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Majidi L, Khateri S, Nikbakht N, Moradi Y, Nikoo MR. The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: a systematic review and meta-analysis of randomized control trials. BMC Sports Sci Med Rehabil 2024; 16:93. [PMID: 38659004 PMCID: PMC11041007 DOI: 10.1186/s13102-024-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Tendinopathy is a common condition that affects the body's tendon structures, causing discomfort, restricted movement, and reduced functionality. In this study, we looked at how extracorporeal shock wave therapy (ESWT) affected pain levels in individuals with various forms of tendinopathy around the world. DESIGN This study is a comprehensive review and meta-analysis of previously published randomized controlled trials. To gather relevant data, the researchers performed keyword searches in international databases, including PubMed (Medline), Scopus, Web of Sciences, Cochrane Central Register of Controlled Trials (CENTRAL), Research Registers of ongoing trials (ClinicalTrials.gov), as well as Embase. The search was conducted up until March 2023. The quality of the selected articles was assessed using the Cochrane risk-of-bias method for randomized trials (RoB2). RESULTS Based on the results of the meta-analysis, which included 45 clinical studies, the use of ESWT was found to have a significant impact on reducing pain in various conditions. The standardized mean difference (SMD) in patients with plantar fasciitis (PF) was reduced by 1.63 (SMD: -1.63, 95% CI: -3.04, -0.21; I2: 77.36%; P heterogeneity: 0.0001). For lateral epicondylitis (LE), the SMD was 0.63 (SMD: -0.63, 95% CI: -1.11, -0.16; I2: 67.50%; P heterogeneity: 0.003). In the case of chronic Achilles tendinopathy, the SMD was 1.38 (SMD: -1.38, 95% CI: -1.66, -1.10; I2: 96.44%; P heterogeneity: 0.0001). Additionally, in individuals with rotator cuff tendinopathy, the SMD for pain reduction was 2.37 units (SMD: -2.37, 95% CI: -3.58, -1.15; I2: 98.46%; P heterogeneity: 0.0001). CONCLUSION This study suggests that ESWT can be a highly effective therapy option for relieving pain in people with tendinopathy. Nonetheless, it is encouraged to make additional recommendations based on high-quality clinical research and more accurate information in order to define the optimal therapeutic options for each type of tendinopathy.
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Affiliation(s)
- Lobat Majidi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Sorour Khateri
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran.
| | - Nikta Nikbakht
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Yousef Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Reza Nikoo
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran.
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Worden JA, Gabig AM, Cooke HL, Gottschalk MB, Wagner ER. The Top 100 Classical and Contemporary Papers on Elbow Surgery: A Trend Analysis of Elbow Surgery Literature. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00002. [PMID: 38421605 PMCID: PMC10906574 DOI: 10.5435/jaaosglobal-d-23-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Bibliometric analyses provide an aggregate of the most frequently cited literature in a given field. The purpose of this study was to analyze the top 100 most-cited classical and contemporary papers relating to elbow surgery to serve as a reference for surgeons and trainees for educational and research purposes. METHODS A search was conducted for all papers containing the term "elbow" in the categories Orthopedics, Surgery, and Sports Science in the Clarivate Web of Science. Classical papers were those published from 1980 to 2009, and contemporary papers were those published from 2010 to 2019. Articles were assessed by country of origin, authors and their credentials, parent journal, level of evidence, and topic. RESULTS Citation frequency ranged from 86 to 867. Among the classical group, there were more level IV papers compared with level I papers; however, the opposite was true in the contemporary group. The most common topic in the classical group was elbow anatomy and function, and the most common topic in the contemporary group was lateral epicondylitis and medial epicondylitis and associated therapies. DISCUSSION This bibliometric analysis serves to help guide surgeons and trainees on the highly cited articles and important topics in elbow surgery, demonstrating a shift to prospective randomized controlled trials in recent years. LEVEL OF EVIDENCE Level V (Systematic Review with Level V as Lowest LOE).
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Affiliation(s)
- Jacob A. Worden
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Andrew M. Gabig
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Hayden L. Cooke
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Michael B. Gottschalk
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Eric R. Wagner
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
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Guidetti M, Naci A, Cerri A, Pagani R, Previtera AM, Priori A, Bocci T. Shock waves modulate corticospinal excitability: A proof of concept for further rehabilitation purposes? Restor Neurol Neurosci 2023; 41:219-228. [PMID: 38217555 DOI: 10.3233/rnn-231371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
Background Focal extracorporeal shock wave therapy (fESWT) is a physical therapy vastly studied and used for various musculoskeletal disorders. However, the effect of fESWT on central nervous system is still to be determined. Objective To elucidate spinal and supra-spinal mechanisms of fESWT in healthy subjects, in order to widen the spectrum of its clinical applications. Methods In this quasi-experimental, unblinded, proof-of-concept clinical study, 10 voluntary healthy subjects underwent fESWT and were assessed immediately before (T0), immediately after (T1) and seven days after (T2) the intervention. As neurophysiological outcomes, motor evoked potentials (resting motor threshold, maximal motor evoked potential and maximal compound muscle action potential ratio, cortical silent period, total conduction motor time, direct and indirect central motor conduction time), F-waves (minimal and mean latency, persistence and temporal dispersion) and H-reflex (threshold, amplitude, maximal H reflex and maximal compound muscle action potential ratio, latency) were considered. Results Resting motor threshold and F-waves temporal dispersion significantly decreased, respectively, from T1 and T2 and from T0 and T2 (for both, p < 0.05). H-reflex threshold increase between T0 and T1. Analysis disclosed a strong negative correlation between Δ3 cortical silent period (i.e., T2 -T1 recordings) and Δ1 Hr threshold (i.e., T1 -T0 recordings) (r = -0.66, p < 0.05), and a positive strong relationship between Δ3 cortical silent period and Δ3 Hr threshold (r = 0.63, p < 0.05). Conclusions fESWT modulates corticospinal tract excitability in healthy volunteers, possibly inducing an early inhibition followed by a later facilitation after one week.
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Affiliation(s)
- Matteo Guidetti
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Anisa Naci
- Neurophysiology Unit, Foundation Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Cerri
- Rehabilitation Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Milan, Italy
| | - Rossella Pagani
- Rehabilitation Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Milan, Italy
| | - Antonino Michele Previtera
- Rehabilitation Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
- Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
- Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Milan, Italy
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Ryskalin L, Morucci G, Natale G, Soldani P, Gesi M. Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life (Basel) 2022; 12:life12050743. [PMID: 35629410 PMCID: PMC9146519 DOI: 10.3390/life12050743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 12/11/2022] Open
Abstract
In recent years, extracorporeal shock wave therapy (ESWT) has received increasing attention for its potential beneficial effects on various bone and soft-tissue pathologies, yielding promising outcomes for pain relief and functional recovery. In fact, ESWT has emerged as an alternative, non-invasive, and safe treatment for the management of numerous musculoskeletal disorders, including myofascial pain syndrome (MPS). In particular, MPS is a common chronic painful condition, accounting for the largest proportion of patients affected by musculoskeletal problems. Remarkably, sensory innervation and nociceptors of the fascial system are emerging to play a pivotal role as pain generators in MPS. At the same time, increasing evidence demonstrates that application of ESWT results in selective loss of sensory unmyelinated nerve fibers, thereby inducing long-lasting analgesia. The findings discussed in the present review are supposed to add novel viewpoints that may further enrich our knowledge on the complex interactions occurring between disorders of the deep fascia including changes in innervation, sensitization of fascial nociceptors, the pathophysiology of chronic musculoskeletal pain of MPS, and EWST-induced analgesia. Moreover, gaining mechanistic insights into the molecular mechanisms of pain-alleviating effects of ESWT may broaden the fields of shock waves clinical practice far beyond the musculoskeletal system or its original application for lithotripsy.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Gianfranco Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
- Museum of Human Anatomy "Filippo Civinini", University of Pisa, 56126 Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
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Analgesic Effect of Extracorporeal Shock-Wave Therapy in Individuals with Lateral Epicondylitis: A Randomized Controlled Trial. J Funct Morphol Kinesiol 2022; 7:jfmk7010029. [PMID: 35323612 PMCID: PMC8955256 DOI: 10.3390/jfmk7010029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
This study was conducted to investigate the effect of extracorporeal shock-wave therapy (ESWT) on pain, grip strength, and upper-extremity function in lateral epicondylitis. A sample of 40 patients with LE (21 males) was randomly allocated to either the ESWT experimental (n = 20) or the conventional-physiotherapy control group (n = 20). All patients received five sessions during the treatment program. The outcome measures used were the Visual Analog Scale (VAS), the Taiwan version of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and a dynamometer (maximal grip strength). Forty participants completed the study. Participants in both groups improved significantly after treatment in terms of VAS (pain reduced), maximal grip strength, and DASH scores. However, the pain was reduced and upper-extremity function and maximal grip strength were more significantly improved after ESWT in the experimental group. ESWT has a superior effect in reducing pain and improving upper-extremity function and grip strength in people with lateral epicondylitis. It seems that five sessions of ESWT are optimal to produce a significant difference. Further studies are strongly needed to verify our findings.
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Yalçın Ü. Comparison of the effects of extracorporeal shockwave treatment with kinesiological taping treatments added to exercise treatment in myofascial pain syndrome. J Back Musculoskelet Rehabil 2021; 34:623-630. [PMID: 33682694 DOI: 10.3233/bmr-200234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although studies examined kinesiological taping (KT) and extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome (MPS), no study has yet compared these two treatments. OBJECTIVE This study aimed to compare the efficacy of KT and ESWT on pain, pain threshold, functional level and neck movements in the treatment of MPS, which is an important cause of disability and constitutes 50-80% of chronic painful diseases. METHODS Two hundred and sixty-two patients diagnosed with MPS in the upper part of the unilateral trapeze muscle were included in the study. The patients were divided into three groups according to the treatment they received: Group 1 (n= 75): ESWT + exercise, Group 2 (n= 82): KT + exercise, Group 3 (n= 105) and the latter receiving only exercise therapy (control group). Visual analog scale (VAS), pain threshold with algometer, Neck Disability Index (NDI), and neck contralateral lateral flexion angle were assessed before and three months after treatment. RESULTS VAS, pain threshold, NDI and contralateral flexion angle values after treatment improved significantly in the ESWT and KT groups (p< 0.05) compared to the control group. The level of improvement in the ESWT group was higher (p< 0.05) than in the KT group in terms of VAS, pain threshold and NDI scores. CONCLUSION Exercise, KT and ESWT applications in MPS were effective in all of the parameters examined. However, the ESWT + exercise therapy was more effective in terms of pain, pain threshold and disability.
