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eswt for tennis elbow

Posted by Dave R. on 4/23/02 at 14:40 (080842)

Is ESWT approved for use in the US for severe tennis elbow? Anyone doing it in NV or western US?

Re: eswt for tennis elbow

Dr. Zuckerman on 4/24/02 at 20:15 (081007)

Not yet but look it real soon !!!!

Re: eswt for tennis elbow

John h on 4/24/02 at 21:53 (081028)

Dave: Look on the Bayshore website as I think I recall seeing they treat tennis elbow with ESWT. Seems they may use the Ossatron on the elbow. I know Dr. Gordon treats shoulders among other areas.

Re: eswt for tennis elbow

DR Zuckerman on 4/24/02 at 22:17 (081029)

I believe they treat both high and low for the elbow in Canada.

Re: eswt for tennis elbow

Sunny Jacob - Bayshore on 4/25/02 at 07:41 (081055)

At Bayshore, in most cases, we use low energy ESWT for tennis elbow. Depending on the specific case (for example, if the patient had previous surgery), Dr. Gordon may recommend high energy (Ossatron)which we also do at Bayshore. The high energy treatment is performed by Dr. Gordon with a team of anaesthesist and ESWT technician. Dr. Gordon is Bayshore's orthopedic consultant.

Re: eswt for tennis elbow

Sunny Jacob - Bayshore on 4/25/02 at 07:48 (081057)

Re High Energy / Low Energy ESWT

Sonocur, Dornier, Storz, are low energy shock wave equipments with shock wave levels 1 to 9/10. These are shock wave levels and not high and low energy levels.
At present the only 'high energy' equipment available on the market is Ossatron. For those who want more detailed scientific information about this question, there are published papers available.

Re: eswt for tennis elbow

Dave R. on 4/25/02 at 10:57 (081083)

Thanks for the info. All the conservative tx doesn't seem to be working and it's been 4 months. My OS said if all else fails he wants to look at surgery. My concern is the success rate of the surgery. My job depends on full use of my arms. The ESWT seems like a good alternative to the knife with little or no down side. Someone mentioned tx in Vancouver? That would be a lot closer to me than Bayshore. Does anyone know the name of who is doing it in Vancouver?

Re: eswt for tennis elbow

john h on 4/25/02 at 11:14 (081088)

I think Bayshore may have a clinic in Vancouver or you might email (email removed) and he can give you the location of the Vancouver facility.

Re: eswt for tennis elbow

David on 4/25/02 at 12:13 (081093)

Sonorex Therapy Center in Vancouver treats many patients with tennis elbow using the Sonocur. The Workers' Compensation Board of British Columbia has been sending hundreds of patients suffering from this condition. Information for patients having treatment in Canada can be found at http://www.sonorex.com/world
A series of 3 treatments is generally required and the cost for all three is CA$750.

A study was recently completed at 3 sites in the United States using the Sonocur for patients suffering from chronic tennis elbow.
The results can be viewed on the American Academy of Orthopaedic Surgeons web site at:
http://www.aaos.org/wordhtml/anmt2002/sciprog/271.htm

For further information, call toll free @ 1 877 766-6287

Re: eswt for tennis elbow

Ed Davis, DPM on 4/25/02 at 17:28 (081120)

The main indication for the Sonocur unit is lateral epicondylitis.
Ed

Re: eswt for tennis elbow

DR Zuckerman on 4/25/02 at 20:10 (081130)

Hi

I have to correct you on this one. The dornier Epos is both a low and high energy machine. The dornier epos delivers energy up to 0.5mj/mm2. We use
level seven which is 0.36mj/mm2. Actually the epos has the ability to deliver more energy then the ossatron.

Re: eswt for tennis elbow

Carole C in NOLA on 4/25/02 at 23:09 (081155)

My sympathy for your tennis elbow. I had a bad case of tennis elbow a couple of years ago. It sounds so debonair and fun, 'Tennis Elbow', but in my case it had zero to do with tennis or anything else that was fun. It was extremely painful. I hope that ESWT can offer you some relief.

