| Extracorporeal shockwave therapy | |
|---|---|
 ESWT device (EMS Swiss DolorClast) | |
| ICD-10-PCS | 6A93 |
| ICD-9-CM | 98.5 |
Extracorporeal shockwave therapy (ESWT) is a treatment using powerful acoustic pulses which is mostly used to treat kidney stones and in physical therapy and orthopedics. [1] [2]
The most common use of extracorporeal shockwave therapy (ESWT) is for lithotripsy to treat kidney stones [3] (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver) using an acoustic pulse. It is also reported to be used for salivary stones [4] and pancreatic stones. [5]
In the UK, the National Institute for Health and Care Excellence (NICE) found that the evidence for ESWT in the majority of indications is conflicting, and therefore ESWT should only be used where there are special arrangements for clinical governance and audit. [6] Two 2017 reviews had similar findings, with moderate level evidence at best. [7] [8]
Extracorporeal shockwave therapy is used as a second line measure to treat tennis elbow, [9] [10] shoulder rotator cuff pain, [11] [12] Achilles tendinitis, [13] [14] plantar fasciitis, [15] [16] and greater trochanteric pain syndrome. [17]
ESWT is also used to promote bone healing and treat bone necrosis. [18] It is an effective alternative to surgical treatment of non-healing fractures. [19]
ESWT is used for wound healing and has shown positive results in short-term and long-term outcomes in diabetic patients with foot ulcers. [20] Randomised controlled trials into the use of ESWT for healing venous leg ulcers are needed as there is a lack of evidence in this area. [21]
Low-intensity extracorporeal shock wave therapy has been used as a treatment for erectile dysfunction. [22] It differs from palliative options by aiming to restore natural erectile function by inducing cellular microtrauma, triggering the release of angiogenic factors and promoting neovascularization in treated tissue. This mechanism is distinct from the high-intensity shock waves used in lithotripsy and medium-intensity shock waves used for anti-inflammatory purposes in orthopedics. Clinical studies, including double-blind randomized trials, have demonstrated LI-ESWT's ability to significantly improve erectile function and penile hemodynamics in men with vasculogenic ED. [23] [24]
The lithotripter attempts to break up the stone with minimal collateral damage by using an externally applied, focused, high-intensity acoustic pulse. The patient is usually sedated or anesthetized for the procedure in order to help them remain still and reduce possible discomfort. [25] Sedation is not required in its application for soft tissue injuries.
Beginning in 1969 and funded by the German Ministry of Defense, Dornier began a study of the effects of shock waves on tissue. In 1972, on the basis of preliminary studies performed by Dornier Medical Systems, an agreement was reached with Egbert Schmiedt, director of the urologic clinic at the University of Munich. The development of the Dornier lithotripter progressed through several prototypes, ultimately culminating in February 1980 with the first treatment of a human by shockwave lithotripsy (SWL). The production and distribution of the Dornier HM3 lithotripter began in late 1983, and SWL was approved by the U.S. Food and Drug Administration in 1984. [26]
In the 1980s people using ESWT for kidney stones noticed that it appeared to increase bone density in nearby bones, leading them to explore it for orthopedic purposes. [27]
In response to concerns raised by NICE, in 2012 a study called the Assessment of the Effectiveness of ESWT for Soft Tissue Injuries was launched (ASSERT). [6]
As of 2018 use of ESWT had been studied as a potential treatment for chronic prostatitis/chronic pelvic pain syndrome in three small studies; there were short-term improvements in symptoms and few adverse effects, but the medium-term results are unknown, and the results are difficult to generalize due to the low quality of the studies. [28]
ESWT is commonly used for treating orthopedic problems in horses, including tendon and ligament injuries, kissing spine, navicular syndrome, and arthritis. The evidence for these uses is weak. [27]
ESWT is used in physical therapy for pain reduction, increase in metabolism at the cellular level, revascularisation, and recovering normal muscle tone following various disorders. [29] The use of ESWT was demonstrated in patients with frozen shoulders compared to therapeutic ultrasound with exercises. [30]
Research suggests that ESWT can accelerate the blood flow, facilitating the healing of the inflamed Achilles tendon.[ citation needed ] In one study involving 23 patients with chronic Achilles tendinopathy, 20 reported improvement in their condition and pain scores after ESWT; three saw no change, and none reported any worsening. [31]
Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships.
Kidney stone disease, also known as renal calculus disease, nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material develops in the urinary tract. Renal calculi typically form in the kidney and leave the body in the urine stream. A small calculus may pass without causing symptoms. If a stone grows to more than 5 millimeters, it can cause blockage of the ureter, resulting in sharp and severe pain in the lower back that often radiates downward to the groin. A calculus may also result in blood in the urine, vomiting, or painful urination. About half of people who have had a renal calculus are likely to have another within ten years.
Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder, elbow, wrist, hip, knee, or ankle.
A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of migrated gallstones within bile ducts.
Plantar fasciitis or plantar heel pain is a disorder of the plantar fascia, which is the connective tissue that supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually, and it affects both feet in about one-third of cases.
Tennis elbow, also known as lateral epicondylitis or enthesopathy of the extensor carpi radialis origin, is an enthesopathy of the origin of the extensor carpi radialis brevis on the lateral epicondyle. Those with tennis elbow often report pain and tenderness over the bony prominence of the lateral epicondyle, which serves as the common origin of the forearm and hand’s long extensor tendons. Symptoms range from mild tenderness to severe, persistent pain. The pain may also extend into the back of the forearm. Onset of symptoms is generally gradual, although they can seem sudden and be misinterpreted as an injury.
