Radial shock wave therapy (RSWT), an extracorporeal shock wave therapy procedure (synonym: radial ESWT), is a medical technology procedure used for the disintegration and removal of calcium concretions and for pain therapy. The physical procedure, which originated in the treatment of kidney and gallstone diseases, is now also used to treat orthopedic conditions such as soft tissue, joint and bone complaints in the context of chronic inflammation. Radial shock wave therapy is based on the mechanical generation of spherical shock waves in the body, which spreads radially (spherically) in the tissue to be treated (radial ESWT). Compared with conventional shock wave therapy, radial ESWT is characterized by a gentler application of the shock waves to the tissue.
Indications (areas of application)
In principle, the penetration depth of radial shock wave therapy is less than that of conventional shock wave therapy, so less energy can be applied to deep structures.
- Epicondylitis humeri lateralis (synonyms: epicondylaris humeri ulnaris; tennis elbow)/epicondylitis humeri medialis (synonyms: epicondylaris humeri ulnaris; golfer’s elbow).
- Dorsal heel spur / calcaneal spur – bony or thorn-like protrusion on the heel as a result of overuse of tendons.
- Patellar tendon syndrome – painful inflammatory process (inflammation) in the area of origin of the patellar tendon of the knee at the tip of the kneecap, in which a fragment (piece of bone) can detach from the patella (kneecap) and necrotize (die).
- Tendinosis calcarea of the shoulder (calcified shoulder) – calcification mostly in the area of the attachment tendon of the supraspinatus muscle; often spontaneously regressive (spontaneously subsiding).
- Trigger point treatment for muscular diseases in orthopedics – Trigger points are localized hardening of skeletal muscles, which are sensitive to pressure and painful.
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.
Before therapy
The correct selection of each shock wave therapy procedure can influence the success of therapy. Not for every indication is every shock wave therapy equally useful.
The procedure
Shock waves are high-energy waves generated in various technical ways, for example, by short pressure pulses generated in water. This can be done using different physical principles: electrohydraulic, piezoelectric (vibrations of quartz crystals) and electromagnetic. The sound pulses can be localized to a specific area and act there, i.e. they develop their effect only at the programmed site 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). The delivery of shock waves in radial shock wave therapy follows a mechanical generation of pressure waves. For this purpose, a ballistic technique is used in which a projectile is strongly accelerated by means of compressed air and then hits an applicator with kinetic energy. The applicator is placed on the skin to transmit the shock waves. For the shock wave application into the tissue, a coupling medium is used, which is for example ultrasound gel or rhizinus oil. This allows the generated impact pulse, which hits the applicator, to be introduced into the tissue in the form of a pressure wave. In principle, radial ESWT is characterized by the fact that there is no so-called splitting of the pressure wave, which means that no classic shock wave focus can occur. Without this focus, however, no energy application is possible in deeper tissue areas.Instead, in this procedure, the applicator surface represents the localization of the highest pressure and energy density. With radial shock wave therapy (RSWT) devices, most of the energy is generated at the surface. Depending on the technique, this loses its effectiveness in an area of about 4 cm.
After therapy
The duration of application and success vary for different indications. Multiple applications and additional procedures should be used as appropriate. In the absence of a response to therapy, use of more invasive procedures and adjunctive drug therapy must be discussed.
Potential complications
In all published clinical studies, in addition to a high clinical success rate, an absence of clinically relevant side effects was found, so that the method of radial extracorporeal shock wave therapy can be described as successful and very low in side effects.
Benefits
Radial shock wave therapy is a successful and proven method both for the destruction and removal of calcifications and for pain therapy. Patients benefit from the gentle procedure by avoiding surgery, reducing pain, and significantly increasing their performance.
