法。
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Title:
The Effectiveness of Extracorporal Shock Wave Therapy on Tendinitis of the Shoulder Author:
L. Gerdesmeyer, S. Wagenpfeil, G. Handle, M. Loew, K. Lehmkuhler, S.Gassel, R. Seil Institution:
Dept of Orthopaedic Surgery and Sportstraumatology, Technical University of Munich, Germany Calcified lesions of the shoulder of the rotator cuff are a common problem in orthopaedic practice. The incidence vary from 2.5% to 20% in patients with asymptomatic shoulders and as much as 54% in patients with shoulder pain. The lesions are mostly located in the supraspinatus tendon close to the insertion area in the critical zone. Patients with calcifying tendinosis were usually treated conservatively ( physiotherapy, analgesics, subacromial injection, ...). Uthoff described the circle of the desease which is mostly self-limiting and at least 10% of patients may require open or arthroscopic surgery. Extracorporeal shock wave therapy ( ESWT ) in treatment of these calcified lesions was first described by Dahmen in Germany. Two different shock wave therapy techniques were know. The low energy one with a mean energy flux density lower than 0.08 mJ/mm2 and the high energy one with energy levels of more than 0.28 mJ/mm2 . Dahmen first used the low energy shock wave and described an analgetic effect. Loew used the high energy level and found a pain relief and also changings of the lesions in most cases. There is an increasing number of clinical trials showing a success in 60% to 80% of patients. Mostly these trial were uncontrolled prospective designed. A better trial was published by Loew et al. They reported there results and stated the high energy ESWT is effective. But a least there is no trial with a design in accordance to the ICH/GCP guidelines. Only these trials have the statistical power and evidence to show the efficacy of a treatment method. Haake at al showed that the application of ESWT must be controlled to verify the position of the ESWT focus. Treatment techniques without control mechanism showed a worther outcome than techniques with an exact fluoroscopic controlled focussing application. Materials and methods:
First we completed a feasibility study to find out the treatment effect size and calculate the sample size. A prospective randomized placebo controlled study in accordance to the ICH and GCP guidelines was designed based on the results of the feasibility trial. We treated 48 patients in low energetic, high energetic and control group each to have the right statistic power. One treatment group received 2 x 1500 high energetic shock waves with mean energy flux density of 0,32 mJ/mm2 and the other one got 2 x 6000 low energetic shock waves with mean energy flux density of 0,08 mJ/mm2 , 48 patients of the blinded placebo group receiced a sham therapy. We used the same device in all patients so we could exclude device related effects. The device we used called EPOS FLUOROR, manufactured by DORNIER MED TECHR. The primary criteria was the Constant-Murley-Score, second criterias the visuell analogue scale and changings of deposit size in x-ray examination. The ESWT was indicated after failed complete conservative therapies. Between the two application setting we have an time interval of two weeks. In all sessions the patients could get an analgosedation if the pain was uncomfortable. An air chambered foil inhibits the transmission of the shock waves from ESWT emmitter into the shoulder in the controlgroupe. The clinical and radiological examinations were done by a blinded observer, during the hole trial phase an independed monitor guaranteed that the protocol was followed by the coworkers. The statistic evaluations, data monitoring and auditing were done independently from applicator and blinded observer. The patients were randomized after they have fullfill the inclusion and exclusion criterias and after they have given a writen informed consent to get the ESWT and to take part of the trial. Comparative analyses were done on an intention-to-treat basis. No prospective cessation rules were defined and no interim analysis was planned. The study protocol was approved of by the ethics committee at the authors’ institution. Results:
24 weeks after ESWT the patients treated with high and low energetic ESWT have a significant better outcome as the shame group by scoring the Constant-Murley-Score ( p<0.001 ). The second-criterias as the visuell analogue scale and the morphological appearence of the deposits changed with high statistical difference ( p<0.001 ). No severe side effects caused by shock waves were observed. In some cases we observed a transient reddening and small cutaneous petechial bleeding but all of them disappeared within 6 weeks when the patients came to the first follow up visit. The comparison between high and low energetic ESWT showed significant better outcome after high energetic ESWT. Discussion:
The exact mechanisms of the therapeutic effect of extracorporeal shock wave therapy for treatment of calcified lesions of the shoulder are still uncertain. Although some investigations show a direct mechanical effect that leads to a mechanical disintegrating effect on the deposit. Other authors prefer a long-lasting hyperstimulation analgesia. The shock waves iniciate an increase of blood flow with increasing oxygen supply of the critical zone. That can induce the further ongoing of the natural selfhealing cycle. In chronic calcified tendinitis of the rotator cuff, the cycle, described by Uthoff rests in the calcific stage. The application of extracorporal shock waves pushs the cycle further to the postcalcific stage that leads to a complete restitutio. Because of the natural history and the normally self limiting deasease of the tendinosis, the shock waves treatment should not used in acute patients. Most of these patients with an acute tendinitis still move from the calcific stage to the postcalcific stage and should only be treated in a symptomatic analgetic of antiphlogistic way. Compared to other published data regarding calcific tendinitis of the shoulder, no study fulfils the requirements of GCP guidelines to show efficacy. Conclusion:
The high energetic shock wave therapy is the best evidence based treatment in calcified lesions of the shoulder and must be indicated before operative intervention.
