Year : 2000 | Volume
: 17 | Issue : 1 | Page : 44--46
Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases
Dushyant Nadar, CS Rao, MJ Naidu, U Satyanarayana, C Nageswara Rao
KCP Nephro-Urological Center and Research Foundation, Pinnamananeni Poly Clinic, Vijayawada and Department of Biochemistry, Siddhartha Medical College, NTR University of Health Sciences, Vijayawada, India
C Nageswara Rao
KCP Nephro-Urological Center and Research Foundation, Pinnamananeni Poly Clinic, Siddhartha Nagar, Vijayawada - 520 010
Objective: Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases.
Patients and methods: 35 patients received shock wave therapy using Econolith 2000 lithotripter 19 patients had isolated lateral epicondylitis, 12 medical epicondylitis and 4 plantar fascitis. A total of 120 shock waves were given in the first sitting. Each patient received a total of three sittings with a gap of one week between each of them.
Results: Based on the patients«SQ» self-assessment, about 75% pain relief was observed in 60% of the patients. Further, in patients having isolated tendinopathies, the pain relief was better.
Conclusion: The study indicated that the application of shock waves is not restricted to the fragmentation of urinary calculi. The shock waves can be effectively used for the pain relief in the common orthopedic diseases. Thus, the urologists can widen the application of lithotripters, in a cost-effective manner, to the other medical specialities.
|How to cite this article:|
Nadar D, Rao C S, Naidu M J, Satyanarayana U, Rao C N. Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases.Indian J Urol 2000;17:44-46
|How to cite this URL:|
Nadar D, Rao C S, Naidu M J, Satyanarayana U, Rao C N. Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases. Indian J Urol [serial online] 2000 [cited 2022 Jun 26 ];17:44-46
Available from: https://www.indianjurol.com/text.asp?2000/17/1/44/41013
The advent of extracorporeal shock wave lithotripsy has revolutionised the treatment strategy of urolithiasis. Several studies have been carried out to find out the effectiveness and side-effects of lithotripters.,,, Use of the shock waves has been extended for the treatment of stones in other organs such as gallbladder, bile duct, pancreas, salivary glands, etc. ,, Treatment of orthopedic disease by the shock waves is of recent origin. 
We, for the first time in India, report the utility of ESWL for the treatment of tendinopathy and other orthopedic diseases.
Patients and Methods
Between July 1999 and January 2000, 35 patients (20 women and 15 men), mean age 38.4 years, underwent shock wave therapy for tendinopathy (both medial and lateral epicondylitis) and plantar fascitis. Out of these, 12 patients were treated for medical epicondylitis (golfers elbow), 19 for lateral epicondylitis (tennis elbow) and 4 for plantar fascitis.
All of these patients had severe symptoms of the disease like excruciating pain and limited joint movements. These patients had a long history of unsuccessful nonoperative treatment in the form of pain killers, physiotherapy and steroid injections. Few of these had unwillingly opted for surgery due to repeated treatment failures. The shock wave therapy was tried with the full consent of the patients as a last resort before subjecting them to surgery.
Using Econolith 2000 lithotripter, 120 shock waves were given in a single sitting to the painful area, keeping the painful part in the extended path of the shock waves. 60 shock waves were given at setting 1 (14 kv) and, 60 at power setting 2 (16 kv). Each patient underwent a total of three sittings with an interval of one week between sittings. The procedure was done without any anesthesia or sedation and most of them tolerated the treatment well.
On review, the patients were given a questionnaire in which subjective parameters such as night pain, pain on movement and decreased intake of painkilling medication were evaluated.
After the completion of 3 sittings of shock wave therapy, the patients were reviewed. The percent relief of pain experienced by the patients is summarized in the table given below.
The present pain relief was observed to be very good in 60%, good in 20%, fair in 11.4% and remained unchanged in 8.6%. The patients with persistent heel pain due to the calcaneal spur showed improvement only in the range of 25-50%. Compared to this, those having tendinopathy showed significant improvement in the pain relief (>75%). The parameters such as night pain and pain with and without activity showed marked improvement as well.
Out of 35 patients, 3 patients having lateral epicondylitis had to be treated again after 3 months for reappearance of the pain. However, the pain intensity was less and all three opted for the shock wave therapy instead of surgery.[Table 1]
Tendinopathies such as lateral epicondylitis (tennis elbow), and medial epicondylitis (golfer's elbow) have been known by the mankind since time immemorial. , Such terms hallowed by tradition, may be useful "aide memoires", but do not reflect the etiology. The exact pathophysiology is however uncertain. Most affected patients are between 40-60 years and women are affected more than the men. Immobilization, physiotherapy, radiotherapy and steroid infections are symptomatic treatment options. , Surgery is reserved for those having minimal response.
