Extracorporeal shock wave therapy (synonym: ESWT) is a medical technology procedure for the disintegration and removal of calcium concretions and for pain therapy. The physical procedure, which has its origins in urology, is now also used to treat orthopedic conditions such as soft tissue, joint and bone complaints in the context of chronic inflammation. Recently, the procedure has also been used in dermatology for patients with subacute posttraumatic/postoperative wounds, burns, and chronic wounds. However, ESWT is used exclusively as part of a multidisciplinary approach additively and not as a “stand alone” therapy as is usually the case. Only orthopedic indications for ESWT are listed below.
Indications (areas of application)
- Achillodynia (pain syndrome of the Achilles tendon)/attachment tendinopathy of the Achilles tendon.
- Dorsal heel spur/calcaneal spur – bony, thorn-like protrusion on the heel due to overuse of tendons.
- Epicondylitis humeri lateralis (synonyms: Epicondylaris humeri ulnaris; tennis elbow)/Epicondylitis humeri medialis (synonyms: Epicondylaris humeri ulnaris; golfer’s elbow).
- Fasciitis plantaris (fasciitis plantaris; plantar fasciitis; plantar fasciitis) – plantar heel spur / lower heel spur; is occasionally accompanied by inflammation of the plantar tendon on the sole of the foot (plantar tendonitis or plantar fasciitis).
- Heel pain
- Haglund exostosis (Haglund heel) – form variant of the calcaneus with calcification of the Achilles tendon insertion (upper or posterior (dorsal) heel spur).
- Pseudarthrosis – delayed bone healing after a bone fracture with formation of a false joint.
- Supraspinatus tendon syndrome – usually inflammatory, degenerative changes in the shoulder area that lead to pain.
- Tendinitis achillea – painful inflammation of the Achilles tendon.
- Tendinosis calcarea of the rotator cuff (calcified shoulder) – calcifications on the tendons of the muscles located at the shoulder joint.
- Tendinopathia patellae – painful inflammation of the tendon apparatus in the area of the kneecap.
- Tendinitis trochanterica – tendon irritation, often with accompanying bursitis in the area of the hip joint.
Contraindications
- Superficial inflammatory skin lesions – In cases of bacterial or mycotic (fungal) superficial inflammation, the use of shock wave therapy should be suspended initially until healing of the inflammation has occurred.
- Deep inflammatory skin lesions – In deep inflammatory processes such as bacterial phlegmon, shock wave treatment should not be applied in the surrounding area. Immediate (antibiotic and, if necessary, surgical) therapy should be sought.
- Malignant tumors – In the presence of malignant (malignant) tumors of the surrounding tissue should not be shock wave therapy.
The procedure
Shock waves are high-energy waves generated in different technical ways, for example, by short pulses of pressure generated in water. This can be done using different physical principles:
- Electrohydraulic
- Piezoelectric (oscillations of quartz crystals).
- Electromagnetic
The sound pulses can be localized to a specific area and act there, that is, they develop their effect only at the programmed place of action or in the diseased area of the body. In extracorporeal shock wave therapy, the shock waves are generated outside the patient’s body (extracorporeally). Shock waves are differentiated according to their energy content, which can be varied depending on the application. The following list relates the energy content to various orthopedic indications:
- Low-energy shock waves – These shock waves are used to treat pain. The therapeutic principle is based on counterirritation: the goal is to convert a chronic inflammation into an acute one. The shock waves cause a controlled injury to the tissues (soft tissues, muscles, tendons), which leads to increased vascularization (vascular or blood supply) and favors the healing process. Another effect is the hyperstimulation analgesia: this is a pain suppression by overloading the pain stimulus conduction.
- Medium-energy shock waves – Medium-energy shock waves promote the formation of cracks in calcium concretions so that the body’s own degradation mechanisms can function again and the concretions can be broken down. This happens, for example, in the treatment of tendinosis calcarea (calcifications in the shoulder joint area).
- High-energy shock waves – These are used, for example, in pseudarthrosis (delayed bone healing after a bone fracture with the formation of a false joint) to stimulate osteogenesis (new bone formation). This is also done by controlled injury to the tissue.
When using low-energy shock waves, local anesthesia (local anesthesia) is not necessary. However, when treating with medium-energy or high-energy shock waves, local or regional anesthesia, which may be associated with a short inpatient stay, should be performed.
Benefits
Extracorporeal shock wave therapy is a successful and proven method for both the destruction and removal of calcifications and pain management. Patients benefit from the gentle procedure by avoiding surgery, reducing pain, and significantly increasing their performance.
