Presentation is loading. Please wait.

Presentation is loading. Please wait.

Prospective cohort study examining short term changes in pain after application of Extracorporeal Shockwave Therapy (ESWT) in 178 consecutive patients.

Similar presentations


Presentation on theme: "Prospective cohort study examining short term changes in pain after application of Extracorporeal Shockwave Therapy (ESWT) in 178 consecutive patients."— Presentation transcript:

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 Athletes
42 136

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


Download ppt "Prospective cohort study examining short term changes in pain after application of Extracorporeal Shockwave Therapy (ESWT) in 178 consecutive patients."

Similar presentations


Ads by Google