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]
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. 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.[22][23]
Procedure
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.[24] Sedation is not required in its application for soft tissue injuries.
History
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.[25]
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.[26]
Research
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.[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.[28] The use of ESWT was demonstrated in patients with frozen shoulders compared to therapeutic ultrasound with exercises.[29]
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.[30]
^Louwerens JK, Sierevelt IN, van Noort A, van den Bekerom MP (August 2014). "Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis". Journal of Shoulder and Elbow Surgery. 23 (8): 1240–1249.
doi:
10.1016/j.jse.2014.02.002.
PMID24774621.
^Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, et al. (August 2014). "Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials". Archives of Physical Medicine and Rehabilitation. 95 (8): 1585–1593.
doi:
10.1016/j.apmr.2014.01.033.
PMID24662810.
^Kong FR, Liang YJ, Qin SG, Li JJ, Li XL (January 2010). "[Clinical application of extracorporeal shock wave to repair and reconstruct osseous tissue framework in the treatment of avascular necrosis of the femoral head (ANFH)]". Zhongguo Gu Shang = China Journal of Orthopaedics and Traumatology (in Chinese). 23 (1): 12–15.
PMID20191955.
^
abChamberlain GA, Colborne GR (2016). "A review of the cellular and molecular effects of extracorporeal shockwave therapy". Veterinary and Comparative Orthopaedics and Traumatology. 29 (2): 99–107.
doi:
10.3415/VCOT-15-04-0057.
PMID26846274.
S2CID19280257.
^Fridman R, Cain JD, Weil L, Weil L (November–December 2008). "Extracorporeal shockwave therapy for the treatment of Achilles tendinopathies: a prospective study". Journal of the American Podiatric Medical Association. 98 (6): 466–468.
doi:
10.7547/0980466.
PMID19017855.