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Background: Focused extracorporeal shock wave therapy (ESWT) has been successfully used to treat musculoskeletal conditions, but ESWT stimulates nociceptors, causing pain deep in the tissue during treatment. The occurrence of pain during ESWT is a side effect, but it can help identify painful sites and assess minimum (MiTI) and maximum (MaTI) pain thresholds to ESWT pressure stimuli. This topic has received limited attention in literature. Methods: This observational study describes a specific approach to using ESWT to study pain in 71 patients. The approach proposes moving the ESWT transducer head of the device over the entire joint surface, progressively increasing the energy level until the patient experiences pain. Results: In the study, MiTI and MaTI were 0.218 ± 0.090 and 0.416 ± 0.165 mJ/mm2 in the affected joint and 0.282 ± 0.128 and 0.501 ± 0.174 mJ/mm2 in the contralateral homologous healthy joint, being significantly lower in the affected joint (MiTI: p < 0.001 and MaTI: p = 0.003, respectively). ESWT induced pain in 94.37% of the sites with the highest subjective pain and in a greater number of sites (204) than digital pressure (123) (p < 0.001). All sites with digital pressure pain also had ESWT pain. Conclusions: These results suggest that the ESWT device may be useful in investigating pain in musculoskeletal conditions and tailoring therapy. [ABSTRACT FROM AUTHOR]

Aims: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) prevalence varies from 8.4% to 25% of the male population and is associated with diminished health‐related quality of life. Managing CP/CPPS remains challenging and there is not any common option to treat all patients effectively because of the complex disease nature. The currently available data for the extracorporeal shockwave therapy (eSWT) effect on pain relief and well‐being were analyzed in the present study. Methods: We adhered to PRISMA 2022 guidelines for reporting the quantitative and qualitative data synthesis. A literature search was conducted in March 2023 using PubMed/Medline, Scopus, and Google Scholar. Randomized prospective studies of eSWT alone or eSWT plus conventional medicinal treatment were included. The risk of bias was estimated using the RoB 2.0. Primary outcomes were self‐reported scores, including the NIH‐CPSI questionnaire and VAS, at 1 month or 2, 3, and 6, months follow‐up. Results: The CP/CPPS patients who receive eSWT have more pronounced pain relief and improvement of other subjective NIH‐CPSI scores compared with control groups that received placebo or medication therapy. The effect of eSWT seems to be long‐lasting and was confirmed in the 6‐month follow‐up (p < 0.01). Conclusions: Based on the meta‐analysis of accessible studies, we receive the equivalence eSWT applicability for the CP/CPPS treatment and can be offered to patients because of its noninvasiveness, high level of safety, and successful clinical results demonstrated in this analysis. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the effects of dry needling (DN) and extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis (PF). The study included 55 patients with PF. The patients were randomly divided into 2 groups. The DN group applied 3 sessions of DN to the myofascial trigger points in the lower limb muscles. The ESWT group applied 3 sessions of ESWT to the plantar fascia. For clinical evaluation, we used a visual analog scale (VAS) (first step, rest, activity) and Foot Function Index (FFI) (pain, disability, activity). Assessments were done baseline, post-treatment first week, and fourth week. Maximum pain-free standing time (Max PfST) and maximum pain-free walking distance (Max PfWD) were recorded at baseline and post-treatment fourth week. In this study, we found significant improvement in VAS, FFI, Max PfST, and Max PfWD in both groups (p <.01). VAS-activity baseline-forth week change was significantly superior in the DN group compared to the ESWT group (p =.023). FFI-disability baseline-fourth week change was significantly superior in the DN group compared to the ESWT group (p =.048). There was no significant difference in other treatment-related changes between the groups (p >.05). However, VAS-rest baseline-fourth week change and FFI-pain baseline-fourth week change trended towards statistical significance between groups ((p =.056), (p =.052) respectively). This study showed that DN may be a good alternative treatment for patients with PF, with effects similar to or even superior to ESWT. [ABSTRACT FROM AUTHOR]

The supraspinatus tendon is one of the most involved tendons in the development of shoulder pain. Extracorporeal shockwave therapy (ESWT) has been recognized as a valid and safe treatment. Sometimes the symptoms cannot be relieved, or a relapse develops, affecting the patient's quality of life. Therefore, a prediction protocol could be a powerful tool aiding our clinical decisions. An artificial neural network was run, in particular a multilayer perceptron model incorporating input information such as the VAS and Constant–Murley score, administered at T0 and at T1 after six months. It showed a model sensitivity of 80.7%, and the area under the ROC curve was 0.701, which demonstrates good discrimination. The aim of our study was to identify predictive factors for minimal clinically successful therapy (MCST), defined as a reduction of ≥40% in VAS score at T1 following ESWT for chronic non-calcific supraspinatus tendinopathy (SNCCT). From the male gender, we expect greater and more frequent clinical success. The more severe the patient's initial condition, the greater the possibility that clinical success will decrease. The Constant and Murley score, Roles and Maudsley score, and VAS are not just evaluation tools to verify an improvement; they are also prognostic factors to be taken into consideration in the assessment of achieving clinical success. Due to the lower clinical improvement observed in older patients and those with worse clinical and functional scales, it would be preferable to also provide these patients with the possibility of combined treatments. The ANN predictive model is reasonable and accurate in studying the influence of prognostic factors and achieving clinical success in patients with chronic non-calcific tendinopathy of the supraspinatus treated with ESWT. [ABSTRACT FROM AUTHOR]

This case report describes a novel and unique combination of both electromagnetic and electrohydraulic focused extracorporeal shockwave therapy (ESWT) and extracorporeal magnetotransduction therapy (EMTT) for accelerated healing in a calcaneus epiphyseal fracture with delayed healing in an adolescent Parkour athlete. After a 2.5m jump, the 14-year-old experienced significant heel pain, however avoided telling his parents. After eight weeks, the initial imaging using ultra low dose weight-bearing cone beam CT (WBCT) revealed a calcaneus non-union situation adjacent to the open calcaneal physis. To improve and accelerate bony healing substantially, we chose to apply both combined focused electromagnetic (Storz Ultra, Storz Medical AG, Tägerwillen, CH) and focused electrohydraulic (MTS, Konstanz, Germany) ESWT in a fractioned fashion plus EMTT (Storz Magnetolith, Tägerwillen, CH) in five consecutive weekly sessions while allowing the patient to fully weight bear. The follow-up WBCT after six weeks revealed a near to total healing of the delayed union and being pain-free. Notably, combination therapy with focused ESWT and EMTT did not result in early closure of the calcaneal epiphysis. We conclude that combined focused electromagnetic and electrohydraulic ESWT and EMTT facilitate bony healing in adolescent calcaneal apophyseal fractures without any adverse effects on the open physis. Evidence level IV (case report). [ABSTRACT FROM AUTHOR]

Abstract Background Rotator cuff tendinopathy (RCT) is a widespread musculoskeletal disorder and a primary cause of shoulder pain and limited function. The resulting pain and limited functionality have a detrimental impact on the overall quality of life. The purpose of this study was to perform a systematic review of the effects of extracorporeal shock wave therapy (ESWT) for RCT. Methods The literature search was conducted on the following databases from inception to February 20, 2024: PubMed, Web of Science, the Cochrane Library, Scopus, MEDLINE, EMBASE, EBSCO, and China National Knowledge Infrastructure (CNKI) were checked to identify the potential studies exploring the effect of ESWT for the treatment of Rotator cuff tendinopathy (Calcification or non-calcification), control group for sham, other treatments (including placebo), without restriction of date, language. Two researchers independently screened literature, extracted data, evaluated the risk of bias in the included studies, and performed meta-analysis using RevMan 5.3 software. Results A total of 16 RCTs with 1093 patients were included. The results showed that compared with the control group, ESWT for pain score Visual Analogue Scale/Score (VAS) (SMD = -1.95, 95% CI -2.47, -1.41, P

