Synonyms in a broader sense
Extracorporeal shock wave treatment, shock wave lithrotripsy, ESWT, ESWL, high-energy low-energy shock wave,
Introduction
It can be considered undisputed that shock waves have a biological effect that can be used therapeutically. Experimental studies have demonstrated various modes of action of shock waves, which can explain the positive influence of shock waves on pseudarthrosis (failure to heal a bone fracture with connective tissue bridging the fracture) and tendon attachment disorders. The shock wave has the following proven biological effects: The current theory states that the activation of the above-mentioned biological processes initiates the body’s self-healing processes.
Through an ingrowth of blood vessels (angioneogenesis) and an increased metabolism, damaged tendon tissue can be “repaired” and local inflammation healed. Depending on the disease being treated, immediate and sustained therapeutic success cannot be expected because the above-mentioned tissue reactions take time. Ultimately, there are still many things that remain unexplained in the mode of action of shock waves.
- Stimulation of bone growth.
- Angioneogenesis (formation of new blood vessels).
- Release of growth factors and other biologically active proteins.
History
Shock waves have been successfully used in urology for over 20 years in the therapy of renal and ureteral stones. Only the mechanical properties of the shock wave are used, whose energy leads to the “disintegration” of renal and ureteral calculi. It was more or less by chance that the German urologist Herbst discovered the effect of shock waves on bone tissue.
Without being able to explain it, it was shown that shock waves had a stimulating effect on bone tissue. The shock wave must therefore have a different effect than the purely mechanical one. It was obvious to make use of this property of the shock wave in the treatment of false joints (pseudarthrosis), the problem of which is the lack of bony fracture development (see below).
Since the beginning of the 1990s, shock wave therapy has been widely used in the treatment of orthopedic clinical pictures. Since then, numerous studies have been able to prove the effectiveness of shock wave treatment, particularly in cases of tendon insertion disorders (enthesiopathy) (see below). Since the biological effect of the shock wave has not been conclusively clarified and the success of therapy is difficult to predict in individual cases, the shock wave is not fully approved as a form of therapy by health insurance companies. Most private health insurance companies generally cover the costs of treatment for tennis elbow, heel spur and calcified shoulder (tendinosis calcarea), since the shock wave effect can be considered as secured in the data available.
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