Hitech Kidney Stone Hospital  Lithotripsy Centre

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Extracorporeal Shock Wave Therapy

What is extracorporeal 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.