Background: Rotator cuff tendinopathy (RCT) is a widespread musculoskeletal disorder and a primary cause of shoulder pain and limited function. The resulting pain and limited functionality have a detrimental impact on the overall quality of life. The purpose of this study was to perform a systematic review of the effects of extracorporeal shock wave therapy (ESWT) for RCT. Methods: The literature search was conducted on the following databases from inception to February 20, 2024: PubMed, Web of Science, the Cochrane Library, Scopus, MEDLINE, EMBASE, EBSCO, and China National Knowledge Infrastructure (CNKI) were checked to identify the potential studies exploring the effect of ESWT for the treatment of Rotator cuff tendinopathy (Calcification or non-calcification), control group for sham, other treatments (including placebo), without restriction of date, language. Two researchers independently screened literature, extracted data, evaluated the risk of bias in the included studies, and performed meta-analysis using RevMan 5.3 software. Results: A total of 16 RCTs with 1093 patients were included. The results showed that compared with the control group, ESWT for pain score Visual Analogue Scale/Score (VAS) (SMD = -1.95, 95% CI -2.47, -1.41, P < 0.00001), function score Constant-Murley score (CMS) (SMD = 1.30, 95% CI 0.67, 1.92, P < 0.00001), University of California Los Angeles score (UCLA) (SMD = 2.69, 95% CI 1.64, 3.74, P < 0.00001), American Shoulder and Elbow Surgeons form (ASES) (SMD = 1.29, 95% CI 0.93, 1.65, P < 0.00001), Range of motion (ROM) External rotation (SMD = 1.00, 95% CI 0.29, 1.72, P = 0.02), Total effective rate (TER) (OR = 3.64, 95% CI 1.85, 7.14, P = 0.0002), the differences in the above results were statistically significant. But ROM-Abduction (SMD = 0.72, 95% CI -0.22, 1.66, P = 0.13), the difference was not statistically significant. Conclusion: Currently limited evidence suggests that, compared with the control group, ESWT can provide better pain relief, functional recovery, and maintenance of function in patients with RCT. [ABSTRACT FROM AUTHOR]

Background: An umbrella review was conducted to compare the effectiveness of extracorporeal shock wave therapy (ESWT) versus non-ESWT in the treatment of knee osteoarthritis (KOA). Materials and methods: Three databases including PubMed, Embase and Web of science were searched up to September 2023. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Metaanalysis of outcome indicators was performed using Revman 5.4 software. Results: A total of eight meta-analysis were included in this umbrella review. All meta-analysis were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and scored between 8 and 11. Compared to the sham group, the ESWT group showed better results in WOMAC (Western Ontario and McMaster Universities Arthritis Index) [mean difference (MD)= -2.94, 95% CI: -5.52, -0.37, P= 0.03, I²= 60%], Visual Analog Scale (VAS) (MD = - 2.0, 95% CI: - 2.5, - 1.5, P< 0.01, I²=0%), range of motion (ROM) (MD =17.55, 95% CI: 13.49, 21.61, P< 0.00001, I²=0%), and Lequesne index (MD = - 2.85, 95% CI: - 3.64, - 2.07, P<0.00001, I²=48%). Conclusion: Based on the results of our analysis, ESWT is now an effective therapy for improving pain and function in patients with KOA. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shock wave therapy (ESWT) promotes tissue healing by modulating inflammation, which has implications for meniscal tear healing in the avascular zone. Purpose: To evaluate the effects of a single dose of radial ESWT on the healing process and inflammation of the meniscus and knee joints after meniscal tears in the avascular zone. Study Design: Controlled laboratory study. Methods: Avascular tears were induced in the medial meniscus (MM) of 72 Sprague-Dawley rats. One week postoperatively, the rats received a single session of radial ESWT with a Power+ handpiece (ESWT group; n = 36) or with a fake handpiece (sham-ESWT group; n = 36). The rats were then euthanized at 2, 4, or 8 weeks postoperatively. The MMs were harvested for analysis of healing (hematoxylin-eosin, safranin O–Fast Green, and collagen type 2 staining) and inflammation (interleukin [IL]-1β and IL-6 staining). Lateral menisci and synovia were obtained to evaluate knee joint inflammation (enzyme-linked immunosorbent assay of IL-1β and IL-6). Cartilage degeneration was assessed in the femurs and tibial plateaus using safranin O–Fast Green staining. Results: The ESWT group showed significantly better meniscal healing scores than the sham-ESWT group at 4 (P =.0066) and 8 (P =.0050) weeks postoperatively. The IL-1β level was significantly higher in the sham-ESWT group than in the ESWT group at 2 (MM: P =.0009; knee joint: P =.0160) and 8 (MM: P =.0399; knee joint: P =.0001) weeks. The IL-6 level was significantly lower in the sham-ESWT group than in the ESWT group at 2 (knee joint: P =.0184) and 4 (knee joint: P =.0247) weeks but higher at 8 weeks (MM: P =.0169; knee joint: P =.0038). The sham group had significantly higher osteoarthritis scores than the ESWT group at 4 (tibial plateau: P =.0157) and 8 (femur: P =.0048; tibial plateau: P =.0359) weeks. Conclusion: A single dose of radial ESWT promoted meniscal tear healing in the avascular zone, modulated inflammatory factors in the menisci and knee joints in rats, and alleviated cartilage degeneration. Clinical Relevance: Radial ESWT can be considered a potential option for improving meniscal tear healing in the avascular zone because of its ability to modulate inflammation. [ABSTRACT FROM AUTHOR]

The current study aims to evaluate the potential role of extracorporeal shock wave therapy (ESWT) on functional status, physical disability, and pain in patients suffering from low back pain (LBP). ESWT may provide superior therapeutic outcomes in reducing pain and ameliorating the patient's functional status regarding LBP.

Achilles tendinopathy is a degenerative process due to excessive and cumulative use of microtrauma with internal and external risk factor. Approximately 52% of runners experience an Achilles tendinopathy (AT) injury during their lifetime. Achilles Tendinopathy can limit Indonesia's athletic performance due to pain on the side of the knee during running, walking and jumping. The aim of this study was to evaluate the physiotherapy management for Achilles Tendinopathy cases in Indonesian para-athletics. This research is a descriptive case studyinvolving one client with participatory observation. The physiotherapy intervention involved modality intervention using Eccentric exercises, ESWT, Stretching, Muscle release, Electrical Stimulation, and Cryotheraphy. The subject of the study was An. B, a 28 year old para athlete with height 182 cm, weight 77 kg, and BMI 23.3 in the ideal category. The patient came to the physiotherapy clinic of NPC Indonesia on 20 August 2023 with complaints of pain and burning in the left leg. Physical examination showed normal results except for pain examination using Numeric Rating Scale (NRS), where silent pain 0/10, tenderness 9/10, and motion pain 7/10 were found. The diagnosis of Achilles Tendinopathy sinistra was confirmed through specific examination. After four physiotherapy sessions Based on the results of studies that have been carried out, ESWT and Eccentric exercise can reduce pain, increase joint range of motion, increase muscle strength, increase ankle stability and improve functional abilities in Achilles tendinopathy patients.

Background: Focused extracorporeal shock wave therapy (ESWT) has been successfully used to treat musculoskeletal conditions, but ESWT stimulates nociceptors, causing pain deep in the tissue during treatment. The occurrence of pain during ESWT is a side effect, but it can help identify painful sites and assess minimum (MiTI) and maximum (MaTI) pain thresholds to ESWT pressure stimuli. This topic has received limited attention in literature. Methods: This observational study describes a specific approach to using ESWT to study pain in 71 patients. The approach proposes moving the ESWT transducer head of the device over the entire joint surface, progressively increasing the energy level until the patient experiences pain. Results: In the study, MiTI and MaTI were 0.218 ± 0.090 and 0.416 ± 0.165 mJ/mm2 in the affected joint and 0.282 ± 0.128 and 0.501 ± 0.174 mJ/mm2 in the contralateral homologous healthy joint, being significantly lower in the affected joint (MiTI: p < 0.001 and MaTI: p = 0.003, respectively). ESWT induced pain in 94.37% of the sites with the highest subjective pain and in a greater number of sites (204) than digital pressure (123) (p < 0.001). All sites with digital pressure pain also had ESWT pain. Conclusions: These results suggest that the ESWT device may be useful in investigating pain in musculoskeletal conditions and tailoring therapy.

