Research

Patient satisfaction reached 90%

In this study we want to evaluate 100 patients with chronic tendon and bone pathologies treated with one or both therapies.

Patient satisfaction reached 90%

HIL versus HIL & RSWT: Pain and Patient Satisfaction Evaluation of 100 Patients

In this study we want to evaluate 100 patients with chronic tendon and bone pathologies treated with one or both therapies.

Methods:

91 patients were treated with HIL and 9 with HIL and RSWT. We evaluate pain and patient satisfaction prospectively after 5 sessions HIL. The same parameters were assessed in patients with combined therapy after 5 sessions HIL and 3 sessions RSWT.

Study Results:

Pain relief average was 68.6% and patient satisfaction average 89.8% in patients treated only with HIL. Pain relief was 41% and patient satisfaction 85.7% in combined treatment.

Improves spasticity and motor functionality

ESWT might efficiently improve spasticity in affected children and also their gross motor functionality.

Improves spasticity and motor functionality

Effect of Shock Wave Therapy on Muscle Spasticity in Children with Cerebral Palsy

ESWT might efficiently improve spasticity in affected children and also their gross motor functionality.

Abstract:

As there are already some reports of the use of Extracorporeal Shockwave Therapy (ESWT) for the management of spasticity of children with Cerebral Palsy (CP) the purpose of our trial was to achieve improvement of our patients.

Methods:

We included 56 spastic children (29 males, 27 females) in our study with CP, aged between 5 and 16 years. We used radial focused ESWT (BTL-5000 SWT) for 4 sessions during the admission of each child on the mainly affected muscles using for all children the same treatment parameters (500 shocks, frequency: 10 Hz). All patients were assessed twice: for the first time during admission (before 1st ESWT application) and the second time at discharge (after the 4th ESWT session). The following examinations have been performed: active range of motion, modified Ashworth scale scores and patient’s Quality of Life (QoL).

Results:

We found a significant decrease of modified Ashworth scale level. ESWT also proved to be efficient for the improvement of global functioning of the upper and lower limbs.

Discussion:

For more reliable statistical assessment and improvement of the methodology further studies are necessary.

Conclusion:

ESWT applied 4 times in 2 weeks decreased spasticity level in children without affecting the Quality of Life as other anti-spastic procedures might do.

Relieves pain & broadens ROM

Relieves pain, broadens range of motion and strengthens muscles in treatment of shoulder calcific tendinitis

Relieves pain & broadens ROM

Radial Extracorporeal Shockwave Therapy in the Treatment of Shoulder Calcific Tendinitis

Relieves pain, broadens range of motion and strengthens muscles in treatment of shoulder calcific tendinitis

Abstract:

Shoulder calcific lesions of the rotator cuff are a common problem in physiatric and orthopedic practice. The lesions are mostly located in the supraspinatus tendon, close to the insertion area in the critical zone. Patients are usually treated conservatively by nonsteroid antiinflammatory drugs, analgesic drugs, local injections, physiotherapy and rarely by applying surgical procedures. Painful shoulder gives rise to functional disabilities and may sometimes lead to pharmacological overuse. In the last twenty years, extracorporeal shock wave therapy (ESWT) has been frequently used in the treatment of calcific tendinopathies. We have evaluated the effectiveness of radial ESWT on the group of 30 patients, aged between 28 and 58 years, with calcific tendinitis of the shoulder. Criotherapy, medical exercises and radial ESWT were applied. We used the radial ESWT device (BTL-5000 SWT), 3 bars pressure, 10 Hz frequency, 2000 shocks. Patients were examined before the beginning of the treatment, immediately after the treatment, and 6 months later. The treatment included measurement of the range of motion (ROM), measurement of voluntary isometric contraction of shoulder muscles with manual muscle test (MMT), and subjective assessment of pain intensity with visual analogue scale (VAS). X-ray was done before and 6 month after treatment. The study has shown the efficiency of the treatment with radial ESWT. The level of statistical significance was determined with student t-test. Radial ESWT applied to patients with shoulder calcific lesions of the rotator cuff resulted in pain relief increase in the range of motion and increase in the muscular strength. As shown by X-ray, these results were followed by the decrease in the size of the rotator cuff calcifications.

Complete elimination of pain

Patients with elbow tendinopathies treated with RSWT+HIL had a 71% decrease of pain on VAS at five-month follow-up.

Patient satisfaction reached 90%

Radial Shockwave Therapy and High Intensity Laser Combined Treatment in Elbow Tendinopathies

Patients with elbow tendinopathies treated with RSWT+HIL had a 71% decrease of pain on VAS at five-month follow-up.

Introduction:

The treatment of elbow tendinopathies with radial pressure waves (RSWT) has showed good and excellent results in over 75% of the cases in most of the series in the literature. In the past ten years we have used a two-session RSWT protocol with 2000 therapeutic radial shockwaves above 2 BAR, preceded by 2000 analgesic shockwaves with high number of repetitions per second, followed by another analgesic 2000 shockwaves. This protocol has allowed us to have 81% success rate in the treatment of chronic elbow tendinopathies. Our protocol includes a follow up visit two weeks after the final SWT session. If the patient reports a VAS pain scale improvement lower than 50%, we proceed to a third and final session, usually with a higher power focused device. Our group has been working in the past year with High Intensity Laser therapy (HIL) for acute musculoskeletal painful conditions with excellent results. We hypothesize that the use of HIL may have a significant control of pain if combined with RSWT. In this study we compare the outcome of a combined therapy of RSWT and HILT on the third session of Focused Shockwaves in patients that did not improve pain over 50% in their follow up evaluation.