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Title:
ESWT Treatment in Calcific Tendinitis of the Shoulder Author:
D. Rozzati, A. Littera, E. Cignini, S. Festari, G. Sessa , A. Carriero Institution:
Universita egli studi del Piemonte Orientale “A.Avogadro” SCDU Radiodiagnostica A.O. Maggiore della Carita Novara - Corso Mazzini 18 28100 NOVARA - Italy The objective of our study was to evaluate the effectiveness of ESWT treatment for symptomatic calcific tendonitis of the shoulder.
Our 2 years experience lasted from Jan. 2004 to Jan. 2006. We treated 110 patients, 44 males and 66 females, (age ranging from 32 to 83 years) with painful shoulder calcific tendinitis who were unresponsive to other conservative therapies. We used a REFLECTRON - HMT ESWT System using a protocol which consisted in one treatment of 500 shocks (frequency 240 shocks/min) each week for three weeks. The treatment was successful in 83 patients with symptomatic resolution. In 21 patients we observed at the post-treatment X-Ray control the complete vanishing of periarticular calcifications. In 39 patients there was a volumetric reduction of the calcifications. 20 patients experienced no change. 1 patient presented a volumetric increase of the calcification. 2 patients showed a symptomatic improvement. Conclusions:
In our experience ESWT can be accepted as a valid conservative treatment in calcific tendinitis of the shoulder leading to a symptomatic, functional and radiological improvement.
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Title:
Extracorporeal Shockwave Therapy (ESWT) in Impingement Syndrome. Medium and Long-Term Results. Authors:
P. Papandrea, MC Vulpiani, M Ciurluini, E Monaco, A Ferretti Institution:
University of Rome "La Sapienza" Italy Purpose of this study was to evaluate efficacy of low-energy shockwave therapy in Impingement Syndrome of the shoulder. MATERIALS AND METHODS:
From December 1997 until December 2001, 247 patients (263 shoulders) affected by this painful syndrome of the shoulder were treated. One hundred and twenty-eight of the patients were females and one hundred and nineteen were males. The patient's range in age was from 16 years to 84 years, with a mean age of 54. All the shoulders were classified, according to clinical evaluation and "imaging" data (X-rays, Ultrasound and MRI) in the three Neer stages (Stage I: inflammation, degeneration; Stage II: partial rotator cuff tear; Stage III: complete rotator cuff tear). X-ray examination was used to document calcified areas in the shoulders. The patients underwent an average of four sessions (Min 3-Max 5), once a week, and received 2500 impulses of the energy density 0,04 - 0,07 mmJ/mm2; in the calcifying tendinitis the energy used was from 0,07 to 0,17 mmJ/mm2. Follow up was at 1 year, 2 years and 3 years post treatment. All of the patients were evaluated pre- and post- ESWT according to Constant score. RESULTS:
The patients treated with ESWT have clinically and statistically significant improvement in function and an important reduction of pain. At 1 year follow-up 80% of patients had excellent and good results: at 2 years follow-up the results excellent and good were 74%. At 3 years follow-up they were 67%. No complications were noted in this study. CONCLUSIONS:
The results of this study show that ESWT is a valuable option for Subacromial Impingement Syndrome patients, when other conservative treatment options have failed, also versus surgical treatment.