Background: We aimed to investigate the effect of Extracorporeal Shock Wave Therapy (ESWT) applied to patients with hemiplegia on somatosensory data, spatiotemporal parameters, posture, and muscle tone. Methods: This was a double-blind, randomised, controlled trial. Patients were randomised within pairs to either the experimental (ESWT) group (n = 20) or the control group (n = 20). All patients participated in the same conventional stroke rehabilitation program for 60 minutes of treatment a day, 5 times a week for 6 weeks (30 sessions). Patients assigned to the ESWT group received additional ESWT over the plantar fascia 3 days/week for 6 weeks. Timed Up and Go (TUG) test, Modified Ashworth Scale (MAS) score, Posture Assessment Scale for Stroke Patients (PASS), spatiotemporal parameters, Semmes--Weinstein monofilament (SWM) test, and vibration sensation test (VST) were performed in all participant before and after treatment. Results: In the ESWT and control groups, statistically, significant differences were obtained in the posttreatment analysis than pre-treatment. Significant differences were found in foot angle, step cycle duration, swing phase, cadence, gait cycle distance, and VST values after ESWT treatment (P < .01). Conclusion: When combined with a neurological rehabilitation program, it was determined that ESWT applied to the plantar face of the foot in individuals with hemiplegia increased somatosensory functions and was more successful in developing postural control and balance. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the results of extracorporeal shock wave therapy (ESWT), corticosteroid injection (CI), and kinesio taping (KT) in terms of pain and function in plantar fasciitis (PF). Patients and methods: In this prospective study, 90 feet of 64 patients (11 males, 53 females; mean age: 38.3±10.4 years; range, 22 to 70 years) who presented with chronic PF between November 2021 and March 2022 were evaluated. The patients were randomized to three groups, with 30 feet in each group: the CI group, the ESWT group, and the KT group. Each group received only the respective treatment modalities assigned to their group. Pain assessment of the patients before the treatment and at six weeks, three months, and six months was evaluated with the Visual Analog Scale (VAS), and their functions were evaluated with the American Orthopedic Foot and Ankle Society (AOFAS) score. Results: There was no statistical difference in the demographic data (age, body mass index, and VAS; all p>0.05). At six weeks, VAS was statistically significantly lower in the CI group compared to the other groups (p<0.001), but there was no difference in AOFAS between the groups (p=0.666). At three months, there was no statistical difference between the groups regarding VAS (p=0.311), while the AOFAS was higher in the ESWT group (p=0.006). At six months, VAS was lower (p<0.001) and AOFAS was higher (p=0.003) in the ESWT group. Conclusion: All three commonly used treatment modalities, ESWT, CI, and KT, are effective in reducing pain and increasing function in chronic PF. However, while CIs can be more effective in relieving pain in the early period, the most significant improvement at the end of the sixth month was achieved by ESWT. [ABSTRACT FROM AUTHOR]

Purpose: Supraspinatus tendinosis (ST) refers to the intratendinous degeneration of the supraspinatus tendon. Platelet-Rich Plasma (PRP) is one of the possible conservative treatments for supraspinatus tendinosis. This prospective observational study aims to evaluate the efficacy and safety of a single ultrasound-guided PRP injection in the treatment of supraspinatus tendinosis and to assess its non-inferiority to the widely used shockwave therapy. Methods: Seventy-two amateur athletes (35 male, mean age: 43.75 ± 10.82, range 21–58 years old) with ST were finally included in the study. All the patients underwent clinical evaluation at baseline, (T0) and at 1-month (T1), 3-month (T2) and 6-month (T3) follow-up using the following clinical scales: the Visual Analogue Scale for pain (VAS), Constant Score and the Disabilities of the Arm, Shoulder and Hand Score (DASH). A T0 and T3 ultrasound examination was also performed. The findings observed in the recruited patients were compared to the clinical results observed in a retrospective control group made up of 70 patients (32 male, mean age = 41.29 ± 13.85, range 20–65 years old) treated by extracorporeal shockwave therapy (ESWT). Results: VAS, DASH and Constant scores significantly improved from T0 to T1; the improvement in clinical scores was kept until T3. No local nor systemic adverse events were observed. An improvement in the tendon structure was observed on ultrasound examination. PRP showed a non-statistical inferiority, in terms of efficacy and safety, compared to ESWT. Conclusion: The PRP one-shot injection is a valid conservative treatment to reduce pain, and improve both quality of life and functional scores in patients with supraspinatus tendinosis. Furthermore, the PRP intratendinous one-shot injection showed a non-inferiority in terms of efficacy at the 6-month follow-up, compared to ESWT. [ABSTRACT FROM AUTHOR]

Abstract Background Extracorporeal shock wave therapy (ESWT) has been widely used for pain control in musculoskeletal disorders. Whether ESWT can relieve chronic low back pain (CLBP) and improve lumbar function is still unclear. Therefore, we conducted a meta-analysis of relevant studies to comprehensively analyse and determine the efficacy and safety of ESWT for chronic low back pain. Methods Four databases were systematically searched for randomized controlled trials (RCTs) on ESWT for CLBP. The quality of the included studies was evaluated according to Cochrane systematic review criteria, relevant data were extracted, and meta-analysis was performed using RevMan 5.4 software. The primary outcomes were pain intensity, disability status, and mental health. The data were expressed as standardized mean differences (SMD) or weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity was assessed using the I 2 statistic. If I 2 ≥ 50%, a random effects model was applied; otherwise, a fixed effects model was used. Results Twelve RCTs involving 632 patients were included in this meta-analysis. The ESWT group reported significantly more pain relief than the control group at 4 weeks (WMD = − 1.04; 95% CI = − 1.44 to − 0.65; P

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Background: Focal extracorporeal shock wave therapy (fESWT) is a physical therapy vastly studied and used for various musculoskeletal disorders. However, the effect of fESWT on central nervous system is still to be determined. Objective: To elucidate spinal and supra-spinal mechanisms of fESWT in healthy subjects, in order to widen the spectrum of its clinical applications. Methods: In this quasi-experimental, unblinded, proof-of-concept clinical study, 10 voluntary healthy subjects underwent fESWT and were assessed immediately before (T0), immediately after (T1) and seven days after (T2) the intervention. As neurophysiological outcomes, motor evoked potentials (resting motor threshold, maximal motor evoked potential and maximal compound muscle action potential ratio, cortical silent period, total conduction motor time, direct and indirect central motor conduction time), F-waves (minimal and mean latency, persistence and temporal dispersion) and H-reflex (threshold, amplitude, maximal H reflex and maximal compound muscle action potential ratio, latency) were considered. Results: Resting motor threshold and F-waves temporal dispersion significantly decreased, respectively, from T1 and T2 and from T0 and T2 (for both, p < 0.05). H-reflex threshold increase between T0 and T1. Analysis disclosed a strong negative correlation between Δ3 cortical silent period (i.e., T2 –T1 recordings) and Δ1 Hr threshold (i.e., T1 –T0 recordings) (r = –0.66, p < 0.05), and a positive strong relationship between Δ3 cortical silent period and Δ3 Hr threshold (r = 0.63, p < 0.05). Conclusions: fESWT modulates corticospinal tract excitability in healthy volunteers, possibly inducing an early inhibition followed by a later facilitation after one week. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal Shockwave Therapy (ESWT) has been indicated to relieve local perineal symptoms caused by Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). Current research has examined the efficacy of ESWT in CPPS patients. Different types of energy generators for ESWT lead to development of different clinical protocols for treatment of CP/CPPS. Therefore in this review, we aimed to compare the clinical protocol, efficacy and safety profile of all these different ESWT machines in CP/CPPS treatment. Methods: A systematic literature search of 3 search engines (PubMed, Scielo, and Science Directs) was undertaken using the following keywords: Chronic Prostatitis, Chronic Pelvic Pain Syndrome, and Extracorporeal Shockwave Therapy. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. This review included original studies that evaluated the efficacy and clinical protocol of Extracorporeal Shockwave Therapy and Chronic prostatitis or Chronic Pelvic Pain Syndrome that are fully written in English with full-text articles readily available. This article excluded letters to the editor, reviews, and editorials about prostatitis other than CPPS. Results: The search strategy yielded 8 journals that meet the inclusion and exclusion criteria from all 3 search engines. These 8 studies included 3 different types of energy generators (Piezoelectric, Electropneumatic, and Electromagnetic) with different protocols applied. All 3 types of energy generators of ESWT can effectively decrease all domains of CPSI score within 12 months of follow-up (P-value 0.05). The limitations of this systematic review include the restricted variety of energy generators with the lack of openly registered protocols. Conclusions: In Conclusion, ESWT provides significant improvement in clinical symptoms as compared to oral medications alone. These therapeutic effects are also observed in all different types of energy generators with different clinical protocols with similar safety profiles.