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Basoli V, Chaudary S, Cruciani S, Santaniello S, Balzano F, Ventura C, Redl H, Dungel P, Maioli M. Mechanical Stimulation of Fibroblasts by Extracorporeal Shock Waves: Modulation of Cell Activation and Proliferation Through a Transient Proinflammatory Milieu. Cell Transplant 2021; 29:963689720916175. [PMID: 32326741 PMCID: PMC7586264 DOI: 10.1177/0963689720916175] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Extracorporeal shock waves (ESWTs) are “mechanical” waves, widely used in regenerative medicine, including soft tissue wound repair. Although already being used in the clinical practice, the mechanism of action underlying their biological activities is still not fully understood. In the present paper we tried to elucidate whether a proinflammatory effect may contribute to the regenerative potential of shock waves treatment. For this purpose, we exposed human foreskin fibroblasts (HFF1 cells) to an ESWT treatment (100 pulses using energy flux densities of 0.19 mJ/mm2 at 3 Hz), followed by cell analyses after 5 min, up to 48 h. We then evaluated cell proliferation, reactive oxygen species generation, ATP release, and cytokine production. Cells cultured in the presence of lipopolysaccharide (LPS), to induce inflammation, were used as a positive control, indicating that LPS-mediated induction of a proinflammatory pattern in HFF1 increased their proliferation. Here, we provide evidence that ESWTs affected fibroblast proliferation through the overexpression of selected cytokines involved in the establishment of a proinflammatory program, superimposable to what was observed in LPS-treated cells. The possibility that inflammatory circuits can be modulated by ESWT mechanotransduction may disclose novel hypothesis on their biological underpinning and expand the fields of their biomedical application.
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Affiliation(s)
- Valentina Basoli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems - Eldor Lab, Innovation Accelerator, CNR, Bologna, Italy
| | - Sidrah Chaudary
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Allgemeine Unfallversicherungsanstalt (AUVA) Research Centre, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Sara Cruciani
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems - Eldor Lab, Innovation Accelerator, CNR, Bologna, Italy
| | - Sara Santaniello
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems - Eldor Lab, Innovation Accelerator, CNR, Bologna, Italy
| | - Francesca Balzano
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Carlo Ventura
- Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems - Eldor Lab, Innovation Accelerator, CNR, Bologna, Italy
| | - Heniz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Allgemeine Unfallversicherungsanstalt (AUVA) Research Centre, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Peter Dungel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Allgemeine Unfallversicherungsanstalt (AUVA) Research Centre, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Margherita Maioli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems - Eldor Lab, Innovation Accelerator, CNR, Bologna, Italy.,Center for Developmental Biology and Reprogramming- CEDEBIOR, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Institute for Genetic and Biomedical Research, National Research Council (CNR), Monserrato, Cagliari, Italy
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Jiang Z, Chen JW, Haughan J, Stefanovski D, Soma LR, Robinson MA. Gene transcripts expressed in equine white blood cells are potential biomarkers of extracorporeal shock wave therapy. Drug Test Anal 2021; 14:973-982. [PMID: 34008346 DOI: 10.1002/dta.3099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 12/27/2022]
Abstract
Extracorporeal shockwave therapy (ESWT) is a treatment applied to musculoskeletal injuries in equine athletes to alleviate pain and accelerate healing. ESWT also causes acute tissue damage. Therefore, its ability to act as an analgesic and cause tissue damage potentially increases the risk of a catastrophic event if used shortly before a strenuous competition such as horseracing. While ESWT is prohibited by many racing jurisdictions within 10 days prior to competition, a test to detect whether a horse has received ESWT is needed. ESWT changes the protein levels of inflammatory mediators in blood, and white blood cells (WBC) typically produce these proteins. Changes in gene expression precede changes in protein production; thus, it was hypothesized that WBC gene transcripts might serve as biomarkers of ESWT. To test this hypothesis, six thoroughbred horses received a single administration of ESWT to the distal limb, and WBC RNA was extracted from blood samples collected before (0 h) and after ESWT (2, 4, 6, 24, 48, and 72 h). Targeted and untargeted analyses evaluated the transcriptome using quantitative PCR (qPCR) and microarray. The expression of IL-1α, IL-1β, TNF-α, IL-1Ra1, IL-1Ra2 and TGF-β1, and BMPR1A in circulating WBCs was significantly up-regulated, while IFN-γ, ZNF483, TMEM80, CAH6, ENPP, and S8723 were significantly down-regulated at various time points following ESWT. These data support the hypothesis that changes in WBC gene transcripts could serve as biomarkers for ESWT.
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Affiliation(s)
- Zibin Jiang
- Department of Clinical Studies - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Jin-Wen Chen
- Department of Clinical Studies - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Joanne Haughan
- Department of Clinical Studies - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Darko Stefanovski
- Department of Clinical Studies - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Lawrence R Soma
- Department of Clinical Studies - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Mary A Robinson
- Department of Clinical Studies - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
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Efficacy of Nonoperative Treatments for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2021; 147:112-125. [PMID: 33002980 DOI: 10.1097/prs.0000000000007440] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lateral epicondylitis is a common overuse injury affecting approximately 1 to 3 percent of the population. Although symptoms may disappear spontaneously within 1 year, the clinical guidelines for conservative treatment are not clear. The authors' objective was to examine the outcomes of nonsurgical treatments for lateral epicondylitis through a meta-analysis and provide a treatment recommendation using the available evidence. METHODS The authors searched the PubMed, EMBASE, Scopus, and Web of Science databases to identify primary research articles studying conservative treatments (electrophysiotherapy, physical therapy, and injections) for lateral epicondylitis. The authors included randomized controlled trials published in peer-reviewed journals. Data related to outcomes (pain, grip strength, Patient-Rated Tennis Elbow Evaluation score, and Disabilities of the Arm, Shoulder and Hand score) and complications were extracted. RESULTS Fifty-eight randomized controlled trials were included in the meta-analysis. Electrophysiotherapy was effective in improving pain [mean difference, -10.0 (95 percent CI, -13.8 to -6.1)], Patient-Rated Tennis Elbow Evaluation score [mean difference, -10.7 (95 percent CI, -16.3 to -5.0)], and Disabilities of the Arm, Shoulder and Hand score [mean difference, -11.9 (95 percent CI, -15.8 to -7.9)]; and physical therapy improved pain [mean difference, -6.0 (95 percent CI, -9.7 to -2.3)] and Patient-Rated Tennis Elbow Evaluation scores [mean difference, -7.5 (95 percent CI, -11.8 to -3.2)] compared to placebo. Injections did not improve any outcome measures. Patients who received electrophysiotherapy and injections reported higher adverse effects than physical therapy patients. CONCLUSIONS Patients who received electrophysiotherapy and physical therapy reported statistically and clinically improved scores in pain and function compared to placebo. Injections may put patients at higher risk for adverse effects compared to other conservative treatments. When managing lateral epicondylitis conservatively, electrophysiotherapy and physical therapy should be prioritized before other interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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Karanasios S, Tsamasiotis GK, Michopoulos K, Sakellari V, Gioftsos G. Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis. Clin Rehabil 2021; 35:1383-1398. [PMID: 33813913 DOI: 10.1177/02692155211006860] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of extracorporeal shockwave therapy compared with other interventions on pain, grip strength and disability in patients with lateral elbow tendinopathy. DATA SOURCES MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, Cochrane Library and clinical trial registries. REVIEW METHODS We included randomized controlled trials assessing the effectiveness of extracorporeal shockwave therapy alone or as an additive intervention compared with sham or other interventions. Pain intensity, grip strength and elbow disability were used as primary outcome measures. We assessed methodological quality with the PEDro score and quality of evidence with the GRADE approach. RESULTS Twenty-seven studies with 1871 patients were finally included. Extracorporeal shockwave therapy reduced pain intensity at mid-term follow-up (standardized mean difference: -1.21, 95% confidence interval:-1.53, -0.89, P < 0.001) and improved grip strength at very short- (mean difference:3.92, 95% confidence interval: 0.91, 6.94, P = 0.01) and short-term follow-up (mean difference:4.87, 95% confidence interval:2.24, 7.50, P < 0.001) compared with sham treatment. However, no clinically significant results were found between comparators in all outcomes and follow-up times. Extracorporeal shockwave therapy presented clinically better compared to Laser in grip strength at short-term (mean difference:3.50, 95% confidence interval:2.40, 4.60, P < 0.001) and ultrasound in pain intensity at very-short-term follow-up (standardized mean difference: -1.54, 95% confidence interval: -2.60, -0.48, P = 0.005). CONCLUSION Low to moderate certainty of evidence suggests that there are no clinical benefits of extracorporeal shockwave therapy compared to sham interventions or corticosteroid injections. Based on very-low and moderate certainty of evidence, extracorporeal shockwave therapy outperforms against Laser and ultrasound, respectively.Level of Evidence: Therapy, level 1a.
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Defoort S, De Smet L, Brys P, Peers K, Degreef I. Lateral elbow tendinopathy: surgery versus extracorporeal shock wave therapy. HAND SURGERY & REHABILITATION 2021; 40:263-267. [PMID: 33636381 DOI: 10.1016/j.hansur.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022]
Abstract
Lateral elbow pain caused by tendinopathy - tendinosis - or tennis elbow is a highly prevalent problem. Unfortunately, no treatment method can guarantee clinical success. Inspired by the lithotripsy technique used for kidney stones, extracorporeal shock wave therapy (ESWT) has been introduced as an alternative to surgical treatment 25 years ago. In a randomized prospective study, we compared 15 patients with lateral elbow tendinopathy who were operated and 14 who underwent ESWT. Almost all patients had good or excellent outcomes according to the criteria by Verhaar. Subjective improvement was 57% for the ESWT group and 76% for the surgery group. No significant differences between both groups were found (p = 0.07). We therefore recommend considering non-invasive techniques such as ESWT treatment prior to surgery in tennis elbow.