Achilles tendinitis, also known as Achilles tendinopathy, is soreness of the Achilles tendon. It is accompanied by alterations in the tendon's structure and mechanical properties. The most common symptoms are pain and swelling around the back of the ankle. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual.
Chronic pancreatitis is a long-standing inflammation of the pancreas that alters the organ's normal structure and functions. It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. It is a disease process characterized by irreversible damage to the pancreas as distinct from reversible changes in acute pancreatitis. Tobacco smoke and alcohol misuse are two of the most frequently implicated causes, and the two risk factors are thought to have a synergistic effect with regards to the development of chronic pancreatitis. Chronic pancreatitis is a risk factor for the development of pancreatic cancer.
Lithotripsy is a procedure involving the physical destruction of hardened masses like kidney stones, bezoars or gallstones, which may be done non-invasively. The term is derived from the Greek words meaning "breaking stones".
An extracorporeal procedure is a medical procedure which is performed outside the body. Extracorporeal devices are the artificial organs that remain outside the body while treating a patient. Extracorporeal devices are useful in hemodialysis and cardiac surgery.
A shin splint, also known as medial tibial stress syndrome, is pain along the inside edge of the shinbone (tibia) due to inflammation of tissue in the area. Generally this is between the middle of the lower leg and the ankle. The pain may be dull or sharp, and is generally brought on by high-impact exercise that overloads the tibia. It generally resolves during periods of rest. Complications may include stress fractures.
Prolotherapy, also called proliferation therapy, is an injection-based treatment used in chronic musculoskeletal conditions. It has been characterised as an alternative medicine practice.
Renal colic, also known as ureteric colic, is a type of abdominal pain commonly caused by obstruction of ureter from dislodged kidney stones. The most frequent site of obstruction is the vesico-ureteric junction (VUJ), the narrowest point of the upper urinary tract. Acute obstruction and the resultant urinary stasis can distend the ureter (hydroureter) and cause a reflexive peristaltic smooth muscle spasm, which leads to a very intense visceral pain transmitted via the ureteric plexus.
Patellar tendinitis, also known as jumper's knee, is an overuse injury of the tendon that straightens the knee. Symptoms include pain in the front of the knee. Typically the pain and tenderness is at the lower part of the kneecap, though the upper part may also be affected. Generally there is no pain when the person is at rest. Complications may include patellar tendon rupture.
Therapeutic effect refers to the response(s) after a treatment of any kind, the results of which are judged to be useful or favorable. This is true whether the result was expected, unexpected, or even an unintended consequence. An adverse effect is the converse and refers to harmful or undesired response(s). What constitutes a therapeutic effect versus a side effect is a matter of both the nature of the situation and the goals of treatment. No inherent difference separates therapeutic and undesired side effects; both responses are behavioral/physiologic changes that occur as a response to the treatment strategy or agent.
Calcific tendinitis is a common condition where deposits of calcium phosphate form in a tendon, sometimes causing pain at the affected site. Deposits can occur in several places in the body, but are by far most common in the rotator cuff of the shoulder. Around 80% of those with deposits experience symptoms, typically chronic pain during certain shoulder movements, or sharp acute pain that worsens at night. Calcific tendinitis is typically diagnosed by physical exam and X-ray imaging. The disease often resolves completely on its own, but is typically treated with non-steroidal anti-inflammatory drugs to relieve pain, rest and physical therapy to promote healing, and in some cases various procedures to breakdown and/or remove the calcium deposits.
Low-level laser therapy (LLLT), cold laser therapy, photobiomodulation (PBM) or red light therapy is a form of medicine that applies low-level (low-power) lasers or light-emitting diodes (LEDs) to the surface of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue, it is claimed that application of low-power lasers relieves pain or stimulates and enhances cell function. The effects appear to be limited to a specified set of wavelengths and new research has demonstrated effectiveness at myopia control. Several such devices are cleared by the United States Food and Drug Administration (FDA), and research shows potential for treating a range of medical problems including rheumatoid arthritis and oral mucositis.
Platelet-rich plasma (PRP), also known as autologous conditioned plasma, is a concentrate of plasma protein derived from whole blood, centrifuged to remove red blood cells but retaining platelets. Though promoted for treating various medical conditions, evidence of its benefits was mixed as of 2020, showing effectiveness in certain conditions and ineffectiveness in others.
A medical procedure is defined as non-invasive when no break in the skin is created and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. For example, deep palpation and percussion are non-invasive but a rectal examination is invasive. Likewise, examination of the ear-drum or inside the nose or a wound dressing change all fall outside the definition of non-invasive procedure. There are many non-invasive procedures, ranging from simple observation, to specialised forms of surgery, such as radiosurgery. Extracorporeal shock wave lithotripsy is a non-invasive treatment of stones in the kidney, gallbladder or liver, using an acoustic pulse. For centuries, physicians have employed many simple non-invasive methods based on physical parameters in order to assess body function in health and disease, such as pulse-taking, the auscultation of heart sounds and lung sounds, temperature examination, respiratory examination, peripheral vascular examination, oral examination, abdominal examination, external percussion and palpation, blood pressure measurement, change in body volumes, audiometry, eye examination, and many others.
Electrohydraulic Lithotripsy (EHL) is a medical procedure which uses targeted shockwaves to break up kidney stones and gallstones. This form of extracorporeal lithotripsy is unique in that the shockwaves are produced by a vaporization bubble expanding and collapsing repeatedly, creating a pressure wave. The procedure is non-invasive and has a 90% success rate, which makes it a first-line treatment for smaller kidney stones.
| Authority control databases: National |
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