The supraspinatus tendon is one of the most involved tendons in the development of shoulder pain. Extracorporeal shockwave therapy (ESWT) has been recognized as a valid and safe treatment. Sometimes the symptoms cannot be relieved, or a relapse develops, affecting the patient’s quality of life. Therefore, a prediction protocol could be a powerful tool aiding our clinical decisions. An artificial neural network was run, in particular a multilayer perceptron model incorporating input information such as the VAS and Constant–Murley score, administered at T0 and at T1 after six months. It showed a model sensitivity of 80.7%, and the area under the ROC curve was 0.701, which demonstrates good discrimination. The aim of our study was to identify predictive factors for minimal clinically successful therapy (MCST), defined as a reduction of ≥40% in VAS score at T1 following ESWT for chronic non-calcific supraspinatus tendinopathy (SNCCT). From the male gender, we expect greater and more frequent clinical success. The more severe the patient’s initial condition, the greater the possibility that clinical success will decrease. The Constant and Murley score, Roles and Maudsley score, and VAS are not just evaluation tools to verify an improvement; they are also prognostic factors to be taken into consideration in the assessment of achieving clinical success. Due to the lower clinical improvement observed in older patients and those with worse clinical and functional scales, it would be preferable to also provide these patients with the possibility of combined treatments. The ANN predictive model is reasonable and accurate in studying the influence of prognostic factors and achieving clinical success in patients with chronic non-calcific tendinopathy of the supraspinatus treated with ESWT.

Spasticity, characterized by a velocity-dependent increase in muscle tone and exaggerated reflexes, is a common complication in individuals with upper motor neuron syndrome, such as stroke survivors. Sensitization, the heightened responsiveness of the nervous system to sensory stimuli, has emerged as a potential cause of spasticity. This perspective article explores three emerging treatments targeting sensitization. Recent studies have investigated novel treatment modalities for spasticity, including Extracorporeal Shockwave Therapy (ESWT), repetitive peripheral magnetic stimulation (rPMS), and needling. ESWT has shown promising results in reducing spasticity in both the upper and lower extremities, potentially through mechanisms such as nitric oxide production, rheological property changes, and neuromuscular transmission dysfunction. rPMS offers a non-invasive approach that may reduce spasticity by increasing sensory input, enhancing cortical activation, and exerting tissue-softening effects. Needling has also demonstrated positive effects on spasticity reduction. The high heterogeneity observed indicates the need for more rigorous research to confirm these findings. Recently, mechanical needling and sterile water injection invented by the author is also promising for reducing spasticity through removing sensitization. In conclusion, the emerging treatment options discussed in this perspective article provide promising avenues for addressing sensitization in spasticity and improving motor function. However, further research is needed to validate their findings, optimize treatment protocols, and investigate their long-term effects on motor recovery and overall quality of life in individuals with spasticity.

Aim. Patellar Tendinopathy is a pathology with implications both in sports activity and the dynamics of everyday life. There are many treatment possibilities described in the specialized literature, but there is no exact guideline regarding the optimal management for this pathology. Because of that, it is important both for the therapist and to identify modern treatment possibilities that are adapted to the particularities of the subject and symptomatology. With this paper we want to present the progression and course of the recovery program from classic to modern approach, but also the 's outcome when two modern ways of treatment complete each other for treating s having Patellar Tendinopathy. The recovery program took place over a period of 24 sessions with a frequency of 3 days/week. During the recovery sessions we used classic physical exercises, the Biodex System 4 pro dynamometer and the ESWT device from Zimmer. The recovery program was staged, in the first phase we used classic physical exercises in combination with the isokinetic dynamometer to have optimal load on the knee. Later, we introduced the ESWT sessions into the recovery plan, which had an effect right from the first session, modulating the pain and by the 3rd session of ESWT the pain was eliminated. Conclusions. Computerized dynamometry and extracorporeal shockwave therapy have proven to be an effective combination in the management of Patellar Tendinopathy and are of real help both for the purpose of evaluating the functional status and in positively influencing it until the complete elimination of pain. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shock wave therapy (ESWT) has been widely used for pain control in musculoskeletal disorders. Whether ESWT can relieve chronic low back pain (CLBP) and improve lumbar function is still unclear. Therefore, we conducted a meta-analysis of relevant studies to comprehensively analyse and determine the efficacy and safety of ESWT for chronic low back pain. Methods: Four databases were systematically searched for randomized controlled trials (RCTs) on ESWT for CLBP. The quality of the included studies was evaluated according to Cochrane systematic review criteria, relevant data were extracted, and meta-analysis was performed using RevMan 5.4 software. The primary outcomes were pain intensity, disability status, and mental health. The data were expressed as standardized mean differences (SMD) or weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. If I2 ≥ 50%, a random effects model was applied; otherwise, a fixed effects model was used. Results: Twelve RCTs involving 632 patients were included in this meta-analysis. The ESWT group reported significantly more pain relief than the control group at 4 weeks (WMD = − 1.04; 95% CI = − 1.44 to − 0.65; P < 0.001) and 12 weeks (WMD = − 0.85; 95% CI = − 1.30 to − 0.41; P < 0.001). Regarding the dysfunction index, ESWT led to significant improvement in lumbar dysfunction compared with the control group at 4 weeks (WMD = − 4.22; 95% CI = − 7.55 to − 0.89; P < 0.001) and 12 weeks (WMD = − 4.51; 95% CI = − 8.58 to − 0.44; P = 0.03). For mental health, there was no significant difference between the ESWT group and the control group after 4 weeks of intervention (SMD = 1.17; 95% CI = − 0.10 to 2.45; P = 0.07). Conclusion: This systematic review and meta-analysis found that ESWT provided better pain relief and improved lumbar dysfunction compared with the other interventions included, and no serious adverse effects were found. There was no significant effect of ESWT on the mental health of patients, but we hope to obtain more RCTs for further analysis in the future. Based on the pooled results, we suggest that ESWT is effective and safe for treating chronic low back pain. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the effects of extracorporeal shock wave therapy (ESWT) for shoulder pain after stroke. Data sources: A systematic review of Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PubMed, Web of Science, CNKI, SinoMed, WanFang Data, VIP, and ClinicalTrials.gov from the establishment of the database to 20 December 2022 was carried out. Review methods: The bibliography was screened to identify randomized controlled trials (RCTs) that applied extracorporeal shock waves to shoulder pain after stroke. Two researchers independently searched, screened, and extracted data from each database according to the search strategy and resolved any disagreements through negotiation. Results: A total of 18 RCTs were included (1248 individuals). Meta-analysis showed that the ESWT group had better visual analogue scale (VAS) scores (mean difference (MD) = − 1.19, 95% confidence interval (CI) [ − 1.43, − 0.95], p < 0.00001), Fugl-Meyer assessment upper extremity scale (FMA-UE) scores (MD = 6.25, 95% CI [4.64, 7.87], p < 0.00001), active range of motion (AROM) assessment (MD = 11.28, 95% CI [5.26, 17.30], p = 0.0002), and functional comprehensive assessment (FCA) scores (MD = 5.47, 95% CI [4.45, 6.49], p < 0.00001) comparative to the control group; no statistical significance in Constant-Murley score (CMS) (MD = 0.98, 95% CI [ − 11.05, 13.02], p = 0.87) and descriptive analysis of modified Barthel Index (MBI) only. Conclusion: The ESWT improves pain levels, motor function, active mobility, comprehensive function of shoulder, and activities of daily living (ADL) better than conventional treatment in patients with shoulder pain after stroke. [ABSTRACT FROM AUTHOR]