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Affiliation(s)
- S Defoort
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - L De Smet
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - P Brys
- Department of Radiology, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - K Peers
- Department of Physical Medicine and Rehabilitation, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - I Degreef
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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Shockwave Therapy Modulates the Expression of BMP2 for Prevention of Bone and Cartilage Loss in the Lower Limbs of Postmenopausal Osteoporosis Rat Model. Biomedicines 2020; 8:biomedicines8120614. [PMID: 33333838 PMCID: PMC7765335 DOI: 10.3390/biomedicines8120614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 01/25/2023] Open
Abstract
Osteoporosis (OP) causes bone loss and weakness, increasing the risk of bone fracture. In this study, rats were divided into Sham, OP, SW(F) (0.25 mJ/mm2 with 1600 impulses to the left medial femur), and SW(T) (0.25 mJ/mm2 with 1600 impulses to the left medial tibia). The bone strength results following SW(T) were better than SW(F) in the modulus, extension at peak load, handleability, and strain at break. SW(T) had the best prevention for bone loss in both lower limbs of ovariectomized (OVX) rats. The cartilage cellular matrixes of both knees were improved in SW(T) and SW(F) compared to that of OP. Serum bone morphogenetic protein 2 (BMP2) in rats undergoing SW(T) or SW(F) was significantly improved compared to that in Sham and OP. The expressions of BMP2, BMP4, and SMAD family member 4 (Smad4) in addition to the Wnt family member 3A (Wnt3a) and Cyclin D1 signaling key factors were significantly induced in the cartilage of both knees by shockwave (SW). SW(T) presented the best efficacy to induce serum BMP2 to prevent bone loss from both lower limbs. Here, we display the protective effects of SW therapy to induce BMP2, BMP4, Smad4, Wnt3a, and Cyclin D1 signaling factors for cartilage loss in both knees of OVX rats.
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Bowman M, Shindel AW. Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ismael MMM, Arafa MM, El Zohiery AAK, Ibrahim SE. Comparative effectiveness of extracorporeal shock wave therapy, local corticosteroid injection, and conventional physiotherapy in treatment of chronic lateral epicondylitis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00024-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lateral epicondylitis (LE) is a popular overuse syndrome involving the forearm’s extensor tendons. Corticosteroid (CS) injection is the popular injection used for management of LE. Extracorporeal shockwave therapy (ESWT) is a noninvasive alternative inducing the neovascularization, tendon repairing, and decreasing pain. Our study aimed to compare the effectiveness of ESWT versus local CS injection versus conventional physiotherapy (PT) in management of chronic LE.
Results
Our results revealed that the three groups displayed a significant decrease of VAS score, decrease of PRTEE score, and increase of grip strength compared to baseline (P < 0.05) at 4 weeks and 12 weeks of follow-up. However, there was a significant decrease of VAS score in ESWT and CS groups more than PT group at 4 weeks follow-up (P < 0.05) while ESWT group displayed a considerable improvement in functional disability score (decrease in PRTEE score) more than CS and PT groups at 4 and 12 weeks of follow-up (P < 0.05), with no considerable change in HGS between the three groups.
Conclusion
ESWT, local CS injection, and conventional PT were efficient in management of chronic LE at 12 weeks of follow-up but ESWT had a higher effect decreasing pain and improving functional disability in daily life activity at short and long term follow-up.
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Does the Type of Extracorporeal Shock Therapy Influence Treatment Effectiveness in Lateral Epicondylitis? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2020; 478:2324-2339. [PMID: 32332245 PMCID: PMC7491893 DOI: 10.1097/corr.0000000000001246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) has been used in various musculoskeletal disorders, including lateral epicondylitis. However, in 2005, a meta-analysis of randomized controlled trials showed that ESWT provides minimal or no benefit in terms of pain and function in patients with lateral epicondylitis. Since the review, several randomized controlled trials including different types of ESWT such as radial type for lateral epicondylitis have been published. Investigations of the effect modifiers such as symptom and follow-up duration on the effects of ESWT on lateral epicondylitis have not been performed. QUESTIONS/PURPOSES (1) Does ESWT reduce pain and improve grip strength in patients with lateral epicondylitis? (2) Which type of ESWT, radial or focused, is more effective? (3) Is the duration of symptoms associated with the efficacy of ESWT for lateral epicondylitis? (4) Do improvements in pain scores remain in patients with longer follow-up? METHODS The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to July 2019 for articles published in English or Korean. Studies were included if patient allocation was randomized, the sample was composed of patients with lateral epicondylitis, interventions were ESWT (focused or radial), comparison group only received sham stimulation or no additional treatment, and the study outcome was pain intensity or grip strength. The quality of the evidence was assessed using the Cochrane risk of bias tool. Twelve studies including 1104 participants fulfilled the inclusion criteria and were included in the meta-analysis. The mean difference for pain reduction and improvement in grip strength was calculated. RESULTS The meta-analysis showed no clinically important difference in the VAS score (2.48 ± 7.55 versus 3.17 ± 9.78, mean difference -0.68 [95% confidence interval -1.17 to -0.19]; p = 0.006) and grip strength (38.02 ± 70.56 versus 34.85 ± 108.26, mean difference 3.33 [95% CI 0.93 to 5.73]; p = 0.007) after ESWT relative to the comparison group's score. Even though radial ESWT showed more improvement than focused, the mean difference for VAS did not exceed the minimal clinically important differences threshold. There were no clinically important effects on the VAS scores of patients with lateral epicondylitis (2.78 ± 5.57 versus 3.92 ± 6.29, mean difference -1.13 [95% CI -1.84 to -0.42]; p = 0.002) and focused ESWT did not improve pain in patients with lateral epicondylitis. In the subgroup analysis, ESWT was effective in patients with a symptom duration of more than 6 months (2.28 ± 8.48 versus 3.31 ± 11.81, mean difference -0.95 [95% CI -1.75 to -0.15]; p = 0.02) but not for those with shorter symptom duration. The effects did not last beyond 24 weeks (2.52 ± 9.19 versus 3.34 ± 5.93, mean difference -0.82 [95% CI -2.57 to 0.93]; p = 0.36). CONCLUSIONS ESWT did not show clinically important improvement in pain reduction and grip strength. Radial ESWT, symptom duration of longer than 6 months, and short follow-up duration (less than 24 weeks) were related to better effects. Further studies are needed to determine the appropriate protocol and elucidate the effects according to the intervention type and specific disease condition. LEVEL OF EVIDENCE Level I, therapeutic study.
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CORR Insights®: Does the Type of Extracorporeal Shock Therapy Influence Treatment Effectiveness in Lateral Epicondylitis? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2020; 478:2340-2342. [PMID: 32576738 PMCID: PMC7491897 DOI: 10.1097/corr.0000000000001386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Çiftçi H, Gezginaslan Ö. High-energy Flux Density Extracorporeal Shock-wave Therapy Versus
Therapeutic Steroid Injection in Costochondritis: A Single-Blind, Randomised
Controlled Study. AKTUEL RHEUMATOL 2020. [DOI: 10.1055/a-1180-8053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background This study aims to investigate the effects of extracorporeal
shock-wave therapy (ESWT) and intra-articular steroid injection (IASI) on pain,
depression, quality of life and pressure pain threshold (PPT) in patients with
costochondritis.
Methods A total of 67 patients diagnosed with costochondritis were
included. Patients were divided into 2 groups. Group 1 (n=34) received
high-energy flux density (H-ESWT)
(> 0.28 mJ/mm2) for a total of 7
sessions at 3-day intervals. Group 2 (n=33) received IASI twice at
2-week intervals. At baseline and one month after treatment, Visual Analog Scale
(VAS), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Beck
Depression Inventory (BDI) scores and PPT values were compared.
Results There was a statistically significant decrease in VAS scores
after treatment compared with baseline scores in both groups. The PPT and SF-36
subscale scores were also statistically significantly higher (p<0.05).
After treatment, VAS and PPT showed a significantly better improvement in Group
1 compared to Group 2. There was a significant correlation between VAS and SF-36
physical functioning as well as pain subscales in Group 1 and a significant
correlation between VAS and SF-36 physical functioning in Group 2.
Conclusions Our data suggest that both treatments H-ESWT and IASI are
effective in costochondritis patients. Of note, H-ESWT has a stronger effect on
pain and PPT scores.
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Affiliation(s)
- Halil Çiftçi
- Thoracic Surgery, University of Health Sciences, Umraniye Training and
Research Hospital, Istanbul, Turkey
| | - Ömer Gezginaslan
- Physical Therapy and Rehabilitation, University of Health Sciences,
Umraniye Training and Research Hospital, Istanbul, Turkey
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Zheng C, Zeng D, Chen J, Liu S, Li J, Ruan Z, Liang W. Effectiveness of extracorporeal shock wave therapy in patients with tennis elbow: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e21189. [PMID: 32791694 PMCID: PMC7387053 DOI: 10.1097/md.0000000000021189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the effectiveness of Extracorporeal Shock Wave (ECSW) in the treatment of lateral epicondylitis (LE) of humerus. HYPOTHESIS ECSW therapy in people with LE effectively reduces the pain and gains functional rehabilitation. MATERIALS/METHODS Databases of PubMed, EMBASE, Web of Science and the Cochrane Library from inception to April 2020 was searched to identify all relevant RCTs comparing ECSW therapy with any other conservative treatment, including injection and local anesthetic versus placebo or control in patients aged 18 with LE. The primary outcome is the mean overall pain score at 12 weeks after treatment. Another secondary outcome mainly included Thomsen test, 50% pain reduction, grip strength and adverse effect at 12 weeks after treatment. RESULTS Nine studies were included in the meta-analysis. Compared with the placebo group, ECSW cannot significantly reduce the pain score (mean deviation [MD] = -4.23, 95% confidence interval [CI]: -8.78 to 0.32, P = .07), but make more people acquire 50% pain reduction (MD = 1.38, 95% CI: 1.09 to 1.75, P = .008). There was no significant difference between ECSW and control in decreasing the pain score of Thomsen test (MD = -3.22, 95% CI: -14.06 to 7.62, P = .56). ECSW was more effective in Grip strength as compared with control at 12 weeks-3 months (MD = 3.52, 95% CI: 2.43 to 4.60, P < .00001) CONCLUSIONS:: Results suggested that ECSW cannot effectively reduce the mean overall pain, but it showed more people acquire 50% pain reduction and might be a better option for the treatment of LE. Because of study limitations, additional high level of evidence, more rigorously designed large-samples and high-quality randomized controlled trials are needed to guide clinical practice.
