Extracorporeal shockwave therapy

Medical uses

The most common use of extracorporeal shockwave therapy (ESWT) is for lithotripsy to treat kidney stones (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver) using an acoustic pulse. It is also reported to be used for salivary stones and pancreatic stones.

In the UK, the National Institute for Health and Care Excellence (NICE) found that the evidence for ESWT in the majority of indications is conflicting, and therefore ESWT should only be used where there are special arrangements for clinical governance and audit.

Extracorporeal shockwave therapy is used as a second line measure to treat tennis elbow, shoulder rotator cuff pain, Achilles tendinitis, plantar fasciitis, and greater trochanteric pain syndrome.

ESWT is also used to promote bone healing and treat bone necrosis. It is an effective alternative to surgical treatment of non-healing fractures.

ESWT is used for wound healing and has shown positive results in short-term and long-term outcomes in diabetic patients with foot ulcers. Randomised controlled trials into the use of ESWT for healing venous leg ulcers are needed as there is a lack of evidence in this area.

Low-intensity extracorporeal shock wave therapy (LI-ESWT) has been used as a treatment for erectile dysfunction. It differs from palliative options by aiming to restore natural erectile function by inducing cellular microtrauma, triggering the release of angiogenic factors and promoting neovascularization in treated tissue. This mechanism is distinct from the high-intensity shock waves used in lithotripsy and medium-intensity shock waves used for anti-inflammatory purposes in orthopedics. Clinical studies, including double-blind randomized trials, have demonstrated LI-ESWT's ability to significantly improve erectile function and penile hemodynamics in men with vasculogenic ED.

Procedure

The lithotripter attempts to break up the stone with minimal collateral damage by using an externally applied, focused, high-intensity acoustic pulse. The patient is usually sedated or anesthetized for the procedure in order to help them remain still and reduce possible discomfort. Sedation is not required in its application for soft tissue injuries.

History

Beginning in 1969 and funded by the German Ministry of Defense, Dornier began a study of the effects of shock waves on tissue. In 1972, on the basis of preliminary studies performed by Dornier Medical Systems, an agreement was reached with Egbert Schmiedt, director of the urologic clinic at the University of Munich. The development of the Dornier lithotripter progressed through several prototypes, ultimately culminating in February 1980 with the first treatment of a human by shockwave lithotripsy (SWL). The production and distribution of the Dornier HM3 lithotripter began in late 1983, and SWL was approved by the U.S. Food and Drug Administration in 1984.

In the 1980s people using ESWT for kidney stones noticed that it appeared to increase bone density in nearby bones, leading them to explore it for orthopedic purposes.

Research

In response to concerns raised by NICE, in 2012 a study called the Assessment of the Effectiveness of ESWT for Soft Tissue Injuries was launched (ASSERT).

As of 2018 use of ESWT had been studied as a potential treatment for chronic prostatitis/chronic pelvic pain syndrome in three small studies; there were short-term improvements in symptoms and few adverse effects, but the medium-term results are unknown, and the results are difficult to generalize due to the low quality of the studies.

Veterinary use

ESWT is commonly used for treating orthopedic problems in horses, including tendon and ligament injuries, kissing spine, navicular syndrome, and arthritis. The evidence for these uses is weak.

Physiotherapy use

ESWT is used in physical therapy for pain reduction, increase in metabolism at the cellular level, revascularisation, and recovering normal muscle tone following various disorders. The use of ESWT was demonstrated in patients with frozen shoulders compared to therapeutic ultrasound with exercises.

Research suggests that ESWT can accelerate the blood flow, facilitating the healing of the inflamed Achilles tendon. In one study involving 23 patients with chronic Achilles tendinopathy, 20 reported improvement in their condition and pain scores after ESWT; three saw no change, and none reported any worsening.