Sune Moeller Skov-Jeppesen,1,2 Nicky Anúel Petersen,1 Knud Bonnet Yderstraede,2,3 Boye L Jensen,4 Claus Bistrup,2,5 Lars Lund1,2 1Department of Urology, Odense University Hospital, Odense, Denmark; 2Clinical Institute, University of Southern Denmark, Odense, Denmark; 3Department of Endocrinology, Odense University Hospital, Odense, Denmark; 4Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; 5Department of Nephrology, Odense University Hospital, Odense, DenmarkCorrespondence: Sune Moeller Skov-Jeppesen, Department of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense, 5000, Denmark, Tel +45 51210911, Fax +45 65411726, Email sun_mjep@hotmail.comBackground: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has been suggested as a treatment for vascular diseases such as ischemic heart disease, diabetic foot ulcers, and erectile dysfunction. Primarily, LI-ESWT is known for its ability to stimulate angiogenesis and activation of stem cells in target tissues. Application of LI-ESWT in chronic progressive renal diseases is a novel area. The aim of the present review was to summarize available data on the effects of LI-ESWT used in the setting of renal diseases.Methods: We systematically searched PubMed, Medline, and Embase databases for relevant studies. Our review included the results from preclinical animal experiments and clinical research.Results: Eleven animal studies and one clinical study were included in the review. In the animal studies, LI-ESWT was used for the treatment of hypertensive nephropathy (n=1), diabetic nephropathy (n=1), or various types of ischemic renal injury (ie, artery occlusion, reperfusion injury) (n=9). The clinical study was conducted in a single-arm cohort as a Phase 1 study with patients having diabetic nephropathy. In animal studies, the application of LI-ESWT was associated with several effects: LI-ESWT led to increased VEGF and endothelial cell proliferation and improved vascularity and perfusion of the kidney tissue. LI-ESWT reduced renal inflammation and fibrosis. LI-ESWT caused only mild side effects in the clinical study, and, similarly, there were no signs of kidney injury after LI-ESWT in the animal studies.Conclusion: LI-ESWT, as a non-invasive treatment, reduces the pathological manifestations (inflammation, capillary rarefaction, fibrosis, decreased perfusion) associated with certain types of renal disease. The efficacy of renal LI-ESWT needs to be confirmed in randomized clinical trials.Keywords: review, kidney disease, extracorporeal shockwave therapy, ESWT

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Stroke remains a leading cause of disability worldwide, with survivors often experiencing impairments in balance, pain, spasticity, and control that limit their ability to perform daily living activities. Extracorporeal shock wave therapy (ESWT) has emerged as a potential treatment modality to improve these outcomes in stroke patients. This review aims to provide a comprehensive examination of the effects of ESWT on stroke patients, focusing on the theoretical background, balance, pain reduction, muscle spasticity and control, and upper and lower extremities. This study reviewed the use of ESWT in treating balance, pain, and spasticity in stroke patients, focusing on articles published in PubMed between January 2003 and January 2023. Systematic reviews related to stroke were used to provide an overview of stroke, and a total of 33 articles related to balance, pain, and spasticity were selected. ESWT has several shock wave generation methods and application methods, and it has been shown to have positive therapeutic effects on various aspects of rehabilitation for stroke patients, such as improving balance, reducing pain, decreasing muscle spasticity and increasing control, and enhancing functional activities of the upper and lower extremities. The efficacy of ESWT may vary depending on the patient's condition, application method, and treatment area. Therefore, it is important to apply ESWT according to the individual characteristics of each patient in clinical practice to maximize its potential benefits. [ABSTRACT FROM AUTHOR]

Introduction/Background: Multiple medical and surgical treatments have been described in the early stages of Avascular Necrosis (AVN) of the femoral head which delay the disease progression. Similarly, multiple studies, trials, reviews, and systematic reviews exist for the various treatments described and their outcomes but with no consensus over which is superior. So in this study, we reviewed the systematic reviews of all the conservative therapies for AVN of the femoral head systematically to identify a single or a combination of non-surgical treatment choices in the initial stages of the disease. Methodology: A thorough literature search has been carried out in January 2022 through the use of Pubmed, EMBASE, and Cochrane electronic databases using PRISMA guidelines. The Mesh words and Keywords used were "femoral head AVN", "Conservative management", and "Systematic Reviews". The inclusion criteria used during the screening were, any systematic reviews which included patients with AVN either idiopathic or secondary, who are managed with conservative therapies like bisphosphonates, Hyper Baric Oxygen Therapy (HBOT), Shock wave therapies like Extracorporeal Shock Wave Therapy (ESWT), or electrical therapy like Pulsed Electro Magnetic Field (PEMF). The quality of the included systematic reviews was assessed using AMSTAR-2 criteria. Results: The initial search yielded 364 studies which on screening based on our inclusion criteria finally resulted in seven systematic reviews to be included in the present study. There were two systematic reviews for Hyper Baric Oxygen Therapy (HBOT), two for Extracorporeal Shock Wave Therapy (ESWT), one for electrical stimulation modalities like Pulsed Electro Magnetic Field (PEMF), and two for bisphosphonates. The follow-up of the patients in the included systematic reviews varied from 6 weeks to 10 years. The total number of patients varied from 77 to over 1000 across the systematic reviews. Almost all of the studies included a control group that either received the intended treatment with adjuncts or did not receive any treatment at all. Because of the heterogeneous nature of included articles in the systematic reviews, meta-analysis was performed in only three of the included systematic reviews. Conclusion: Of all the modalities of treatment described, bisphosphonates are easily available and cost-effective and do not require any hospital resources/machinery for delivering the treatment. So they can be used as an initial line of treatment for patients with early stages of AVN (Ficat and Arlet 1–3) and based on the hospital availability of resources could be supplemented with any of the biophysical modalities (ESWT/PEMF/HBOT) for maximum efficacy to delay the disease progression. Level of Clinical Evidence: Systematic review. [ABSTRACT FROM AUTHOR]

Polydeoxyribonucleotide (PDRN) is a proprietary and registered drug with several beneficial effects, including tissue repairing, anti-ischemic action, and anti-inflammatory properties. The present study aims to summarize the current evidence about PRDN's clinical effectiveness in the management of tendon disorders. From January 2015 to November 2022, OVID-MEDLINE®, EMBASE, Cochrane Library, SCOPUS, Web of Science, Google Scholar and PubMed were searched to identify relevant studies. The methodological quality of the studies was evaluated, and relevant data were extracted. Nine studies (two in vivo studies and seven clinical studies) were finally included in this systematic review. Overall, 169 patients (male: 103) were included in the present study. The effectiveness and safeness of PDRN has been investigated in the management of the following diseases: plantar fasciitis; epicondylitis; Achilles tendinopathy; pes anserine bursitis; chronic rotator cuff disease. No adverse effects have been recorded in the included studies and all the patients showed an improvement in clinical symptoms during the follow-up. PDRN are a valid emerging therapeutic drug in the treatment of tendinopathies. Further multicentric randomized clinical studies are needed to better define the therapeutic role of PDRN, especially in combined clinical protocols. [ABSTRACT FROM AUTHOR]