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Affiliation(s)
- Chenxiao Zheng
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Dongjie Zeng
- Graduate School of Guangzhou University of Traditional Chinese Medicine, Guangzhou
| | - Jiayi Chen
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Sijing Liu
- Department of Orthopaedics and Traumatology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jianyi Li
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Zhaohai Ruan
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Wusheng Liang
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
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Surace SJ, Deitch J, Johnston RV, Buchbinder R. Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database Syst Rev 2020; 3:CD008962. [PMID: 32128761 PMCID: PMC7059880 DOI: 10.1002/14651858.cd008962.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shock wave therapy has seen widespread use since the 1990s to treat various musculoskeletal disorders including rotator cuff disease, but evidence of its efficacy remains equivocal. OBJECTIVES To determine the benefits and harms of shock wave therapy for rotator cuff disease, with or without calcification, and to establish its usefulness in the context of other available treatment options. SEARCH METHODS We searched Ovid MEDLINE, Ovid Embase, CENTRAL, ClinicalTrials.gov and the WHO ICTRP up to November 2019, with no restrictions on language. We reviewed the reference lists of retrieved trials to identify potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that used quasi-randomised methods to allocate participants, investigating participants with rotator cuff disease with or without calcific deposits. We included trials of comparisons of extracorporeal or radial shock wave therapy versus any other intervention. Major outcomes were pain relief greater than 30%, mean pain score, function, patient-reported global assessment of treatment success, quality of life, number of participants experiencing adverse events and number of withdrawals due to adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data and assessed the certainty of evidence using GRADE. The primary comparison was shock wave therapy compared to placebo. MAIN RESULTS Thirty-two trials (2281 participants) met our inclusion criteria. Most trials (25) included participants with rotator cuff disease and calcific deposits, five trials included participants with rotator cuff disease and no calcific deposits, and two trials included a mixed population of participants with and without calcific deposits. Twelve trials compared shock wave therapy to placebo, 11 trials compared high-dose shock wave therapy (0.2 mJ/mm² to 0.4 mJ/mm² and above) to low-dose shock wave therapy. Single trials compared shock wave therapy to ultrasound-guided glucocorticoid needling, ultrasound-guided hyaluronic acid injection, transcutaneous electric nerve stimulation (TENS), no treatment or exercise; dual session shock wave therapy to single session therapy; and different delivery methods of shock wave therapy. Our main comparison was shock wave therapy versus placebo and results are reported for the 3 month follow up. All trials were susceptible to bias; including selection (74%), performance (62%), detection (62%), and selective reporting (45%) biases. No trial measured participant-reported pain relief of 30%. However, in one trial (74 participants), at 3 months follow up, 14/34 participants reported pain relief of 50% or greater with shock wave therapy compared with 15/40 with placebo (risk ratio (RR) 1.10, 95% confidence interval (CI) 0.62 to 1.94); low-quality evidence (downgraded for bias and imprecision). Mean pain (0 to 10 scale, higher scores indicate more pain) was 3.02 points in the placebo group and 0.78 points better (0.17 better to 1.4 better; clinically important change was 1.5 points) with shock wave therapy (9 trials, 608 participants), moderate-quality evidence (downgraded for bias). Mean function (scale 0 to 100, higher scores indicate better function) was 66 points with placebo and 7.9 points better (1.6 better to 14 better, clinically important difference 10 points) with shock wave therapy (9 trials, 612 participants), moderate-quality evidence (downgraded for bias). Participant-reported success was reported by 58/150 people in shock wave therapy group compared with 35/137 people in placebo group (RR 1.59, 95% CI 0.87 to 2.91; 6 trials, 287 participants), low-quality evidence (downgraded for bias and imprecision). None of the trials measured quality of life. Withdrawal rate or adverse event rates may not differ between extracorporeal shock wave therapy and placebo, but we are uncertain due to the small number of events. There were 11/34 withdrawals in the extracorporeal shock wave therapy group compared with 13/40 withdrawals in the placebo group (RR 0.75, 95% CI 0.43 to 1.31; 7 trials, 581 participants) low-quality evidence (downgraded for bias and imprecision); and 41/156 adverse events with extracorporeal shock wave therapy compared with 10/139 adverse events in the placebo group (RR 3.61, 95% CI 2.00 to 6.52; 5 trials, 295 participants) low-quality evidence (downgraded for bias and imprecision). Subgroup analyses indicated that there were no between-group differences in pain and function outcomes in participants who did or did not have calcific deposits in the rotator cuff. AUTHORS' CONCLUSIONS Based upon the currently available low- to moderate-certainty evidence, there were very few clinically important benefits of shock wave therapy, and uncertainty regarding its safety. Wide clinical diversity and varying treatment protocols means that we do not know whether or not some trials tested subtherapeutic doses, possibly underestimating any potential benefits. Further trials of extracorporeal shock wave therapy for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review. A standard dose and treatment protocol should be decided upon before further research is conducted. Development of a core set of outcomes for trials of rotator cuff disease and other shoulder disorders would also facilitate our ability to synthesise the evidence.
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Affiliation(s)
- Stephen J Surace
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Jessica Deitch
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Renea V Johnston
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Rachelle Buchbinder
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
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Efficacy of Extracorporeal Shockwaves Therapy on Peripheral Nerve Regeneration. J Craniofac Surg 2020; 30:2635-2639. [PMID: 31577651 DOI: 10.1097/scs.0000000000005671] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study was conducted to determine the effects of different doses and methods of extracorporeal shock wave treatment (ESWT) on the sciatic nerve regeneration of rat model using unbiased quantitative stereological techniques and to know which method and dose were effective. METHODS Twenty-five Wistar albino rats were used in the experiment. All animals were randomly divided into 5 groups. To the first group (control, n = 5) ESWT and surgery were not applied. To 2nd group (E300*2, n = 5), twice doses of 300 impulses uESWs (unfocused) were applied. To 3rd group (E500*2, n = 5), twice doses of 500 impulses uESWs (unfocused) were applied. To 4th group (E300*2, n = 5), twice doses of 300 impulses of fESWs (focused) were applied. To 5th group (E500*2, n = 5), twice doses of 500 impulses of fESWs (focused) were applied. Rats were sacrificed and nerve samples analyzed on the 22nd day following the operation. RESULTS There is a variable increase in the axon numbers among the shockwave treated groups in compare to the control group. The focused groups showed better improvement and the 300-focused group has shown the highest regeneration rate. CONCLUSION The authors found that ESWT promotes nerve regeneration, increases the thickness of the myelin sheath and that the most effective result is in the 300 shock wave.
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Chen JW, Stefanovski D, Haughan J, Jiang Z, Boston R, Soma LR, Robinson MA. Inflammatory mediators are potential biomarkers for extracorporeal shockwave therapy in horses. Equine Vet J 2019; 52:449-454. [PMID: 31505057 DOI: 10.1111/evj.13183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/29/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Extracorporeal shockwave therapy (ESWT) can potentially mask painful injuries in equine athletes. Tests to detect whether a horse has received ESWT prior to competition are needed. Extracorporeal shockwave therapy is known to affect inflammatory mediators in other species, and if these mediators are altered in the horse, these could serve as biomarkers of ESWT. OBJECTIVES To test the hypothesis that a single application of ESWT will alter the circulating protein concentrations of 10 inflammatory mediators in horse plasma. STUDY DESIGN Prospective repeated measures experimental study. METHODS Eleven healthy horses were administered a single dose of ESWT on the dorsal surface of proximal MCIII. Blood samples were collected at -168, -144, -120, -96, -72, -70, -68, -66, -48, -24, -6, -4, -2, 0 h before and 2, 4, 6, 24, 48, 72, 96, 168, 336 and 504 h after ESWT. Plasma concentrations of interleukin 1 beta (IL-1β), IL-1 receptor antagonist (IL-1RA), IL-2, IL-4, IL-6, IL-10, IL-15, interferon gamma (IFN-γ), soluble toll-like receptor 2 (sTLR2) and tumour necrosis factor alpha (TNF-α) were measured to assess the effects of ESWT on these mediators. RESULTS Baseline concentrations of inflammatory mediators did not change substantially during the week prior to ESWT. Plasma concentrations of five inflammatory factors changed following ESWT. IL-1β and IL-6 were significantly down-regulated (P<0.01), while TNF-α, IL-1RA and TLR2 were significantly up-regulated (P<0.01). The remaining cytokines were not significantly affected by ESWT. MAIN LIMITATIONS This study was performed in a small number of sedentary, healthy pasture-kept horses using a single dose of ESWT applied to a single location. Additional studies are necessary to determine the effect of ESWT on inflammatory mediators in athletic horses undergoing treatment for musculoskeletal injuries. CONCLUSIONS Plasma concentrations of TNF-α, IL-1β, IL-1RA, IL-6 and TLR2 were significantly affected by ESWT, and deserve further investigation as possible biomarkers of ESWT.
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Affiliation(s)
- J-W Chen
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - D Stefanovski
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - J Haughan
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Z Jiang
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - R Boston
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - L R Soma
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - M A Robinson
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA.,Pennsylvania Equine Toxicology and Research Laboratory, West Chester, Pennsylvania, USA
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Furness ND, Phillips A, Gallacher S, Beazley JCS, Evans JP, Toms AD, Thomas W, Smith CD. Vibration therapy versus standard treatment for tennis elbow: A randomized controlled study. J Orthop Surg (Hong Kong) 2019; 26:2309499018792744. [PMID: 30111240 DOI: 10.1177/2309499018792744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM To determine whether a mechanical, high-frequency vibration device (Tenease™) can improve pain and function for the treatment of tennis elbow (TE), compared with standard treatment. METHODS Adults presenting to an elbow clinic with a clinical diagnosis of TE were randomized to standard treatment with physiotherapy, activity modification and analgesia or standard treatment plus Tenease therapy. Tenease therapy consisted of a 6-week period of treatment using the Tenease device with three 10-min episodes each day. The primary outcome measure was the quick Disabilities of the Arm, Shoulder and Hand score at 6 months, with scores also taken at 6 weeks. Secondary outcome measures were the Patient Rated Tennis Elbow Evaluation Score and EuroQol 5-Dimension Visual Analogue Scale at the same time points. RESULTS Fifty-four patients were recruited into the study. Following randomization and initial dropout, 18 patients were included in the standard group and 27 in the Tenease group. Both groups reported improvements in primary outcome measure scores. The control group had a mean score of 44.3 (standard deviation (SD) = 18.8) at baseline, which dropped to 31.2 (SD = 17.2) at 6 months ( p = 0.002). The Tenease group had a mean score of 43.2 (SD = 22.7) at baseline, which dropped to 23.4 (SD = 15.0) at 6 months ( p = 0.064). Similar improvements were seen in secondary outcome measures with none reaching statistical significance. There were no statistically significant differences seen between the primary outcome scores at 6 weeks ( p = 0.9) or 6 months ( p = 0.5). No complications were noted in either group. CONCLUSIONS Vibration therapy did not result in any statistically significant improvement in functional outcome scores compared to standard treatment for TE. It is important to note that this was a relatively small cohort and a high dropout rate was observed.