Carole C

Re: eswt for tennis elbow / high energy: low energy

Sunny Jacob - Bayshore on 4/27/02 at 07:33 (081292)

High Energy / Low Energy
The definitions are based on the shockwave source. There are three types on the market:
i) Electrohydraulic, i.e. Ossatron, Orthospec
ii) Electromagnetic (e.g. Sonocur by Siemens, Epos Ultra by Dornier, Storz)
iii)Piezoelectric (e.g. Piezoson by Wolf)
To establish the energy level it is important to distinguish between energy and total energy flux density. Total energy flux density measured as mJ/mm2 is one of the current 13 parameters to measure energy level.
Energy level is measured in mega Pascals. The table below gives a comparison of energy levels. Based on this, shock heads using the electrohydraulic principle are high energy devices. Shock waves using electromagnetic and piezo electric principles are low energy. In ESWT therapy each has its own specific use.
__________________________________________________________________
Energy level Elect.hydraulic Electr.magnetic Piezo electric
in mPa
__________________________________________________________________

Positive Peak
Pressure 40-87 25-91 15-40

- 6dB
focal area 6-26 2- 6 1- 7

5 mPa
focal area 13-45 16-32 15-17
__________________________________________________________________

Literature references are available.

Re: eswt for tennis elbow / high energy: low energy

Sunny Jacob - Bayshore on 4/27/02 at 07:40 (081293)

Unfortunately, the table does not show properly. I will try to explain in the following:

Comparison of Shock Wave Generators in Mega Pascals:

1) Energy level: Positive Peak Pressure
Electro hydraulic 40-87
Electromagnetic 25-91
Piezo electric 15-40

2) Energy level: -6 dB focal area
Electro hydraulic 6-26
Electromagnetic: 2-6
Piezo electric 1-7

3) Energy level: 5 MPa focal area
Electro hydraulic 13-45
Electromagnetic 16-32
Piezo electric 15-17

Re: eswt for tennis elbow / high energy: low energy

John h on 4/27/02 at 09:39 (081311)

Sunny: you are bringing back one of my worst nightmares! College Physics! I can tell you about the shockwave of going through the sound barrier and from the pilots seat there is none. When that baby hits the ground however it will rattle your bones.

Re: eswt for tennis elbow / high energy: low energy

DR Zuckerman on 4/28/02 at 15:38 (081478)

I am confused. So what you are saying is that electromagnetic heads can't produce high energy. Or that only Electrohydraulic forms of delivering shockswave are high enegy.

Re: eswt for tennis elbow / high energy: low energy

Sunny Jacob - Bayshore on 4/29/02 at 07:48 (081563)

Please provide me with your email address and I will forward some literature references. My email is (email removed)

Re: eswt for tennis elbow

Dr. Zuckerman on 4/24/02 at 20:15 (081007)

Not yet but look it real soon !!!!

Re: eswt for tennis elbow

John h on 4/24/02 at 21:53 (081028)

Dave: Look on the Bayshore website as I think I recall seeing they treat tennis elbow with ESWT. Seems they may use the Ossatron on the elbow. I know Dr. Gordon treats shoulders among other areas.

Re: eswt for tennis elbow

DR Zuckerman on 4/24/02 at 22:17 (081029)

I believe they treat both high and low for the elbow in Canada.

Re: eswt for tennis elbow

Sunny Jacob - Bayshore on 4/25/02 at 07:41 (081055)

At Bayshore, in most cases, we use low energy ESWT for tennis elbow. Depending on the specific case (for example, if the patient had previous surgery), Dr. Gordon may recommend high energy (Ossatron)which we also do at Bayshore. The high energy treatment is performed by Dr. Gordon with a team of anaesthesist and ESWT technician. Dr. Gordon is Bayshore's orthopedic consultant.

Re: eswt for tennis elbow

Sunny Jacob - Bayshore on 4/25/02 at 07:48 (081057)

Re High Energy / Low Energy ESWT

Sonocur, Dornier, Storz, are low energy shock wave equipments with shock wave levels 1 to 9/10. These are shock wave levels and not high and low energy levels.
At present the only 'high energy' equipment available on the market is Ossatron. For those who want more detailed scientific information about this question, there are published papers available.

Re: eswt for tennis elbow

Dave R. on 4/25/02 at 10:57 (081083)

Thanks for the info. All the conservative tx doesn't seem to be working and it's been 4 months. My OS said if all else fails he wants to look at surgery. My concern is the success rate of the surgery. My job depends on full use of my arms. The ESWT seems like a good alternative to the knife with little or no down side. Someone mentioned tx in Vancouver? That would be a lot closer to me than Bayshore. Does anyone know the name of who is doing it in Vancouver?

Re: eswt for tennis elbow

john h on 4/25/02 at 11:14 (081088)

I think Bayshore may have a clinic in Vancouver or you might email (email removed) and he can give you the location of the Vancouver facility.