Objective: To compare the rehabilitation effects of extracorporeal shock wave therapy (ESWT) and thermomagnetic therapy (TMT) in patients with low back pain (LBP). Methods: As a single-centre retrospective observational study, clinical data of patients with LBP who received rehabilitation treatment in our hospital from January 2020 to May 2021 were retrospectively collected. Based on the treatment mode, the patients were retrospectively divided into two groups: the control group (patients received core muscle training + TMT, n=51) and the observation group (patients received core muscle training + ESWT, n=56). The general data of the patients were collected and the groups were matched for age, gender and pain duration. The visual analogue scale (VAS) score of pain, improvement of limb function, β-endorphin (β-EP), prostaglandin E2 (PGE2) and nitric oxide (NO) were compared between the two groups before and after treatment. Results: The VAS scores of the observation group were lower than those of the control group at one, two weeks and one month after the treatment (P<0.05). After the treatment, the proportion of mild limb dysfunction in the observation group was 57.14% (32/56), which was higher than 35.29% (1 /51) in the control group. The proportion of patients with severe and obvious disorders was 0 and 5.36% (3/56), respectively, which was lower than 11.76% (6/51) and 5.88% (3/51) in the control group (P<0.05). After the treatment, levels of NO and PGE2 in the observation group were lower, and the level of β-EP was significantly lower than in the control group (P<0.05). Conclusions: A combination of core muscle training and ESWT can effectively improve the analgesic effect of the treatment and promote greater improvement of limb function in patients with LBP. [ABSTRACT FROM AUTHOR]

Although the classical treatments listed in the guidelines for osteoarthritis are widely used, the majority of patients do not fully recover from their pain. It is a fact that new treatment methods are needed both to relieve pain and restore deteriorated joint function. No study has been found to date that evaluated the efficacy of ESWT in hip OA. This pilot trial is the first in the literature to investigate the comparative effects of the two ESWT types (f-ESWT and r-ESWT) in the treatment of hip OA. Briefly, 148 patients were randomly distributed into the three ESWT groups: focused (f-ESWT), radial (r-ESWT), and sham (s-ESWT). Patients were assessed with the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores just before the treatment (0 week), just after the treatment (4th week), and 1 month after completion of the treatment (8th week). VAS and all WOMAC scores were significantly reduced at follow-up points (4th and 8th weeks) in both the f-ESWT and r-ESWT groups compared with baseline (0 week) (for all, p < 0.001). Statistical comparisons between the f-ESWT and r-ESWT groups showed that f-ESWT was superior to r-ESWT for the decrease in VAS and WOMAC scores from baseline to the 4th and 8th weeks (p < 0.001 or p < 0.002). Both r-ESWT and f-ESWT were found to have significant treatment efficacy compared with s-ESWT. However, f-ESWT produced a superior improvement in follow-up parameters compared to r-ESWT. [ABSTRACT FROM AUTHOR]

Background: Myofascial pain syndrome (MPS) is a musculoskeletal disorder, that results from trigger points, which are small, taut skeletal muscle and fascia. Objective: To compare the efficacy of Extracorporeal Shock Wave Therapy (ESWT) versus corticosteroid injection in the treatment of patients with MPS of the upper trapezius muscle. Patients and Methods: This prospective randomized study included fifty patients with MPS who were randomly divided equally into two groups. The active myofascial trigger points (MTrPs) in the upper trapezius were identified. Group 1 patients received ESWT 3 times at one-week intervals and group 2 patients received one injection of corticosteroids. The visual analog scale (VAS), Neck Disability Index (NDI), and pain pressure threshold (PPT) assessed the outcomes. Results: VAS scores were 7.24±1.01, 3.72 ±1.43 and 2.44±1.36 at baseline, week-4 and -8 respectively in group1; while were 7.16±1.03, 5.76 ±1.16 and 5.24±1.48 at baseline, week-4 and -8 respectively in group2. NDI scores were 11±2.63, 7.92±2.63 and 6.52±2.66 at baseline, week-4, and -8 respectively in group1, whereas were 11.16±2.36, 8.72±2.37 and 7.64±2.66 at baseline, week-4 and -8 respectively in group2. PPT scores were 2.81±0.70 at baseline, and 4.64 ±1.03 and 5.54±1.1 at week-4 and week-8 in group1, while, in group2 the scores were 2.89±0.71, 3.92 ±0.81 and 4.08±0.92 at baseline and week-4 and -8 respectively. VAS, NDI, and PPT pre- and post-treatment results showed statistically significant improvements in both groups, P <0.001. Conclusion: ESWT and corticosteroid injection considerably reduced pain intensity, physical impairment, and MTrP sensitivity to pressure in patients with MPS. ESWT was more effective in the reduction of pain and MTrPs sensitivity to pressure. [ABSTRACT FROM AUTHOR]

Abstract Background Calcific tendinitis of the shoulder (CT) is a common disorder with a large disease burden. The initial treatment is with conservative measures. However, when this fails the next step treatment remains unclear. Minimal invasive treatment modalities have emerged. Needle aspiration of the calcific deposits (NACD) and extracorporeal shock wave therapy (ESWT) have both shown good clinical results. Nonetheless, in the current orthopedic literature there are not any studies available that compare both the effectiveness and cost-effectiveness of those two treatment modalities. Therefore, our primary objective is to compare the effectiveness of NACD to ESWT. A secondary objective is to compare the cost-effectiveness of both treatment modalities and workability. Methods Following a power calculation using the minimal clinical important difference of our primary outcome (Constant-Murley score, CMS) 140 patients will be included in the study. Enrolment is based upon strict inclusion/ exclusion criteria outlined in the Methods section. Participants will be randomized by computer in two groups (e.g. 70 patients will receive NACD and 70 patients will receive ESWT). The NACD treatment will consist of a sonographically guided removal of the calcific deposits and the ESWT treatment will be a focused ESWT. Both treatments will be conducted according to a standardized protocol, as part of care as usual in our hospital. The primary outcome will be the between group differences in functional outcome (measured with the CMS) between baseline and after 12 months follow-up. Secondary outcomes will be questionnaires regarding the clinical outcome (SST) and quality of life (EQ-5D-5L). Furthermore, NRS pain and cost related questionnaires (iPCQ and ProDisQ) will be collected during follow-up after two months, six months and at final follow-up after 12 months. Discussion This study will provide more insight regarding treatment for conservative therapy resistant calcific tendinitis of the shoulder by comparing NACD to focused ESWT, which will aid the physician and patient in determining the appropriate treatment plan. Trial registration Dutch trial register: NTR7093 registered on 11 March 2018.

Introduction: Extracorporeal shock wave therapy is an established treatment for erectile dysfunction and Peyronie's disease. Concerns regarding the safety of extracorporeal shock wave therapy for andrological purposes on testicular function were raised by animal studies. Aim: To evaluate the impact of extracorporeal shock wave therapy for erectile dysfunction or Peyronie's disease on reproductive and hormonal testicular function. Methods: We designed a prospective controlled study in which consecutive patients were enrolled. Males aged between 18 and 40 years with mild vasculogenic erectile dysfunction or acute inflammatory Peyronie's disease and normozoospermia were included. All enrolled patients were offered extracorporeal shock wave therapy, and subjects who refused extracorporeal shock wave therapy for any reason were considered as the Control group. All patients in the Intervention group were treated with DUOLITH SD1 T‐TOP by a single expert urologist. Semen analysis and serum total testosterone dosage were performed before the start (T0) and 3 months after the end of extracorporeal shock wave therapy (T1) in Intervention group. The same parameters were evaluated after the extracorporeal shock wave therapy refusal (T0) and at the end of the following 3 months (T1) in Control group. Normozoospermia was chosen as the primary outcome, serum total testosterone concentration was selected as the secondary outcome. Results: A total of 94 patients were enrolled in the study (48 Group A, 46 Group B). At T0, all patients were normozoospermic in both groups (p = 0.563), and no significant difference in mean ± SD total testosterone levels was recorded between the groups (582.5 ± 107.2 vs. 634.6 ± 108.4 ng/dl; p = 0.221). At T1, no significant deterioration (p > 0.05) in semen parameters was recorded in both groups. Only a statistically significant reduction in seminal pH was found after extracorporeal shock wave therapy compared to baseline (7.9 ± 0.3 vs. 7.5 ± 0.2; p < 0.001) and untreated patients (7.8 ± 0.2 vs. 7.5 ± 0.2; p < 0.001). No significant difference in total testosterone levels was recorded in Intervention group after extracorporeal shock wave therapy compared to baseline (p = 0.584). Conclusion: Extracorporeal shock wave therapy in erectile dysfunction and Peyronie's disease patients does not seem to affect reproductive and hormonal testicular function. [ABSTRACT FROM AUTHOR]

