Extracorporeal shockwave therapy for the treatment of scaphoid delayed union in a tennis player: A case report

Clinical investigation of extracorporeal shock wave therapy combined with kinesitherapy on the treatment of delayed union of tibia and fibula fractures

OBJECTIVE

To investigate the therapeutic efficacy of extracorporeal shock wave therapy (ESWT) combined with kinesitherapy (KT) for the treatment of delayed union of tibia and fibula fractures.

METHODS

A total of 68 patients with delayed healing of tibiofibular fractures were enrolled. These patients were divided into three groups: control, ESWT, and ESWT+KT. All patients underwent standard surgical treatment following the fracture. Patients in the ESWT group received shockwave therapy twice a week for 4 months, while those in the ESWT+KT group received additional exercise therapy twice a week over the same duration. The control group did not receive any specific intervention during this period. The pain levels of patients in all three groups were assessed using the Numerical Rating Scale (NRS) before and after treatment. Bone repair and callus formation were evaluated using the Lane-Sandhu and Fernandez-Esteve X-ray grading scales before and after treatment. Additionally, walking ability was assessed using the Functional Ambulation Classification (FAC), Hoffer walking ability grade, and Holden walking ability grade before and after treatment.

RESULTS

No significant differences were observed in patient baseline characteristics across the three groups (P > 0.05), indicating comparability among groups. Post-treatment, improvements were noted in the NRS, Lane-Sandhu X-ray scale, Fernandez-Esteve X-ray scale, FAC level, Hoffer grade, and Holden grade in all three groups compared to their respective pre-treatment values (P < 0.05). Notably, the Lane-Sandhu X-ray scale, FAC level, Hoffer grade, and Holden grade showed significant improvements in the ESWT+KT group after treatment compared to the control group (P < 0.05). Additionally, the ESWT group demonstrated significant improvements in FAC level and Holden grade compared to the control group after treatment (P < 0.05).

CONCLUSION

ESWT can enhance the walking function in patients with delayed union of tibia and fibula fractures. ESWT combined with KT demonstrates superior efficacy compared to monotherapy, as it not only improves walking function but also promotes bone healing.

Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review

OBJECTIVE

To determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals.

DESIGN

Systematic review.

DATA SOURCES

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and searched four databases: PubMed (NLM), Embase (Elsevier), CINAHL Complete (EBSCO) and Web of Science (Clarivate).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Included studies were randomised controlled trials, cohort and case-control studies, cases series and reports that evaluated outcomes following ESWT for athletes, physically active individuals and occupational groups requiring regular physical activity such as military cadets.

RESULTS

56 studies with 1874 athletes or physically active individuals were included. Using the Oxford level of evidence rating, included studies were 18 level I (32.1%), 3 level II (5.4%), 10 level III (17.9%), 13 level IV (23.2%) and 12 level V (21.4%). Based on the level I studies, ESWT may be effective alone in plantar fasciitis, lateral epicondylitis and proximal hamstring tendinopathy and as an adjunct to exercise treatment in medial tibial stress syndrome and osteitis pubis in athletes or physically active individuals. In most studies, athletes were allowed to continue activities and training and tolerated ESWT with minimal side effects.

CONCLUSION

ESWT may offer an efficacious treatment alone or as an adjunct to concurrent exercise therapy in selected sports-related injuries and without major adverse events. Further high-level research is needed to better define the role and clinical outcomes of ESWT.