|
E X T R A
C O R P O R E A L S H O C K
W A V E T H E R A P Y |
| |
|
|
What is extra
corporeal shock wave therapy (ESWT)? |
 |
|
|
|
|
|
“Extra
corporeal” means “outside the body”. Shock waves are created by
strong acoustic (sound) energy pulses. Extra corporeal shock
wave therapy has recently been found to be effective to treat
many forms of tendonitis, including lateral epicondylitis,
sometime called tennis elbow, a condition that causes pain in
the elbow of the affected arm. |
|
The ESWT device
is a shock wave generator, very similar to the shock wave
devices used to treat kidney stones without surgery. The
spherical shock wave head holds a kind of loudspeaker that
drives acoustic pulses through a lens and a water channel to the
treatment area. The shock head is attached to a suspension arm
that allows the shock head to reach to a patient’s arm or leg if
the patient is in a sitting or lying position. Trained medical
professionals will operate the ESWT system. These professionals
are familiar with how to treat tendonitis with ESWT. They will
focus shock waves by moving the shock wave head and by adjusting
shock waves to go deep enough to give you the best treatment. |
|
| |
|
|
Who should consider having ESWT for
tendonitis? |
|
| |
|
|
ESWT is for
patients who have had tendonitis for at least 6 months and who
have tried other methods for treating their pain. The best
outcomes have been observed in patients who have failed to
respond to at least two of the following three conventional
therapy programs:At least 4 weeks of physical/occupational
therapy;
At
least 4 weeks course of NSAIDS (nonsteroidal anti-inflammatory
medications such as aspirin, Tylenol, Advil, or aleve);Local
steroid injection(s). |
|
| |
|
|
Who should not have ESWT for
tendonitis? |
|
| |
|
|
There are no
known contraindications for low-energy ESWT for treatment of
tendonitis. |
|
| |
|
|
What else should I know about low-energy ESWT
treatment? |
|
|
Patients with
tendonitis affecting both arms and legs at the same time or who
have had previous surgery for this condition have not been
studied. Therefore, no statement regarding the effectiveness of
ESWT for these conditions can be made.
You must stop taking NSAIDs a week before you have ESWT to allow
time for this medicine to completely pass through and out of
your body. You should do this because these medications may
cause problems with blood clotting. If this happens, bruising is
more likely to occur after ESWT treatment.
The safety and effectiveness of the low-energy ESWT has not been
established for: Pregnant women; Patients younger than 18 years
of age; Patients with a coagulation abnormality, infection,
arthritis, or nerve entrapment or abnormality; Patients who have
had previous surgery for tendonitis; Patients who suffer from
systemic disease that may lead to sensory changes or nerve
related pain. For example, this may include diseases such as
gout, diabetes mellitus, and rheumatoid arthritis; Patients with
a cardiac pacemaker; Patients who received physical or
occupational therapy less than 4 weeks prior to ESWT; Patients
who received a local steroid injection less than 6 weeks prior
to ESWT.Your doctor can provide you with additional information
about these and other conditions, and how they might affect your
decision to have ESWT. |
|
| |
|
|
What other treatments are
available for treating tendonitis? |
|
| |
|
|
Physicians know
that some patients with tendonitis get better with time, even
with no active treatment. Other patients get better after trying
one or more non-surgical treatment, which include: Rest from
excessive or abusive activity; Application of heat or cold;
Physical conditioning and stretching exercises;
Physical/occupational therapy; Over-the-counter pain relievers,
such as aspirin or Tylenol; Prescription pain relievers; NSAIDs,
such as aspirin, Tylenol, ibuprofen, or Aleve; Steroid
injections (cortisone). If these conservative therapies are not
successful, another alternative to ESWT is to have surgery. |
|
| |
|
|
What adverse effects could happen with low-energy
ESWT treatment? |
|
| |
|
|
The following
effects have been observed during clinical trials of low-energy
ESWT:Pain during and immediately after treatment was most
commonly reported; Nausea was the second most commonly reported
side effect; ESWT may cause sweating, dizziness, tremor,
paleness, and may temporarily widen blood vessels at the site of
treatment. Most reported events were mild in severity and
resolved within 24 hours of treatment; ESWT may cause skin
reddening or bruising of the treated area, which usually
resolves within a few days of treatment’s may cause muscle pain
(myalgia) and muscle tension (hypertonia) near the treatment
area. The reported side effects included muscle soreness,
cramps, and spasms. Most of these side effects were mild and
resolved within 48 hours of treatment; ESWT may cause joint
stiffness. This side effect disappeared within 48 hours of
treatment. Some patients reported numbness and tingling
sensations near the treatment area. Most of these sensations
resolved without further treatment. Potential adverse effects
not seen during the studies include: Neuropathy (problems with
the nervous system) Tendon rupture; Local hematoma (bruising);
Misdirection of the energy of the treatment. |
|
| |
|
|
What happens during ESWT treatment? |
|
| |
|
|
If
your UNC Orthopedist recommends ESWT treatment he/she will feel
the painful area in order to locate the exact point of
tenderness. This point may be marked on your skin with a color
marker. You will be treated with ESWT while sitting in a chair
or lying down with your arm or leg supported in a relaxed
position. Prior to the treatment, the operator will apply a
coupling gel to the treatment area. This gel makes it possible
for the shock waves to enter your arm or leg. Next, the ESWT
machine’s shockwave head is applied to the treatment area (the
marked spot). The treatment will be started with very low
intensity pulses. You may experience some irritation in your arm
or leg every time you hear the “clapping sound” produced by the
system’s “loud speaker.” The irritation that you feel should be
in the area of your tendonitis. If this is not the case, you
should move your arm or leg with the operator’s help until you
feel the treatment in the area of your tendonitis pain. After
about 100 pulses you may experience some kind of local numbness,
and the operator will increase the energy to the treatment
level. This may cause more pain that should wear off after a
couple hundred pulses. If the pain is too uncomfortable, you
should tell the operator so that the shockwave head may be
moved. A total of 2100 pulses will be applied during a single
treatment session. One treatment session will take about 20
minutes and is performed as an outpatient procedure. A complete
therapy for tendonitis usually requires 3 treatment sessions
with a week pause between sessions. |
|
| |
|
|
What are the expected
results of ESWT treatment? |
|
| |
|
|
In
a clinical study it was shown that low-energy ESWT significantly
reduced pain and improved functional activity compared to a
placebo (mock) group 12 weeks after the last treatment. 114
patients participated in the clinical study. The patients were
randomly distributed in the two groups, with one group receiving
ESWT treatment, and one group receiving placebo (mock)
treatment.
During the study, patients were asked to comment on their level
of pain, and to score their level of pain on a scale of 0 to
100. A score of 0 meant that they felt no pain and a score of
100 meant that they felt a great deal of pain. The average pain
score for patients who received the active ESWT treatment was 74
when they entered the study and 37.6 12 weeks after treatment.
The average score for the patients who received placebo (mock)
treatment was 75.6 when they entered the study and 51.3 at 12
weeks. This was an average improvement of 49% for the active
ESWT treatment group and 32% for the placebo group. |
|