Dahmen et al first used shock waves for the treatment of the soft tissue pains in the proximity to the bones in 512 patients.  He reported 52% of the patients having good results, 28% improved and only 2% requiring surgery.
Haist and Von Keitz-Steeger reported on 812 patients treated for various tendinitis. They reported an average of 2.2 shock wave treatment per patient using Siemen's lithostar overhead module.  They followed 460 patients for 3 months after the treatment. 86.1% of their patients experienced good result and only 7.1 % were unsatisfied. 
In the treatment of painful heel due to calcaneal spur, 68% showed improvement after shock wave therapy, 43% of the patients had become completely free of the disease and 12% still complained of severe pain.
In our study, 35 patients had received the shock wave therapy. The percent pain relief was found to be very good in 60, good in 20, fair in 11.4, and unsatisfactory in 8.6 after completion of the 3 sittings of shock wave therapy. We had used lesser number of shock waves to keep the treatment an out patient procedure. In the near future, we wish to extend the application for the treatment of delayed union of fractures and tendinopathy of the shoulder as well. Increasing the number of shocks is also under consideration.
To date ESWL in India and other developing countries has been confined to the treatment of urinary stones. Our results reported above clearly indicate the potential utility of the lithotripter in the treatment of orthopedic diseases. Considering the large population affected by these diseases, the utility of shock wave has immense importance for the treatment. The wider usage of the lithotripter can make it more economical for all categories of the patients. The experience of the urologist in handling the lithotripter can be a boon to his orthopedic colleagues.
|1||Coleman AJ, Saunders JE. A review of the physical properties and biological effects of the high amplitude acoustic field used in lithotripsy. Ultrasonics 1993; 31: 75.|
|2||Eisenberger F. Schmidt A. ESWL and the future of stone management. World J Urol 1993; 11: 2.|
|3||Holbauer J. Ludvik G. Grbovic M. Marberger M. Stellenwert and kunftige Entwicklung in der extrakorporalen Stobwellenlithotripsie (ESWL). Wein. Med. Wochenschr 1995: 145: 254.|
|4||Haupt G, Haupt A. Donovan JM, Drach GW, Chaussy C. Shortterm changes of laboratory values after extracorporeal shock wave lithotripsy: a comparative study. J Urol 1989; 142: 259-262.|
|5||Sauerbruch T. Delius M. Paumgartner G et al. Fragmentation of gallstones by extracorporeal shock waves. N Engl J Med 1986; 314: 818.|
|6||Sauerbruch T, Holl J, Sackmann M et al. Disintegration of a pancreatic stone with extrcorporeal shock waves in a patient with chronic pancreatitis. Endoscopy 1987; 19: 207.|
|7||Iro H, Schneider H, Fodra C et al. Shock wave lithotripsy of salivary gland stones. Lancet 1992; 19: 207.|
|8||Gerald Haupt. Use of extracorporeal shock waves in the treatment of pseudoarthrosis tendinopathy and other orthopedic diseases. J Urol 1997: 158: 4-11.|
|9||Runge F. Zur Genese and behandlung des Schreibkrampfes. Berl Klin Wochenschr 1873; 10: 245.|
|10||Duplay S. Uber die Periarthritis humero scapularis and die daraus entstehende schulterseife. Arch Gen Med 1892; 2: 513.|
|11||Baslund B, Thomsen BS, Jensen EM. Humoroscapular periarthrosis. Ugeskr Laeger 1991: 153: 170.|
|12||Sommerich CM, McGlothin JD, Marras WS. Occupational risk factors associated with soft tissue disorders of the shoulder: a review of recent investigations in the literature. Ergonomics 1993; 36: 697.|
|13||Dahmen GP. Meiss L. Nam VC. Franke R. Gonchars V. Extrakorporale Stobwellentherapie (ESWT) im knochennahen Weichteilbereich an der schulter. Erste Therapieergebnisse Ext Orthopaed 1992; 9: 317.|
|14||Haist J, von Keitz-Steeger D. Shock wave therapy in the treatment of near-to-bone soft tissue pain in sportsmen. Int J Sports Med 1996; 17: S79.|
|15||Haist J, Steeger D, Witzsch U, Burger RA, Haist U. The extracorporeal shockwave therapy in the treatment of disturbed bone union. Int Conf Biomed Eng 1992; 222.|