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- 德國Technical University of Munich大學對衝擊波治療肩鈣化性筋腱炎的研究。
網球肘(Lateral epicondylitis)
- 台灣長庚醫院對衝擊波治療網球肘的研究。
研究結果：衝擊波治療網球肘是安全和有效的療法。 - 加拿大University of British Columbia大學對衝擊波治療工作引起的網球肘的研究。
研究結果：衝擊波治療網球肘是有效的療法。 - 韓國Hallym University Sacred Heart Hospital醫院對衝擊波治療網球肘的研究。
研究結果：衝擊波治療網球肘是有效的療法。
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Title:
Shockwave Therapy for Patients with Lateral Epicondylitis of the Elbow: a One to Two Years Follow-Up Study Authors:
Ching-Jen Wang, Han-Shiang Chen* Institution:
Department of Orthopedic Surgery and Department of Surgery *, Chang Gung Memorial Hospital / Kaohsiung Medical Center, Taiwan The effect of shock wave therapy was investigated in 57 patients (58 elbows) with lateral epicondylitis of the elbow. Forty-three patients (44 elbows) with one to two years follow-up were included in this study. In addition, 6 patients (6 elbows) were treated as control study. This series included 24 men and 19 women with an average age of 46 (range 33-66) years. One patient was treated for bilateral elbows. The right elbow was affected in 28 cases and left elbow 16. Each patient was treated with 1000 impulses of shock wave at 14 kV to the affected elbow. A 100-point scoring system was used for evaluation including 40 points for pain, 30 points for function, 20 points for strength and 10 points for elbow motion. The intensity of pain was based on a visual analogue scale from 0 to 10. The average follow-up time was 17.4 (range 12, 26) months. The overall results were complaints free in 27 (61.4)%, significantly better in 13 (29.5)%, slightly better in 3 (6.8%) and unchanged ! in 1 (2.3%). Recurrent pain of lesser degree was noted in 3 patients (6.8%) including 1 at 12 months after one treatment, and 2 at 24 months after two treatments. In the control group, however, the results were unchanged in all 6 patients. There was no device-related problems, systemic or local complications. Shock wave therapy is a safe and effective modality in the treatment of patients with lateral epicondylitis of the elbow.
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Title:
Clinical Focusing and Low Energy ESWT in the Treatment of Work-Induced Chronic Lateral Epicondylitis Author:
Brian Day MD FRCS (C) Institution:
Associate Professor, Department of Orthopaedics, University of British Columbia, Canada Methods:
41 patients with work-related lateral epicondylitis of over 6 months duration, who had been referred for consideration of surgery because of failed conservative treatment (rest, bracing, anti-inflammatory agents, physiotherapy and steroid injections) were included in the ESWT study group. Five once-weekly treatments of low energy shock wave therapy were applied using the Siemens Basic Sonocur. The technique emphasized the role of clinical focusing with shock waves being targeted at the point of maximal tenderness with direct patient feedback. The analgesic affect allows the energy level to be slowly increased and focusing is rechecked every 200-400 impulses. A total of 2000 impulses were applied in each treatment session. Imaging and local anaesthesia were not used. The control group, who had similar inclusion and exclusion criteria, underwent surgical treatment. The primary outcome measurement was return to work status and secondary outcomes assessed were changes in pain, function and overall patient satisfaction. Three and 6 month post-treatment assessments were performed. Results:
76% of those in the ESWT treatment group returned to work, compared to only 30% after surgery. Furthermore, of those, 83% of the ESWT group returned to full-time work compared with 43% in the surgery group. Patient satisfaction in the ESWT group was 81%. There were no complications in either group. It is concluded that low dose ESWT using a clinical focusing technique is an effective non-invasive method for the treatment of chronic refractory lateral epicondylitis in workers and appears to have results that are superior to surgery.