Myofascial pain syndrome (MPS) is a common chronic musculoskeletal disease and the lifetime prevalence is about 85%. Comparison of the effects of ESWT (extracorporeal shock wave therapy) and trigger point injection (TPI) treatments on sleep quality in myofascial pain syndrome has rarely been studied. The aim of this study was to compare the effects of TPI + Dry Needling (DN) and ESWT treatments on pain, neck disability level, and sleep quality in patients with myofascial pain syndrome. 63 patients diagnosed with myofascial pain syndrome were included in the study. The patients were divided into two groups. ESWT was given to 32 patients and TPI to 31 patients. These two treatment regimens were compared in terms of pain (VAS), sleep quality (PSQI), and neck disability (NDI). In terms of mean VAS, NDI, and PSQI values, there was no statistically significant difference between the groups in the mean of pre-treatment, post-treatment day 0 and post-treatment 1 month. A similar and significant improvement was observed in both groups in terms of the evaluated parameters and based on our results, we can recommend both treatment options to MPS patients. [ABSTRACT FROM AUTHOR]

Introduction: Predictive factors for the treatment success of low-intensity extracorporeal shockwave therapy (Li-ESWT) for erectile dysfunction (ED) are still under debate. Methods: Li-ESWT was performed in 50 patients suffering from ED by applying 3,000 shock waves once a week over a period of 6 weeks. Treatment success was defined as an increase in the International Index of Erectile Function 5 (IIEF-5) score by ≥5 points or an Erectile Hardness Score (EHS) of ≥3 points. IIEF-5 and EHS were measured at baseline and at 3 and 6 months of follow-up. Results: Treatment success according to either the IIEF-5 score or EHS at any time of follow-up was achieved in 28 patients (56%). Twenty-five patients (50%) experienced an improvement during the first 3 months, which lasted for 6 months in 8 cases (16%). Three patients reported improved erectile function only after 6 months. When stratifying the cohort with regard to potential influencing factors, a significantly improved IIEF-5 score could be achieved in men with cardiovascular risk factors (p = 0.026) and in men with antihypertensive medication (p = 0.009). Men without cardiovascular risk factors showed no therapeutic benefit from Li-ESWT. Discussion/Conclusion: Li-ESWT is a valid but often short-lived treatment option for ED, especially in men with cardiovascular risk factors or controlled hypertension. Future studies should assess the feasibility and safety of repeated applications of Li-ESWT. [ABSTRACT FROM AUTHOR]

Jonas Mortensen,1 Sune Møller Skov-Jeppesen,1,2 Peter Bill Juul Ladegaard,1 Lars Lund1,2 1Department of Urology, Odense University Hospital, Odense, Denmark; 2Institute of Clinical Research, University of Southern Denmark, Odense, DenmarkCorrespondence: Jonas MortensenDepartment of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense, 5000, DenmarkTel +45 40172260Email Jonas.Mortensen2@rsyd.dkPurpose: The aim of this study was to investigate whether ESWT with a higher energy as an add-on therapy to vacuum-pump followed by manipulation exercises could reduce the penile curvature, pain and improve IIEF-5 score.Materials and Methods: Men aged > 18 and < 80 years and diagnosed with PD in stable phase with no history of penile surgery or previous ESWT treatment were eligible to participate. They were randomised to either active ESWT (n = 16) or sham ESWT (n = 16). Both groups were treated once a week for five weeks. Each treatment session consisted of 2000 shockwaves at 0.5mJ/mm2. All patients in both groups used a vacuum pump followed by manipulation exercises.Results: Thirty men completed the study protocol. Mean age in the treatment group was 61.7 (SD 8.3) and 63 (SD 7.35) in the control group. After six months, mean change in penile curvature was − 12.8 (SD 13) degrees in the treatment group and − 6.6 (SD 8.9) in the control group (p = 0.204). Mean IIEF-5 score decreased by 0.17 (SD 3) in the treatment group and 3.06 (SD 5.5) in the control group (p = 0.086) at six-month follow-up. Pain was assessed using both VAS and PDQ and demonstrated no difference between the groups after six months (p = 0.648).Conclusion: In the treatment group, we observed a greater but non-significant change in penile curvature and no adverse effects.Keywords: Peyronie’s disease, ESWT, vacuum pump, erectile dysfunction, manipulation exercises

Introduction: Within the last few decades, focused high-energy extracorporeal shockwave therapy (ESWT) has proven to be an effective alternative to standard of care revision surgery in delayed healing fractures or manifest non-unions in various anatomical regions. Materials and methods: A retrospective multi-variant analysis of an open prospective, single-armed clinical study was conducted. Patients receiving focused high-energy ESWT for a delayed healing or an apparent non-union of a humeral fracture between January 1999 and December 2015 at a single trauma center were included in the study. Bony healing was defined as cortical continuity in three of four cortices and pain-free force loading and evaluated using CT scans and clinical examination at three- and six-month follow-ups after ESWT. Results: A total of 236 patients were included. N = 93 (43.8%) showed bony consolidation three months after ESWT and n = 105 (52.5%) after six months. Sub-group analysis showed significantly better healing for the proximal metaphyseal humerus (66.7% after six months, n = 42) compared to the diaphyseal region (48.1%, n = 133) and distal metaphyseal humerus (48.1%, n = 25). Regression analysis indicated significantly increased healing rates for patients of younger ages (p = 0.001) and a fracture diastasis of less than 5 mm (p = 0.002). Conclusion: The findings of this study indicate that ESWT can be considered as a treatment option for a well-selected patient population despite the lower healing rates compared to other anatomical regions. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome. Design: A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale–pain, a Visual Analog Scale–numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment. Results: Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale–pain, Visual Analog Scale–numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale–pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups. Conclusions: Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection. [ABSTRACT FROM AUTHOR]