Re: eswt for tennis elbow

David on 4/25/02 at 12:13 (081093)

Sonorex Therapy Center in Vancouver treats many patients with tennis elbow using the Sonocur. The Workers' Compensation Board of British Columbia has been sending hundreds of patients suffering from this condition. Information for patients having treatment in Canada can be found at http://www.sonorex.com/world
A series of 3 treatments is generally required and the cost for all three is CA$750.

A study was recently completed at 3 sites in the United States using the Sonocur for patients suffering from chronic tennis elbow.
The results can be viewed on the American Academy of Orthopaedic Surgeons web site at:
http://www.aaos.org/wordhtml/anmt2002/sciprog/271.htm

For further information, call toll free @ 1 877 766-6287

Re: eswt for tennis elbow

Ed Davis, DPM on 4/25/02 at 17:28 (081120)

The main indication for the Sonocur unit is lateral epicondylitis.
Ed

Re: eswt for tennis elbow

DR Zuckerman on 4/25/02 at 20:10 (081130)

Hi

I have to correct you on this one. The dornier Epos is both a low and high energy machine. The dornier epos delivers energy up to 0.5mj/mm2. We use
level seven which is 0.36mj/mm2. Actually the epos has the ability to deliver more energy then the ossatron.

Re: eswt for tennis elbow

Carole C in NOLA on 4/25/02 at 23:09 (081155)

My sympathy for your tennis elbow. I had a bad case of tennis elbow a couple of years ago. It sounds so debonair and fun, 'Tennis Elbow', but in my case it had zero to do with tennis or anything else that was fun. It was extremely painful. I hope that ESWT can offer you some relief.

Carole C

Re: eswt for tennis elbow / high energy: low energy

Sunny Jacob - Bayshore on 4/27/02 at 07:33 (081292)

High Energy / Low Energy
The definitions are based on the shockwave source. There are three types on the market:
i) Electrohydraulic, i.e. Ossatron, Orthospec
ii) Electromagnetic (e.g. Sonocur by Siemens, Epos Ultra by Dornier, Storz)
iii)Piezoelectric (e.g. Piezoson by Wolf)
To establish the energy level it is important to distinguish between energy and total energy flux density. Total energy flux density measured as mJ/mm2 is one of the current 13 parameters to measure energy level.
Energy level is measured in mega Pascals. The table below gives a comparison of energy levels. Based on this, shock heads using the electrohydraulic principle are high energy devices. Shock waves using electromagnetic and piezo electric principles are low energy. In ESWT therapy each has its own specific use.
__________________________________________________________________
Energy level Elect.hydraulic Electr.magnetic Piezo electric
in mPa
__________________________________________________________________

Positive Peak
Pressure 40-87 25-91 15-40

- 6dB
focal area 6-26 2- 6 1- 7

5 mPa
focal area 13-45 16-32 15-17
__________________________________________________________________

Literature references are available.

Re: eswt for tennis elbow / high energy: low energy

Sunny Jacob - Bayshore on 4/27/02 at 07:40 (081293)

Unfortunately, the table does not show properly. I will try to explain in the following:

Comparison of Shock Wave Generators in Mega Pascals:

1) Energy level: Positive Peak Pressure
Electro hydraulic 40-87
Electromagnetic 25-91
Piezo electric 15-40

2) Energy level: -6 dB focal area
Electro hydraulic 6-26
Electromagnetic: 2-6
Piezo electric 1-7

3) Energy level: 5 MPa focal area
Electro hydraulic 13-45
Electromagnetic 16-32
Piezo electric 15-17

Re: eswt for tennis elbow / high energy: low energy

John h on 4/27/02 at 09:39 (081311)

Sunny: you are bringing back one of my worst nightmares! College Physics! I can tell you about the shockwave of going through the sound barrier and from the pilots seat there is none. When that baby hits the ground however it will rattle your bones.

Re: eswt for tennis elbow / high energy: low energy

DR Zuckerman on 4/28/02 at 15:38 (081478)

I am confused. So what you are saying is that electromagnetic heads can't produce high energy. Or that only Electrohydraulic forms of delivering shockswave are high enegy.

Re: eswt for tennis elbow / high energy: low energy

Sunny Jacob - Bayshore on 4/29/02 at 07:48 (081563)

Please provide me with your email address and I will forward some literature references. My email is (email removed)