Methods:

We performed a case control study on 21 patients diagnosed for chronic lateral epicondyle elbow tendinopathy, that did not improve pain control over 50% in the VAS scale on the follow up visit two weeks after the second RSWT session. We had 14 female and 7 male subjects with and average age of 35.5 y/o (19-52 y/o). They were divided in two groups of 10 and 11 patients. The two groups were statistically similar. They all signed an informed consent. In all cases we used for the first two sessions a Radial SWT generator (BTL-5000 Power – BTL Industries Czech Rep). All subjects were tested and evaluated by ISMST & ONLAT certified specialists. In the Cases Group (RSWT+HIL ) we applied a progressive protocol using 200 shocks on 15 Hz, 200 shocks on 10 Hz and 200 shocks on 5 Hz, plus the application of 2500 laser shots over the elbow epicondyle painful region. We used a HIL unit (BTL Industries Czech Rep). The laser treatment was then repeated every 4 days in four more sessions. In the Control Group (RSWT+FSWT) we used a our regular protocol of 1000 focused shockwaves using an electrohydraulic device (MTS Orthogold – OE155 – soft focused applicator - MTS Medical – Konstanz, Germany). We followed up the patients for four months, with a monthly record of VAS pain score, the Roles and Maudsley scale, and a record for any adverse effects. All data was recorded and analyzed using a One-Way ANOVA, and the P value was based in < 0.01. The study was done independently with no financial or material support from the manufacturers of the mentioned devices.

Results:

Both the cases group and the control group patients improved pain and function in the fourmonth follow up. The RSWT+HIL treated patients had a 71% VAS pain reduction after 5 months, as compared with a 70% in the RSWT+FSWT control group. The Roles and Maudsley scores showed good and excellent results in 70% of the cases group patients, as compared with 73% in the control group. 9/11 patients improved 25%-50% their pain in the four-month follow up, and 2/11 improved over 50% in the cases group. The control group had similar results, with 7/10 patients that improved 25%-50% and 3/10 over 50%. All reported data in pain control, functional score and improvement rates were not statistically significant. No patients showed increase in pain or any complications.

Discussion:

The use of HIL has proven efficacy and safety in pain control of musculoskeletal lesions, and its regenerative power is still under research. Shockwave medicine has proven to be a great tool in tissue regeneration, neovasculogenesis and healing, but pain control is still a short and long-term issue. This study shows a possible use of the best of both technologies in benefit of our tendinopathy patients. We do have better results in our cases with RSWT that did not require a third session, with a 81% pain control, as compared with the 71% and 70% of the patients included in this study, who were the poor-results individuals who required a third treatment session. In future studies we will compare primary patients using RSWT, FSWT and combined RSWT+HILT.

Conclusion:

The use of a combined therapy of radial shockwaves and high intensity laser therapy showed similar results as the use of focused shockwaves in the recurrent pain after a primary shockwave treatment for tennis elbow.

Good results in 84% of the patients

This paper tries to optimize the existent classical treatments for patellar tendinopathies that are resistant to classical forms of therapy, in professional athletes.

Improves spasticity and motor functionality

The Effects of Extracorporeal Shockwave Therapy (ESWT) and Cryotherapy in Treating Patellar Tendinopathies in Professional Athletes

This paper tries to optimize the existent classical treatments for patellar tendinopathies that are resistant to classical forms of therapy, in professional athletes.

Hypotheses:

This research wants to highlight the effectiveness of the ESWT and cryotherapy in treating patellar tendinopathies in professional athletes who previously underwent classical treatments that had no positive results.

Materials:

The research was conducted at the Bacau Spinal Care Rehabilitation Clinic, where the systems BTL-6000 SWT and Cryo 6 Zimmer were used.

Methods:

The study comprised 38 male athletes, of which 12 volleyball players, 13 handball players, 5 badminton players, 5 tennis players, and 3 football players, who were subjected over the course of 3 months (previous to this experiment) to steroidal and non-steroidal antiinflammatory treatment, cortical injections and electrotherapy, without any results. The present treatment span over 3 weeks, with two sessions per week, during which ESWT and cryotherapy (-30°C) were applied. The pain was assessed using the Visual Analogue Scale (VAS) for Pain.

Results and conclusions:

At the end of the research, out of the total 38 subjects, 32 recorded very good results both during the study, and during the intermediary assessments, one month, two and three months after the treatment ended; 4 of them, at the 3 months assessment still felt a slight pain during training, while 2 of them did not respond favorably to the treatment, at the end of which they were send to the orthopedist for PRP infiltrations. After analyzing the results, one can say that the ESWT, combined with locally administered cryotherapy of -30°C, has very good results in treating the patellar tendinopathies that are resistant to other forms of therapy. Another positive aspect that can be said after this study is that the positive effects of the applied therapy have maintained also 3 months after its end.

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