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Affiliation(s)
| | - Alistair Phillips
- 2 University of Southampton Hospital NHS Foundation Trust, Southampton, UK
| | - Sian Gallacher
- 1 Shoulder and Elbow Unit, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | | | - Jonathan Peter Evans
- 1 Shoulder and Elbow Unit, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Andrew David Toms
- 1 Shoulder and Elbow Unit, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - William Thomas
- 1 Shoulder and Elbow Unit, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
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Alessio-Mazzola M, Repetto I, Biti B, Trentini R, Formica M, Felli L. Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study. J Orthop Surg (Hong Kong) 2019; 26:2309499017749986. [PMID: 29320964 DOI: 10.1177/2309499017749986] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the efficacy of two independent groups of patients treated with ultrasound (US)-guided extracorporeal shock wave (ESW) therapy and with US-guided injection of platelet-rich plasma (PRP) for chronic lateral epicondylitis (LE) with a minimum of 2-year follow-up. METHODS We retrospectively evaluated 63 patients treated for chronic LE (31 patients with autologous US-guided PRP injection and 32 patients with US-guided focal ESW therapy) from 2009 to 2014. All the patients were evaluated by means of Roles-Maudsley (RM) score, quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, visual analogic scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) to retrospectively assess the pain relief, level of activity, the self-reported function and subjective satisfaction at minimum of 2-year follow-up. RESULTS Both US-guided autologous PRP injection and US-guided focal ESW administration proved effective in chronic LE with significant improvement in the QuickDASH, VAS, RM and PRTEE scores ( p < 0.0001). No adverse effects or complications were recorded in any groups. No differences were found in recurrence rate and final results of the QuickDASH, VAS, RM and PRTEE scores between the two groups ( p > 0.05). The mean time between treatment and symptom resolution was significantly shorter for the PRP treatment ( p = 0.0212); furthermore, the mean time to return to the normal activities was quicker for PRP group ( p = 0.0119). CONCLUSION Both PRP injection and ESW therapy are feasible and safe options for the treatment of chronic LE with low risk of complications and with good long-term follow-up results. US-guided PRP injection has quick efficacy when compared with US-guided focal ESW therapy.
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Affiliation(s)
- Mattia Alessio-Mazzola
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Ilaria Repetto
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Besmir Biti
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Roberto Trentini
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Matteo Formica
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Lamberto Felli
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
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Xiong Y, Xue H, Zhou W, Sun Y, Liu Y, Wu Q, Liu J, Hu L, Panayi AC, Chen L, Yan C, Mi B, Liu G. Shock-wave therapy versus corticosteroid injection on lateral epicondylitis: a meta-analysis of randomized controlled trials. PHYSICIAN SPORTSMED 2019; 47:284-289. [PMID: 30951399 DOI: 10.1080/00913847.2019.1599587] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Shock-wave (SW) therapy has been widely promoted and proven to be effective in ameliorating symptoms of lateral epicondylitis (LE) during recent years. Corticosteroid (CS) injection is another common treatment of LE, and several researches have documented its significant effect in the treatment of LE. Despite this, few studies have focused on comparing the use of SW and CS in the treatment of LE. The aim of this meta-analysis is to assess whether SW is superior to CS in managing LE, both in terms of ameliorating pain and improving functionality. Methods: A systematic search of the literature was conducted to identify relevant articles that were published in Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov and OVID from the databases' inception to December 2018. All studies comparing the efficacy of SW and CS in terms of pain levels and functionality improvement were included. Data on the two primary outcomes were collected and analyzed using the Review Manager 5.3. Results: Four studies were included in the current meta-analysis. A significant difference in VAS score (SMD = 1.13, Cl 0.72-1.55 P < 0.00001, I2 = 0) was noted between the SW group and the CS group. Furthermore, Significant difference was also seen in the term of grip strength (including HGS and GSS scoring system) (SMD = -1.42, Cl -1.85--0.98 P < 0.00001, I2 = 0). Conclusions: In light of the better improvement in the terms of VAS and grip strength with follow-up more than 12 weeks, we assume that SW may be a superior alternative for the treatment of LE.
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Affiliation(s)
- Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yun Sun
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yi Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Qipeng Wu
- Department of Orthopedics, Pu'ai Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Jing Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Liangcong Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Adriana C Panayi
- The division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Lang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Chenchen Yan
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
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Ahadi T, Esmaeili Jamkarani M, Raissi GR, Mansoori K, Emami Razavi SZ, Sajadi S. Prolotherapy vs Radial Extracorporeal Shock Wave Therapy in the Short-term Treatment of Lateral Epicondylosis: A Randomized Clinical Trial. PAIN MEDICINE 2019; 20:1745-1749. [PMID: 30698771 DOI: 10.1093/pm/pny303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of prolotherapy with hypertonic dextrose and radial shock wave therapy in chronic lateral epicondilosis. DESIGN Prospective single-blind randomized clinical trial. SETTING Physical medicine and rehabilitation clinic. SUBJECTS Thirty-three patients with at least three months of signs and symptoms of lateral epicondilosis, as well as failure of at least one of the conservative treatments, randomly allocated into two groups. METHODS Sixteen patients received three sessions of shock wave therapy, and 17 received one session prolotherapy. Severity of pain via visual analog scale (VAS), grip strength via Baseline Pneumatic Dynamometer, pressure pain threshold (PPT) by algometer and Disabilities of Arm, Shoulder, and Hand quick questionnaire (Quick DASH) were assessed at baseline, four weeks, and eight weeks after the intervention. RESULTS Within-group analysis showed that in both groups, differences between all of the outcome measures were significant after four and also eight weeks. Between-group analysis after four and eight weeks showed that the VAS and Quick DASH had significantly more improvement in the shock wave group. However, the two groups were similar regarding grip strength and PPT. No complication was observed in the two groups. CONCLUSIONS Based on the results of this study, a regiment of three sessions (weekly) of radial extracorporeal shock wave therapy is significantly more effective than one session of prolotherapy with 20% dextrose regarding pain and function in the management of chronic lateral epicondylosis in short-term follow-up.
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Affiliation(s)
- Tannaz Ahadi
- Neuromusculoskeletal Research Centre, Firoozgar Hospital
| | | | | | - Korosh Mansoori
- Neuromusculoskeletal Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Zahra Emami Razavi
- Physical medicine and rehabilitation department, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Sajadi
- Neuromusculoskeletal Research Centre, Iran University of Medical Sciences, Tehran, Iran
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Yan C, Xiong Y, Chen L, Endo Y, Hu L, Liu M, Liu J, Xue H, Abududilibaier A, Mi B, Liu G. A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2019; 14:248. [PMID: 31387611 PMCID: PMC6683364 DOI: 10.1186/s13018-019-1290-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tennis elbow or lateral epicondylitis is a common source of pain among craftsmen. Although it cannot be completely resolved, extracorporeal shock wave therapy (ESWT) and ultrasonics (US) have been found to be effective for tennis elbow as highlighted in previously published randomized controlled trials (RCTs) and reviews. However, the efficacy of these two therapies in treating tennis elbow is unknown. This meta-analysis compares the effectiveness of ESWT and US in relieving pain and restoring the functions of tennis elbow following tendinopathy. METHODS RCTs published in the PubMed, Embase, Cochrane Library, and SpringerLink databases comparing ESWT and US in treating tennis elbow were identified by a software and manual search. The risk of bias and clinical relevance of the included studies were assessed. Publication bias was explored using funnel plot and statistical tests (Egger's test and Begg's test). The major outcomes of the studies were analyzed using the Review Manager 5.3. RESULTS Five RCTs comprising five patients were included in the present meta-analysis. The results revealed a significantly lower VAS score of pain in the ESWT group (1 month: MD = 4.47, p = 0.0001; 3 months: MD = 20.32, p < 0.00001; and 6 months: MD = 4.32, p < 0.0001) compared to US. Besides, the grip strength was markedly higher 3 months after the intervention in ESWT (MD = 8.87, p < 0.00001) than in the US group. Although no significant difference was observed in the scores of the elbow function after 3 months of treatment (SMD = 1.51, p = 0.13), the subjective scores of elbow functions were found to be better in the ESWT group (SMD = 3.34; p = 0.0008) compared to the US group. CONCLUSIONS Although there was no significant difference in the elbow function evaluation scores between ESWT and US, the superiority of the ESWT group in the VAS of pain (both at 1 month, 3 months, and 6 months follow-ups) raised grip strength in ESWT group and the scores for subjective evaluation of efficacy indicated that ESWT offers more effective therapy for lateral epicondylitis than US therapy.
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Affiliation(s)
- Chenchen Yan
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China
| | - Lang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China
| | - Yori Endo
- Department of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, 02152, USA
| | - Liangcong Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China
| | - Mengfei Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China
| | - Jing Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China
| | - Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China
| | - Abudula Abududilibaier
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China.
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Rd. 1277#, Wuhan, 430022, Hubei, China.