References

References

1. (2012). "Extracorporeal shockwave therapy in musculoskeletal disorders". Journal of Orthopaedic Surgery and Research.
2. (2002). "Extracorporeal Shockwave Therapy". Sports Medicine.
3. (August 2023). "Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones". The Cochrane Database of Systematic Reviews.
4. "Salivary duct stones". U.S. National Library of Medicine.
5. (September 2012). "Pancreatic stone and treatment using ERCP and ESWL procedures: a case study and review". The New Zealand Medical Journal.
6. (March 2018). "The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction". British Journal of Sports Medicine.
7. (September 2017). "Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs". British Journal of Sports Medicine.
8. "Tennis Elbow Treatment Shockwave Therapy".
9. (August 2009). "Extracorporeal shockwave therapy for refractory tennis elbow". National Institute for Health and Clinical Excellence.
10. (December 2015). "Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy". International Journal of Surgery.
11. (November 2003). "Extracorporeal shockwave lithotripsy for calcific tendonitis (tendinopathy) of the shoulder". National Institute for Health and Clinical Excellence.
12. (August 2014). "Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis". Journal of Shoulder and Elbow Surgery.
13. (August 2009). "Extracorporeal shockwave therapy for refractory Achilles tendinopathy". National Institute for Health and Clinical Excellence}}{{Update inline.
14. (June 2013). "Treatment for insertional Achilles tendinopathy: a systematic review". Knee Surgery, Sports Traumatology, Arthroscopy.
15. (August 2009). "Extracorporeal shockwave therapy for refractory plantar fasciitis". National Institute for Health and Clinical Excellence.
16. (August 2014). "Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials". Archives of Physical Medicine and Rehabilitation.
17. (January 2011). "Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome". National Institute for Health and Clinical Excellence.
18. (December 2015). "Biological mechanism of shockwave in bone". International Journal of Surgery.
19. (January 2010). "[Clinical application of extracorporeal shock wave to repair and reconstruct osseous tissue framework in the treatment of avascular necrosis of the femoral head (ANFH)]". Zhongguo Gu Shang = China Journal of Orthopaedics and Traumatology.
20. (December 2015). "Extracorporeal shockwave therapy in diabetic foot ulcers". International Journal of Surgery.
21. (June 2018). "Extracorporeal shock wave therapy for the healing and management of venous leg ulcers". The Cochrane Database of Systematic Reviews.
22. (2024-10-09). "Low-intensity extracorporeal shockwave therapy for erectile dysfunction: an overview of systematic reviews". Translational Andrology and Urology.
23. (March 2023). "Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities". Investigative and Clinical Urology.
24. (April 2013). "Shockwave treatment of erectile dysfunction". Therapeutic Advances in Urology.
25. [https://www.kidney.org/atoz/content/lithotripsy "Lithotrypsy"] National Kidney Foundation, Accessed February 6, 2017
26. (February 8, 1999). "Gastroenterology and Urology Devices; Reclassification of the Extracorporeal Shock Wave Lithotripter AGENCY: Food and Drug Administration, HHS ACTION: Proposed rule". Federal Register (US Government).
27. (September 2014). "Assessment of the Effectiveness of Extracorporeal Shock Wave Therapy (ESWT) For Soft Tissue Injuries (ASSERT): An Online Database Protocol". Translational Medicine @ UniSa.
28. (May 2018). "Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome". The Cochrane Database of Systematic Reviews.
29. (2016). "A review of the cellular and molecular effects of extracorporeal shockwave therapy". Veterinary and Comparative Orthopaedics and Traumatology.
30. (May 2012). "Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical and ultrasonographical comparison". Clinical Rheumatology.
31. (July 2019). "The effectiveness of extracorporeal shockwave therapy for frozen shoulder in patients with diabetes: randomized control trial". Journal of Physical Therapy Science.
32. (November–December 2008). "Extracorporeal shockwave therapy for the treatment of Achilles tendinopathies: a prospective study". Journal of the American Podiatric Medical Association.