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Title:
A Preliminary Study on Clinical Outcomes of Lateral Epicondylitis after ESWT: Importance of Radiologically Detectable Calcification in Extensor Tendons Authors:
Seok-Beom Lee, Duck-Joo Kwon, Jong-Cheol Jung, Yong-Joon Song, Sung-Kyu Cha, Kee-Byung Lee Institution:
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Pyungchon, Korea PURPOSES:
This study was to investigate the effects of ESWT on lateral epicondylitis and to elucidate the importance of calcification in extensor tendons detectable by plane film and/or ultrasonography in clinical outcomes. MATERIAL AND METHODS:
24 subjects with refractory lateral epicondylitis were treated with 1000 impulses of shockwaves at 14 Kv using an OssaTron orthotriptor (High Medical Technology, Kreuzlingen, Switzerland). Average age being 45 (range: 33-57). Eighteen subjects were female and 6 were male. Duration of symptom was 2.1 years on average (range: 1 month ?4 years). All the subjects had steroid injections before shockwave therapy. The subjects were evaluated by Simple Elbow Test (SET) questionnaire of the University of Washington and Visual Analogue Scale (VAS) analysis before and after ESWT. Comparison of clinical outcomes for the subjects with and without calcification in the extensor tendon detectable by plane film and/or ultrasonography was tried to determine if this could be a possible prognostic factor in clinical settings. Follow up was carried out at 6 and 12 months after ESWT. RESULTS:
Significant improvement of symptoms were observed in 20 (83 %) patients at 6 and 12 months follow up. 4 (17%) patients did not respond to treatment. Average SET and VAS scores were substantially improved after ESWT. Calcification deposits of varying sizes were documented in 12 patients (50%) by plane film and/or ultrasonography. Ultrasonography could also show swelling of tendons and fluid accumulation about lateral epicondyle as well as tiny calcifications that could not be found on plane film. The subjects with calcification in the extensor tendons improved significantly better, when compared to the subjects without calcification at follow-up. CONCLUSIONS:
This study suggests that shockwave therapy could be considered an effective noninvasive treatment modality for refractory lateral epicondylitis of the elbow. The shockwave treatment seemed to be more successful for patients with calcific deposits in extensor tendons, which were detected by plane film and/or ultrasonography.
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- 台灣長庚醫院對衝擊波治療網球肘的研究。
肌肉激發點(Trigger Points)
- 德國Orthopadische Privatpraxis Dr.med. Hannes Muller-Ehrenberg對衝擊波治療肌肉激發點的研究。
研究結果：衝擊波能成功治療肌肉激發點的痛症。
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Title:
Extracorporeal Shockwave Therapy In Myofascial Pain Syndrome Authors:
H. Muller-Ehrenberg, MD Institution:
Orthopadische Privatpraxis Dr.med. Hannes Muller-Ehrenberg Tibusplatz 6 48143 Munster, Germany Myofascial Pain Syndrome is one of the most common causes of acute and chronic pain of the musculoskeletal system. It is characterized by myofascial trigger points (MTrPs), which are hyperirritable spots in a palpable tense band of skeletal muscle. MTrPs are caused by a dysfunction from involved motor endplates, which is followed by a segmental shortening of groups of sarcomeres.
Diagnostic approach is based on the criteria defined by J.Travell and D.Simons: while palpating the hyperirretable MTrP a characteristic referred pain and familiar pain (recognition) is elicited. Effective diagnosis and treatment requires clinical experience and diagnostic skill, especially palpation ability. Exact pressure or impulse with minimum irritation or even damage of the collateral tissue is needed to identify and release MTrPs. The focussed extracorporeal shockwave therapy (ESWT) is, on the contrary to the radial ESWT, able to apply an exact mechanical impulse on a small spot to release MTrPs.
Moreover the focussed ESWT was also able to reproduce, while treating a MTrP, the referred and also the familiar pain of the patient.
In a pilot study 40 patients with various musculoskeletal pain have been examined and treated by an experienced medical doctor (Triggerpunkt-Therapeut -IMTTR) and identified MTrPs were treated by focussed ESWT (Piezoson 100 plus, Fa. Wolf). In more than 90% of the cases the characteristic referred pain and familiar pain (recognition) has been elicited by the focussed ESWT, when precisely the MTrP was hit by the exact impulse. This study revealed that the focussed ESWT is able to improve the diagnosis of MTrPs and also to treat musculoskeletal pain successfully. CONCLUSION:
In clinical routine there was so far no imaging method or laboratory test of MTrPs. Diagnosis depended entirely on history and physical examination. The use of the focussed ESWT detects MTrps accurately and will lead us more often to recognize muscle-tissue being the cause of most of musculoskeletal pain.
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- 德國Orthopadische Privatpraxis Dr.med. Hannes Muller-Ehrenberg對衝擊波治療肌肉激發點的研究。
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