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Yalvaç B, Mesci N, Geler Külcü D, Yurdakul OV. Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:357-362. [PMID: 30497658 PMCID: PMC6204478 DOI: 10.1016/j.aott.2018.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) and therapeutic ultrasound (US) in the treatment of lateral epicondylosis (LE). METHODS Our study enrolled 50 patients with LE. Patients were randomized into two groups. Group 1 underwent therapeutic US (n = 24; 5 males and 15 females; mean age: 43.75 ± 4.52) Group 2 underwent ESWT (n = 20; 8 males and 16 females; mean age: 46.04 ± 9.24). Patients were evaluated at baseline, after treatment,and 1 month following treatment. The outcome measures were the visual analog scale (VAS), algometer, grip dynamometer, quick-disability of the arm,shoulder,and hand (QDASH), patient-rated tennis elbow evaluation (PRTEE), and Short Form-36 (SF-36) health survey questionnairre. RESULTS Both groups showed significant improvements in terms of VAS (all p values < 0.0001), dynamometer (p = 0.001 vs p = 0.015), algometer (all p values < 0.0001), PRTEE (all p values < 0.0001), QDASH (all p values < 0.0001), and SF-36 scores (p = 0.001 vs p = 0.005) within time. There was no significant difference between the two groups, except algometer scores in favor of ESWT (p = 0.029). CONCLUSION ESWT and therapeutic US are equally effective in treating LE. ESWT is an alternative therapeutic intervention and as effective as US. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Bestami Yalvaç
- Özel Başarı Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Nilgün Mesci
- Haydarpaşa Numune Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey.
| | - Duygu Geler Külcü
- Haydarpaşa Numune Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Ozan Volkan Yurdakul
- Bezmialem Vakıf University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
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28
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Park KD, Lee WY, Park MH, Ahn JK, Park Y. High- versus low-energy extracorporeal shock-wave therapy for myofascial pain syndrome of upper trapezius: A prospective randomized single blinded pilot study. Medicine (Baltimore) 2018; 97:e11432. [PMID: 29995794 PMCID: PMC6076058 DOI: 10.1097/md.0000000000011432] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To compare the efficacy of high- and low-energy extracorporeal shock wave therapy (ESWT) for patients with myofascial pain syndrome (MPS) of the upper trapezius. METHODS Thirty patients (3 men, 27 women) were randomly assigned to receive either high-energy ESWT (0.210 mJ/mm) or low-energy ESWT (0.068 mJ/mm). Both groups received 1500 pulses of ESWT once a week, for 2 weeks. Outcome measurement was assessed by verbal numeric pain scale (VNS), neck disability index (NDI), neck range of motion (ROM) (flexion, extension, rotation, lateral bending), and pressure threshold (PT). Statistical analysis was performed with significance level of P < .05. RESULTS No statistically significant differences of demographic and clinical characteristics existed between the 2 groups. VNS, NDI, neck ROM (rotation to sound side, lateral bending to affected side, lateral bending to sound side), and PT were improved in both groups. In contrast, statistically significant improvements in neck flexion and neck extension were observed only in the high-energy group. We also found significant differences in post-treatment NDI (4.20 ± 1.78 vs 6.47 ± 2.48) and post-treatment neck flexion ROM (65.47 ± 10.09 vs 55.93 ± 11.07) between high-energy and low-energy group. CONCLUSION ESWT effectively improves VNS, NDI, neck ROM, and PT to patients with MPS of the upper trapezius. High-energy ESWT was more effective in improving NDI and neck flexion ROM compared to the low-energy ESWT, suggesting superiority in functional improvement. Further studies are required to specify the effect of ESWT by energy intensity.
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Affiliation(s)
- Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon
| | | | - Min-ho Park
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jae Ki Ahn
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Yongbum Park
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
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29
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The clinical utility of extracorporeal shock wave therapy for burn pruritus: A prospective, randomized, single-blind study. Burns 2018; 44:612-619. [DOI: 10.1016/j.burns.2017.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 11/17/2022]
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30
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Altun RD, Incel NA, Cimen OB, Sahin G. EFFICACY OF ESWT FOR LATERAL EPICONDYLITIS TREATMENT: COMPARISON WITH PHYSICAL THERAPY MODALITIES. ACTA ACUST UNITED AC 2018. [DOI: 10.1142/s021895771850001x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lateral epicondylitis (LE) is a common condition characterized by pain in the lateral side of the elbow with tenderness on lateral epicondyle, caused by repetetive overuse of extensor muscles of the wrist. Extracorporeal shockwave therapy (ESWT) is used in musculoskeletal problems with the possible mechanism of action including hyperstimulation analgesia, neovascularization and induction of healing process. LE generally responds well to conservative treatment. One of the widely used and accepted terms of treatment for LE is physical therapy (PT). In this study, we aimed to compare the efficacy of ESWT for LE treatment with conventional therapy modalities. This is a prospective randomized study with 73 patients with elbow pain and otherwise healthy, diagnosed as LE. Patients were randomized to two groups to receive either ESWT weekly for 3 weeks or PT for 10 days. Our analysis revealed similar treatment success rates for both groups in many of the evaluation parameters. As a result of our study we were unable to display a major difference between the short-term outcome for two options. However, ESWT still has the advantage of being less time consuming for both the patient and the doctor, an important parameter we believe.
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Affiliation(s)
- Resa D Altun
- Department of Physical Medicine and Rehabilitation, Mersin Toros State Hospital, Mersin, Turkey
| | - Nurgül Arinci Incel
- Department of Physical Medicine and Rehabilitation, Mersin University School of Medicine, Mersin, Turkey
| | - Ozlem Bölgen Cimen
- Department of Physical Medicine and Rehabilitation, Mersin University School of Medicine, Mersin, Turkey
| | - Gunsah Sahin
- Department of Physical Medicine and Rehabilitation, Mersin University School of Medicine, Mersin, Turkey
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Are Passive Physical Modalities Effective for the Management of Common Soft Tissue Injuries of the Elbow?: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Clin J Pain 2017; 33:71-86. [PMID: 27022675 DOI: 10.1097/ajp.0000000000000368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. METHODS We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis. RESULTS We screened 6618 articles; 21 were eligible for critical appraisal and 9 (reporting on 8 randomized controlled trials) had a low risk of bias. All randomized controlled trials with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low-level laser therapy for persistent lateral epicondylitis. DISCUSSION Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low-level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.
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Lee JH, Lee S, Choi S, Choi YH, Lee K. The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. J Phys Ther Sci 2017; 29:536-538. [PMID: 28356649 PMCID: PMC5361028 DOI: 10.1589/jpts.29.536] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/14/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to identify the effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. [Subjects and Methods] Twenty patients with degenerative knee arthritis were divided into a conservative physical therapy group (n=10) and an extracorporeal shock wave therapy group (n=10). Both groups received general conservative physical therapy, and the extracorporeal shock wave therapy was additionally treated with extracorporeal shock wave therapy after receiving conservative physical therapy. Both groups were treated three times a week over a four-week period. The visual analogue scale was used to evaluate pain in the knee joints of the subjects, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used to evaluate the function of the subjects. [Results] The comparison of the visual analogue scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores within each group before and after the treatment showed statistically significant declines in scores in both the conservative physical therapy group and extracorporeal shock wave therapy group. A group comparison after the treatment showed statistically significant differences in these scores in the extracorporeal shock wave therapy group and the conservative physical therapy group. [Conclusion] extracorporeal shock wave therapy may be a useful nonsurgical intervention for reducing the pain of patients with degenerative knee arthritis and improving these patients' function.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
| | - Sangyong Lee
- Department of Physical Therapy, U1 University, Republic of Korea
| | - SeokJoo Choi
- Department of Physical Therapy, Taegu Science University, Republic of Korea
| | - Yoon-Hee Choi
- Department of Physical Therapy, Graduate School, Deajeon University, Republic of Korea
| | - Kwansub Lee
- Department of Physical Therapy, The Kang Hospital, Republic of Korea
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Williams H, Jones SA, Lyons C, Wilson C, Ghandour A. Refractory patella tendinopathy with failed conservative treatment-shock wave or arthroscopy? J Orthop Surg (Hong Kong) 2017; 25:2309499016684700. [PMID: 28118806 DOI: 10.1177/2309499016684700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM To identify whether the location of refractory patella tendinopathy (PT) has an effect on treatment modality (radial extracorporeal shock wave therapy (rESWT) or arthroscopic debridement). METHODS Between 2012 and 2014, 40 patients with PT underwent a magnetic resonance imaging (MRI) scan. This confirmed the diagnosis as either involving the tendon itself (group A, 20) or with retropatella fat pad extension (group B, 20). All patients underwent rESWT. If there was no improvement patients proceeded with surgery in the form of arthroscopic debridement (by senior authors CW and AG). Outcomes were assessed before and after treatment using the Victorian Institute of Sports Assessment-Patella (VISA-P) score. RESULTS There were 18 males and 2 females in group A and 15 males and 5 females in group B. The mean age was 41.4 years in group A (23-59) and 34.7 in group B (19-52). Seventeen of 20 in group A reported good or excellent outcomes and did not require surgical intervention (remaining three improved after second course of ESWT). All patients in group B failed to improve with rESWT, resulting in arthroscopic debridement and reported good or excellent outcomes. After 6 months, group A mean VISA-P score increased from 50.2 to 65.0 ( p = 0.01) and group B from 39.6 to 78.4 ( p = <0.001). CONCLUSION An MRI should be performed to determine the precise location of tendinosis in patients with refractory PT who fail standard conservative management. If the MRI scan shows intratendon changes only, ESWT should be performed and those with extension into the fat pad should proceed to arthroscopic debridement without rESWT.
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Affiliation(s)
- Hlm Williams
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
| | - S A Jones
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
| | - C Lyons
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
| | - C Wilson
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
| | - A Ghandour
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
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Cho YS, Joo SY, Cui H, Cho SR, Yim H, Seo CH. Effect of extracorporeal shock wave therapy on scar pain in burn patients: A prospective, randomized, single-blind, placebo-controlled study. Medicine (Baltimore) 2016; 95:e4575. [PMID: 27512886 PMCID: PMC4985341 DOI: 10.1097/md.0000000000004575] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients. METHODS A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm (0.05-0.15 mJ/mm) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores. RESULTS The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128). CONCLUSION ESWT significantly reduced scar pain in burn patients after wound recovery.
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Affiliation(s)
- Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University
| | - So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University
| | - Huisong Cui
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine
| | - Haejun Yim
- Department of Burn Surgery, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University
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Radial Extracorporeal Shock Wave Therapy Is Not More Effective Than Placebo in the Management of Lateral Epicondylitis. Am J Phys Med Rehabil 2016; 95:495-506. [DOI: 10.1097/phm.0000000000000407] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim SH, Ha KW, Kim YH, Seol PH, Kwak HJ, Park SW, Ryu BJ. Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome. Ann Rehabil Med 2016; 40:509-19. [PMID: 27446789 PMCID: PMC4951371 DOI: 10.5535/arm.2016.40.3.509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/20/2015] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome. Methods In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed. Results VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were –1.69±1.90 and –0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were –1.60±1.74 and –0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were –1.61±1.73 and –0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05). Conclusion rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.