Sune Moeller Skov-Jeppesen,1– 3 Knud Bonnet Yderstraede,3,4 Boye L Jensen,5 Claus Bistrup,3,6 Milad Hanna,7 Lars Lund1,3 1Department of Urology, Odense University Hospital, Odense, Denmark; 2OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark; 3Clinical Institute, University of Southern Denmark, Odense, Denmark; 4Department of Endocrinology, Odense University Hospital, Odense, Denmark; 5Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; 6Department of Nephrology, Odense University Hospital, Odense, Denmark; 7Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UKCorrespondence: Sune Moeller Skov-JeppesenDepartment of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense C, 5000, DenmarkTel +45 51210911Fax +45 65411726Email sun_mjep@hotmail.comPurpose: Treatment with low-intensity shockwave therapy (LI-ESWT) is associated with angiogenesis and is suggested as a treatment for different types of vascular diseases. It was hypothesized that LI-ESWT improves the renal filtration barrier and halts the progression of GFR decline in diabetic kidney disease (DKD) potentially through VEGF and NO formation. We present the first data on LI-ESWT in human DKD.Methods: The study was designed as an interventional, prospective, one-arm, Phase 1 study. We investigated change in GFR and albuminuria in 28 patients with DKD treated with six sessions of LI-ESWT over three weeks. The patients were followed for six months. Urine excretion of kidney injury markers, vascular endothelial growth factor (VEGF) and nitric oxide metabolites (NOx) was studied after LI-ESWT.Results: There were no significant changes in GFR and albuminuria up to six months after LI-ESWT compared to baseline. Urine VEGF was transiently reduced one month after LI-ESWT, but there were no other significant changes in urine VEGF or NOx after LI-ESWT. Secondary analysis showed that NOx increased after LI-ESWT in patients who had low levels of NOx at baseline. Kidney injury marker trefoil factor 3 (TFF3) increased acutely after the first session of LI-ESWT indicating transient endothelial repair. Other markers of kidney injury were stable in relation to LI-ESWT.Conclusion: LI-ESWT treatment did not significantly improve kidney function and albumin excretion. It is concluded that LI-ESWT is not harmful. A randomized blinded study should be performed to clarify whether adjunctive treatment with LI-ESWT is superior to standard treatment of DKD.Keywords: albuminuria, clinical trial, diabetic kidney disease, glomerular filtration rate, ESWT, extracorporeal shockwave therapy

Amaç: Topuk dikeni klinikte sıkça karşılaşılan, kronik plantar topuk ağrısına neden olan klinik bir tablodur. Hastalara uygulanan kortikosteroid enjeksiyonu, steroid olmayan antiinflamatuvar ilaçlar ve çeşitli fizik tedavi modaliteleri gibi seçeneklerin yanında, ‘Extracorporeal Shock Wave Therapy’ (ESWT) cerrahi olmayan yöntemler arasında yerini almıştır. Bu prospektif kontrollü çalışmanın amacı klinik ve radyolojik olarak topuk dikeni tanısı alan hastalarda ESWT tedavisinin etkinliğini araştırmaktır. Gereç-Yöntem: Çalışmaya klinik ve radyolojik olarak topuk dikeni tanısı konan 49 hasta alındı. Hastalar randomize olarak iki gruba ayrıldı. Grup 1 (n=25) dört gün aralıkla 3 seans boyunca 8 Hz frekans ile her seans 1000 atım olacak şekilde ESWT tedavisi aldı. Grup 2 (n=24) ise kontrol grubu olarak kabul edildi ve sadece silikon tabanlık kullandı. Ağrı şiddeti gece ağrısı, sabah ilk basma sırasındaki ağrı, hareket ile ağrı, istirahat ağrısı, engebeli zeminde ağrı ve gün sonunda ağrı olmak üzere Görsel Analog Skala (GAS) ile ve ayak aktiviteleri ile ilgili fonksiyonel düzey ise Foot Ankle Outcome Score (FAOS) indeksi ile değerlendirildi. Ölçümler hastalar tedaviye alınmadan önce ve 4 haftalık izlem sonrasında yapıldı. Bulgular: Tedavi sonrasında her iki grupta tüm parametrelerde istatistiksel olarak anlamlı iyileşme saptandı (p0,05). Sonuç: Çalışmamızın sonuçları; ESWT uygulamasının topuk dikeni tedavisinde etkili olduğunu ve diğer konservatif yöntemler arasında etkin bir seçenek olabileceğini desteklemektedir.

Stroke remains a leading cause of disability worldwide, with survivors often experiencing impairments in balance, pain, spasticity, and control that limit their ability to perform daily living activities. Extracorporeal shock wave therapy (ESWT) has emerged as a potential treatment modality to improve these outcomes in stroke patients. This review aims to provide a comprehensive examination of the effects of ESWT on stroke patients, focusing on the theoretical background, balance, pain reduction, muscle spasticity and control, and upper and lower extremities. This study reviewed the use of ESWT in treating balance, pain, and spasticity in stroke patients, focusing on articles published in PubMed between January 2003 and January 2023. Systematic reviews related to stroke were used to provide an overview of stroke, and a total of 33 articles related to balance, pain, and spasticity were selected. ESWT has several shock wave generation methods and application methods, and it has been shown to have positive therapeutic effects on various aspects of rehabilitation for stroke patients, such as improving balance, reducing pain, decreasing muscle spasticity and increasing control, and enhancing functional activities of the upper and lower extremities. The efficacy of ESWT may vary depending on the patient’s condition, application method, and treatment area. Therefore, it is important to apply ESWT according to the individual characteristics of each patient in clinical practice to maximize its potential benefits.

Extracorporeal shock wave therapy (ESWT) is a safe and effective treatment option for various pathologies of the musculoskeletal system. Many studies address the molecular and cellular mechanisms of action of ESWT. However, to date, no uniform concept could be established on this matter. In the present study, we perform a systematic review of the effects of exposure of musculoskeletal tissue to extracorporeal shock waves (ESWs) reported in the literature. The key results are as follows: (i) compared to the effects of many other forms of therapy, the clinical benefit of ESWT does not appear to be based on a single mechanism; (ii) different tissues respond to the same mechanical stimulus in different ways; (iii) just because a mechanism of action of ESWT is described in a study does not automatically mean that this mechanism is relevant to the observed clinical effect; (iv) focused ESWs and radial ESWs seem to act in a similar way; and (v) even the most sophisticated research into the effects of exposure of musculoskeletal tissue to ESWs cannot substitute clinical research in order to determine the optimum intensity, treatment frequency and localization of ESWT. [ABSTRACT FROM AUTHOR]

Objective: Epin calcanei is a common clinical problem with chronic plantar heel pain. 'Extracorporeal Shock Wave Therapy (ESWT)' is a non-surgical method administered to patients along with a variety of other options such as corticosteroid injections, non-steroidal antiinflammatory drugs and physical therapy modalities. The aim of this prospective controlled study is to investigate the efficacy of ESWT in patients with clinical and radiological diagnosis of epin calcanei. Materials-Methods: The study included 49 patients diagnosed with epin calcanei according to the clinical and radiological criteria. Patients were randomly divided into two groups. Group 1 (n=25) used silicone insoles and received ESWT treatment as 1000 shots in each session at a frequency of 8 Hz, 3 sessions in total with intervals of four days. Group 2 (n=24) was accepted as the control group and used silicone insoles alone. The severity of pain was evaluated using the pain Visual Analog Scale (VAS) as pain at night, pain in the morning, on the first step, pain on motion, pain at rest, pain on uneven ground and pain at the end of the day. The functional level of activity of the foot was evaluated by the Foot and Ankle Outcome Score (FAOS) index. Measurements were taken before treatment and after 4 weeks of follow-up. Results: After treatment, both groups showed statistically significant improvement in all parameters (p<0.05). Post-treatment VAS scores showed significant improvements in pain at night and pain in the morning on the first step (p<0.05) in ESWT group. However there was no significant difference in other parameters between the two groups (p>0.05). Conclusion: According to the results of our study, ESWT application is seen as an effective conservative method in decreasing pain related to heel spur. [ABSTRACT FROM AUTHOR]

Trigger finger is a stenosing tenosynovitis of flexor tendons with consecutive conflict with the A1 pulley. Quinnell defined 4 grades according to the clinical manifestation of the conflict. Studies focused on grade 2 and 3 for conservative treatment. Extracorporeal shockwave therapy (ESWT) is a conservative method to receive extensive attention in the musculoskeletal pathology. Researchers analyzed the effects of ESWT on trigger finge, aiming at defining its effects, dosing and side reactions. We reviewed the only 7 published studies in the literature, one retrospective, three before-after interventional studies and three randomized controlled studies. The most prescribed form was radial ESWT, with variable dosing, with clinical and functional improvement mainly on medium and long term. ESWT and corticosteroid injections led to similar improvement, with more rapid analgesia for corticosteroids and a lower rate of recurrence for ESWT. Focused ESWT with high-energy was more effective than low-energy, counting for a dose-effect relation. [ABSTRACT FROM AUTHOR]