1. Prospective cohort study examining short term changes in pain after application of Extracorporeal Shockwave Therapy (ESWT) in 178 consecutive patients
Dr. Aston Ngai
Sports Medicine Physician

2. Disclosures: None

3. Question?
Does focal ESWT provide pain relief and a positive response of patient improvement rating for chronic musculoskeletal injuries?

4. Methods December 2015 and May 2016
178 patients (136 non-athletes, 42 athletes), 83 Male; 95 Female; 302 treatments;
Chronic musculoskeletal injuries (≥ 3/12) and a pain score of (VAS≥3) and failure of conservative treatment.
Obtained patient questionnaire, history, clinical findings and investigations, written informed consent;

5. Methods Electrohydraulic focal ESWT (Orthogold 100)
Incremental protocol dependent on tissue or injury ( mJ/mm2)
pulses given at 3-5 Hz
Pre and post treatment VAS score and subjective improvement rating recorded
Adverse effects recorded

6. Energy Flux Density and Impulses Used
Indication
Lower Limit (mJ/mm2)
Upper limit (mJ/mm2)
Impulses
Plantar fasciitis
0.1
0.19
1000
Calcific tendinopathy
0.27
1200
Tendinopathy
Elbow tendinopathy
0.14
Medial Tibial Stress Syndrome
1400
Partial tear of plantar fascia
0.08
0.13
Knee OA
AC joint OA
Ankle anterior impingement
Trigger Finger
Wrist ext tendinopathy
Stress Fracture
Frequency of 3-5 Hz used depending on patient tolerance

7. Achilles insertional calcific tendinopathy 8
AC joint OA 3
Achilles insertional calcific tendinopathy 8
Achilles insertional tendinopathy 13
Achilles tendinopathy 7
Achilles tendinopathy + partial tear 1
Adhesive Capsulitis 2
Ankle anterior Impingement
Ankle posterior Impingement
Ankle sprain
Ankle tibialis posterior tendinopathy
Avulsion Fracture
Biceps tendinopathy
Bone Contusion
Calcaneal Stress Fracture
DRUJ subluxation / sprain
Elbow lateral epicondylopathy
Elbow medial epicondylopathy
Elbow triceps tendinopathy
Fibular periostitis with peroneal overload
Finger comminuted fracture
Finger Tendinopathy
Freiberg's disease
Heel ft pad contusion 4
Knee OA 6
MCL chronic strain 1
MCL ossification
Medial Tibial Stress Syndrome 3
Metatarsalgia 2
Patella insertional tendinopathy
Patella proximal calcific tendinopathy / old SLJ
Patella proximal tendinopathy / old SLJ
Patella tendinopathy
Patellofemoral chondromalacia 9
Patellofemoral joint pain 5
Peroneal tenosynovitis
Pes anserinus tendinopathy
Plantar fasciopathy 56
Plantar fasciopathy + partial tear
Quadriceps tendinopathy
Rotator cuff calcific tendinopathy 12
Rotator cuff tendinopathy 7
Rotator cuff tendinopathy + partial tear
Shoulder impingement
Talar dome OCD
Tibial stress fracture
Tibiofemoral joint pain
Trochanteric Pain syndrome
Wrist TFCC partial tear

8. Results

9. 55.6%
21.9%
7.9%
1.7%
0.6%

10. Subjective Improvement Rating by Gender

11. Subjective Improvement Rating among Athletes and Non Athletes42
136

12. Reduction in VAS score according to region (n=178)

13. Reduction in VAS score according to Tissue type (n=178)

14. Reduction in VAS score according to Tendon type (n=178)* * *

15. Adverse Events
Mild Erythema (1.6%) –, medial epicondylitis (twice same patient), lateral epicondylopathy (1), rotator cuff calcific tendinopathy(1);
Short term pain increase (1.6%) – trigger finger (1), rotator cuff calcific tendinopathy (2), peroneal tenosynovitis (1)

16. Limitations
Duration of follow up treatment was variable between 1- 4 weeks
No controls for comparison and blinding with spam ESWT was not possible
There was no longer term evaluation
The quality of home based exercises and physiotherapy could not be determined

17. Conclusion
There is good short term reduction in reported pain after treatment with focal ESWT in almost all tissue types in different regions of the body;
Male patients seemed to improve more female patients.
Focal ESWT can be used safely
Future research should examine the durability of these pain reductions to longer term.

18. Thank you

19. REFERENCE
Speed C.A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. Br J Sports Med Nov;48(21):
Schmitz C, Császár, Milz S, Schieker M, Maffulli N, Rompe J, Furia J. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Br Med Bull. 2015; 116:
Chow IHW, Cheing GLY Comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain . Clin Rehabil 2007;21:131–41