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Affiliation(s)
- Sung Hwan Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Kang Wook Ha
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Yun Hee Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Pyong-Hwa Seol
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Ho-Jun Kwak
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Seung-Wan Park
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
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Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci 2015; 27:3755-8. [PMID: 26834345 PMCID: PMC4713784 DOI: 10.1589/jpts.27.3755] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 11/30/2022] Open
Abstract
[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal
shock wave therapy and local corticosteroid injection in patients with lateral
epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were
randomly divided into extracorporeal shock wave therapy and steroid injection groups.
Patients were evaluated using hand grip strength, visual analog scale, and short-form
McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both
groups showed statistically significant increase in hand grip strength and decreases on
the visual analog scale and short form McGill pain questionnaire overtime. There was no
statistically significant difference in the percentage of improvement in hand grip
strength and on the short-form McGill pain questionnaire between groups at 4 weeks
post-treatment, whereas the extracorporeal shock wave therapy group showed better results
on the visual analog scale. The percentages of improvements in all 3 parameters were
higher in the extracorporeal shock wave therapy group than in the injection group at 12
weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid
injection were safe and effective in the treatment of lateral epicondylitis. However,
extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at
the long-term follow-up.
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Affiliation(s)
- Münevver Serdaroğlu Beyazal
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Turkey
| | - Gül Devrimsel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Turkey
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Park C, Lee S, Yi CW, Lee K. The effects of extracorporeal shock wave therapy on frozen shoulder patients' pain and functions. J Phys Ther Sci 2015; 27:3659-61. [PMID: 26834326 PMCID: PMC4713765 DOI: 10.1589/jpts.27.3659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/01/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study was conducted to examine the effects of extracorporeal shock
wave therapy on frozen shoulder patients’ pain and functions. [Subjects] In the present
study, 30 frozen shoulder patients were divided into two groups: an extracorporeal shock
wave therapy group of 15 patients and a conservative physical therapy group of 15
patients. [Methods] Two times per week for six weeks, the extracorporeal shock wave
therapy group underwent extracorporeal shock wave therapy, and the conservative physical
therapy group underwent general physical therapy. Visual analog scales were used to
measure frozen shoulder patients’ pain, and patient-specific functional scales were used
to evaluate the degree of functional disorders. [Results] In intra-group comparisons, the
two groups showed significant decreases in terms of visual analog scales and
patient-specific functional scales, although the extracorporeal shock wave therapy group
showed significantly lower scores than the conservative physical therapy group.
[Conclusion] Extracorporeal shock wave therapy is considered an effective intervention for
improving frozen shoulder patients’ pain and functions.
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Affiliation(s)
- Chan Park
- Department of Rehabilitation Science, Graduate School Daegu University, Republic of Korea
| | - Sangyong Lee
- Department of Physical Therapy, Youngdong University, Republic of Korea
| | - Chae-Woo Yi
- Department of Physical Therapy, College of Medical Science, Graduate School, Catholic University of Daegu, Republic of Korea
| | - Kwansub Lee
- Department of Physical Therapy, The Kang Hospital, Republic of Korea
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Ramon S, Gleitz M, Hernandez L, Romero LD. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia. Int J Surg 2015; 24:201-6. [DOI: 10.1016/j.ijsu.2015.08.083] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/31/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
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Long L, Briscoe S, Cooper C, Hyde C, Crathorne L. What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations. Health Technol Assess 2015; 19:1-134. [PMID: 25629427 DOI: 10.3310/hta19080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Lateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient's social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year. OBJECTIVES This systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET. DATA SOURCES A comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases. METHODS AND OUTCOMES We conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013. RESULTS A total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified. LIMITATIONS The summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect. CONCLUSIONS Clinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003593. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Linda Long
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Simon Briscoe
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Louise Crathorne
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
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Thiele S, Thiele R, Gerdesmeyer L. Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy. Int J Surg 2015; 24:165-70. [PMID: 26455532 DOI: 10.1016/j.ijsu.2015.09.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/29/2015] [Accepted: 09/09/2015] [Indexed: 12/30/2022]
Abstract
Extracorporeal shockwave therapy (ESWT) is used in a number of indications in the medical field. A number of tendinopathies show good and excellent results due to evidence based medicine. The treatment of lateral epicondylitis is known to show conflicting results. This overview of the published RCT's on ESWT for lateral epicondylitis tries to show the reasons for this conflicting data-base and point out, why we think that this is still a main indication for extracorporeal shockwave therapy.
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Affiliation(s)
- S Thiele
- IZS - Berlin, Internationales Stoßwellenzentrum Berlin, Kurfürstendamm 61, D-10707, Berlin, Germany.
| | - R Thiele
- IZS - Berlin, Internationales Stoßwellenzentrum Berlin, Kurfürstendamm 61, D-10707, Berlin, Germany
| | - L Gerdesmeyer
- Dept. Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, D-24105 Kiel, Germany
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Trentini R, Mangano T, Repetto I, Cerruti P, Kuqi E, Trompetto C, Franchin F. Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis. Musculoskelet Surg 2015; 99 Suppl 1:S91-S97. [PMID: 25957547 DOI: 10.1007/s12306-015-0361-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Lateral epicondylitis of the elbow is a common and disabling overuse syndrome. Several treatment modalities are currently available for this condition, but the optimal treatment method remains undefined. Extracorporeal shock wave therapy (ESWT) has been widely used in the last 10 years, although conflicting results are present in the literature. MATERIALS AND METHODS In this study, we evaluated 36 patients (37 elbows), with a mean follow-up time of 24.8 months. Focal ESWT was administered by means of an electromagnetic generator equipped with in-line ultrasound guidance, during one or more cycles of 3-4 weekly sessions. In the setting of the study, patients were clinically evaluated and subjective satisfaction and rate of relapse were investigated. RESULTS A positive response was described in 75.7 % of the patients after treatment. Mean quickDASH score and VAS attested at 5.5 and 1.1, respectively. Roles and Maudsley score was rated as I or II in 33 cases. Four patients resulted not responders to the therapy, while 5 patients complained one or more episodes of symptoms relapse. No influence on the final outcome was evident with respect to demographic features and previous therapies as well. Response rate to further ESWT cycles in patients refractory to the first cycle of ESWT was 33.3 %. CONCLUSIONS Focal ESWT represents a valuable and safe solution in case of elbow lateral epicondylitis, both in newly diagnosed and previously treated cases, representing a definitive treatment in the majority of patients. Patients refractory to a 3- to 4-session ESWT cycle have lower chances of positive response after further ESWT cycles.
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Affiliation(s)
- R Trentini
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - T Mangano
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy.
| | - I Repetto
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - P Cerruti
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - E Kuqi
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - C Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, School of Medicine, University of Genova, Genoa, Italy
| | - F Franchin
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
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Weber C, Thai V, Neuheuser K, Groover K, Christ O. Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis. BMC Musculoskelet Disord 2015; 16:223. [PMID: 26303397 PMCID: PMC4549077 DOI: 10.1186/s12891-015-0665-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/10/2015] [Indexed: 01/27/2023] Open
Abstract
Background Physical therapy for the treatment of lateral epicondylitis (LE) often comprises movement therapies, extracorporeal shockwave therapy (ECSWT), low level laser therapy (LLLT), low frequency electrical stimulation or pulsed electromagnetic fields. Still, only ECSWT and LLLT have been meta-analytically researched. Methods PUBMED, EMBASE and Cochrane database were systematically searched for randomized controlled trials (RCTs). Methodological quality of each study was rated with an adapted version of the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pain reduction (the difference between treatment and control groups at the end of trials) and pain relief (the change in pain from baseline to the end of trials) were calculated with mean differences (MD) and 95 %-Confidence intervals (95 % CI). Results One thousand one hundred thirty eight studies were identified. One thousand seventy of those did not meet inclusion criteria. After full articles were retrieved 16 studies met inclusion criteria and 12 studies reported comparable outcome variables. Analyses were conducted for overall pain relief, pain relief during maximum handgrip strength tests, and maximum handgrip strength. There were not enough studies to conduct an analysis of physical function or other outcome variables. Conclusions Differences between treatment and control groups were larger than differences between treatments. Control group gains were 50 to 66 % as high as treatment group gains. Still, only treatment groups with their combination of therapy specific and non-therapy specific factors reliably met criteria for clinical relevance. Results are discussed with respect to stability and their potential meaning for the use of non-therapy specific agents to optimize patients’ gain. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0665-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Weber
- Department of Psychology, TU Darmstadt, Alexanderstrasse 10, 64287, Darmstadt, Germany. .,DMB Die MPU Berater GmbH, Bad Nauheimerstrasse 4, 64289, Darmstadt, Germany.
| | - Veronika Thai
- Justizvollzugsanstalt Darmstadt, Marienburgstrasse 74, 64297, Darmstadt, Germany.
| | - Katrin Neuheuser
- Department of Psychology, TU Darmstadt, Alexanderstrasse 10, 64287, Darmstadt, Germany. .,DMB Die MPU Berater GmbH, Bad Nauheimerstrasse 4, 64289, Darmstadt, Germany.
| | - Katharina Groover
- Department of Psychology, TU Darmstadt, Alexanderstrasse 10, 64287, Darmstadt, Germany. .,DMB Die MPU Berater GmbH, Bad Nauheimerstrasse 4, 64289, Darmstadt, Germany.
| | - Oliver Christ
- School of Applied Psychology, University of Applied Sciences and Arts NortherwesternSwitzerland, Riggenbachstrasse 16, 4600, Olten, Switzerland.
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Lizis P. Analgesic effect of extracorporeal shock wave therapy versus ultrasound therapy in chronic tennis elbow. J Phys Ther Sci 2015; 27:2563-7. [PMID: 26357440 PMCID: PMC4563315 DOI: 10.1589/jpts.27.2563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/15/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study compared the analgesic effects of extracorporeal shock wave therapy
with those of ultrasound therapy in patients with chronic tennis elbow. [Subjects] Fifty
patients with tennis elbow were randomized to receive extracorporeal shock wave therapy or
ultrasound therapy. [Methods] The extracorporeal shock wave therapy group received 5
treatments once per week. Meanwhile, the ultrasound group received 10 treatments 3 times
per week. Pain was assessed using the visual analogue scale during grip strength
evaluation, palpation of the lateral epicondyle, Thomsen test, and chair test. Resting
pain was also recorded. The scores were recorded and compared within and between groups
pre-treatment, immediately post-treatment, and 3 months post-treatment. [Results] Intra-
and intergroup comparisons immediately and 3 months post-treatment showed extracorporeal
shock wave therapy decreased pain to a significantly greater extent than ultrasound
therapy. [Conclusion] Extracorporeal shock wave therapy can significantly reduce pain in
patients with chronic tennis elbow.
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Affiliation(s)
- Paweł Lizis
- Department of Physiotherapy in Kielce, Holycross College, Poland
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Yoon JP, Chung SW, Yi JH, Lee BJ, Jeon IH, Jeong WJ, Lee HJ. Prognostic Factors of Arthroscopic Extensor Carpi Radialis Brevis Release for Lateral Epicondylitis. Arthroscopy 2015; 31:1232-7. [PMID: 25828167 DOI: 10.1016/j.arthro.2015.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 01/27/2015] [Accepted: 02/06/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to analyze factors affecting the treatment outcomes and prognoses of arthroscopic debridement for refractory lateral epicondylitis. METHODS We included 45 patients who had undergone arthroscopic extensor carpi radialis brevis release for chronic refractory lateral epicondylitis between October 2008 and December 2012. Demographic data, magnetic resonance imaging studies, and arthroscopic findings were examined and analyzed. RESULTS The mean age of the enrolled patients (23 men and 22 women) was 45.9 ± 7.8 years, and the mean follow-up duration was 26.9 ± 9.0 months. All the patients showed significant clinical improvement on all parameters assessed using the visual analog scale (6.9 preoperatively to 0.9 postoperatively), the Upper Extremity Functional Scale (34.8 to 66.7), and the Mayo Elbow Score (63.5 to 92.3) (P < .05). There were no reports of serious surgical complications. At final follow-up, 37 patients (82.2%) were satisfied with their outcomes whereas 8 patients (17.8%) were dissatisfied. In terms of demographic factors, female sex was significantly different between the 2 groups. On preoperative magnetic resonance imaging, 7 patients in the satisfied group (18.9%) had a definite tendon lesion (grade III defect, ≥6 mm) whereas 6 patients in the dissatisfied group (75%) had a grade III defect (P = .016). CONCLUSIONS Overall, clinical outcome scores showed improvement after arthroscopic extensor carpi radialis brevis release for refractory lateral epicondylitis. However, preoperative tendon status and sex were associated with dissatisfaction and poor postoperative outcomes after the arthroscopic release procedure. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Jae Hyuck Yi
- Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Byoung-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Won-Ju Jeong
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
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Abdel Gawad HA, Abdel Karim AE, Mohammed AH. Shock wave therapy for spastic plantar flexor muscles in hemiplegic cerebral palsy children. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2015. [DOI: 10.1016/j.ejmhg.2014.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Notarnicola A, Maccagnano G, Tafuri S, Fiore A, Margiotta C, Pesce V, Moretti B. Prognostic factors of extracorporeal shock wave therapy for tendinopathies. Musculoskelet Surg 2015; 100:53-61. [PMID: 25982090 DOI: 10.1007/s12306-015-0375-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/06/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Extracorporeal shock wave therapy is very widely used for the management of tendinopathies and plantar fasciitis. AIM The aim of the study is to determine whether there are prognostic factors that may influence the outcome of extracorporeal shock wave therapy for these diseases. METHODS Three hundred fifty-five patients were analyzed 2 months after shock wave treatment for rotator cuff tendinitis, epicondylitis, Achilles tendinopathy, trocanteritis, jumper's knee or plantar fasciitis. We recorded the epidemiological, clinical and treatment protocol, and these data were correlated with treatment outcome. RESULTS Clinical improvement was achieved in 45.9 % of these patients. We discovered that laterality different to the dominant limb (p < 0.0001) and repeated shock wave treatments (p = 0.004) are prognostic factors in an unsuccessful therapy, while being male (p = 0.015) and a high body mass index (p = 0.004) are factors for success. We found no differences in relation to age, diet, blood type, work or sport activity, presence of co-morbidities, drugs, type of tendinopathy, density of energy delivered and other physiotherapy treatment. Knowledge of these prognostic factors may lead to improved insight for physicians and physiotherapists to predict the extent of the recovery and adjust rehabilitation and patient expectations accordingly.
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Affiliation(s)
- A Notarnicola
- Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Lungomare Starita 1, 70123, Bari, Italy. .,Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - G Maccagnano
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - S Tafuri
- Department of Biomedical Sciences and Human Oncology, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A Fiore
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - C Margiotta
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - V Pesce
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - B Moretti
- Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Lungomare Starita 1, 70123, Bari, Italy.,Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Effect of extracorporeal shock wave therapy on gait pattern in hemiplegic cerebral palsy: a randomized controlled trial. Am J Phys Med Rehabil 2015; 93:1065-72. [PMID: 24879552 DOI: 10.1097/phm.0000000000000133] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of shock wave therapy on gait pattern in children with hemiplegic cerebral palsy. DESIGN Fifteen children were assigned to the study group, whose members received shock wave therapy (1500 shots/muscle, frequency of 5Hz, energy of 0.030 mJ/mm, one session/wk). Another 15 were assigned to the control group, whose members participated in a conventional physical therapy exercise program for 3 successive months. Baseline and posttreatment assessments were performed using the Modified Ashworth Scale to evaluate spasticity degrees and using a three-dimensional gait analysis to evaluate gait parameters. RESULTS Children in the study group showed a significant improvement when compared with those in the control group (P < 0.005). The Modified Ashworth scores after treatment were 1.86 (0.22) and 1.63 (0.23) for the control and study groups, respectively. The gait parameters (stride length, cadence, speed, cycle time, and stance phase percentage) after treatment were 0.5 m, 125 steps/min, 0.6 m/sec, 0.48 sec, and 50.4% and 0.74 m, 119 steps/min, 0.75 m/sec, 0.65 sec, and 55.9% for the control group and the study group, respectively. CONCLUSIONS Shock wave therapy may be a useful tool for improving spasticity and gait pattern in children with hemiplegic cerebral palsy.
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Han H, Lee D, Lee S, Jeon C, Kim T. The effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients. J Phys Ther Sci 2015; 27:397-9. [PMID: 25729177 PMCID: PMC4339147 DOI: 10.1589/jpts.27.397] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/24/2014] [Indexed: 12/13/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of extracorporeal shock
wave therapy on pain, disability, and depression of chronic low back pain patients.
[Subjects] In this study, 30 chronic low back pain patients were divided into an
extracorporeal shock wave therapy group (ESWTG, n=15) and a conservative physical therapy
group (CPTG, n=15). [Methods] The ESWTG received extracorporeal shock wave therapy and the
CPTG received general conservative physical therapy two times per week for six weeks. Pain
was measured using a visual analog scale (VAS), the degree of disability of the patients
was assessed using the Oswestry Disability Index (ODI), and their degree of depression was
measured using the Beck depression index (BDI). [Results] In intra-group comparisons,
ESWTG and CPTG showed significant decreases in VAS, ODI, and BDI scores. Intergroup
comparisons revealed that these decreases in VAS, ODI, and BDI scores were significantly
larger in ESWTG than in CPTG. [Conclusion] Extracorporeal shock wave therapy is an
effective intervention for the treatment of pain, disability, and depression in chronic
low back pain patients.
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Affiliation(s)
- Hyeonjee Han
- Department of Psychology, Graduate School, Daegu Catholic University, Republic of Korea
| | - Daehee Lee
- Department of Physical Therapy, Youngdong University, Republic of Korea
| | - Sangyong Lee
- Department of Physical Therapy, Youngdong University, Republic of Korea
| | - Chunbae Jeon
- Department of Physical Therapy, Most Holy Trinity Hospital, Republic of Korea
| | - Taehoon Kim
- Department of Rehabilitation, Graduate School Daegu University, Republic of Korea
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Schmitz C, Császár NBM, Milz S, Schieker M, Maffulli N, Rompe JD, Furia JP. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Br Med Bull 2015; 116:115-38. [PMID: 26585999 PMCID: PMC4674007 DOI: 10.1093/bmb/ldv047] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system. SOURCES OF DATA This systematic review used data derived from the Physiotherapy Evidence Database (PEDro; www.pedro.org.au, 23 October 2015, date last accessed). AREAS OF AGREEMENT ESWT is effective and safe. An optimum treatment protocol for ESWT appears to be three treatment sessions at 1-week intervals, with 2000 impulses per session and the highest energy flux density the patient can tolerate. AREAS OF CONTROVERSY The distinction between radial ESWT as 'low-energy ESWT' and focused ESWT as 'high-energy ESWT' is not correct and should be abandoned. GROWING POINTS There is no scientific evidence in favour of either radial ESWT or focused ESWT with respect to treatment outcome. AREAS TIMELY FOR DEVELOPING RESEARCH Future randomized controlled trials should primarily address systematic tests of the aforementioned optimum treatment protocol and direct comparisons between radial and focused ESWT.
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Affiliation(s)
- Christoph Schmitz
- Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Pettenkoferstr. 11, Munich 80336, Germany
| | - Nikolaus B M Császár
- Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Pettenkoferstr. 11, Munich 80336, Germany
| | - Stefan Milz
- Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Pettenkoferstr. 11, Munich 80336, Germany
| | - Matthias Schieker
- Department of Surgery, Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-University of Munich, Nussbaumstr. 20, Munich 80336, Germany
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Salerno, Italy Queen Mary University of London, Centre for Sports and Excercise Medicine, Mile End Hospital, Mann Ward, 275 Bancroft Road, London E1 4DG, UK
| | - Jan-Dirk Rompe
- OrthoTrauma Evaluation Institute, Oppenheimer Str. 70, Mainz 55130, Germany
| | - John P Furia
- SUN Orthopaedics and Sports Medicine, Division of Evangelical Community Hospital, 900 Buffalo Road, Lewisburg, PA 17837, USA
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