ESWT high energy discussion. anyone please commentPosted by Dr. Z on 3/18/04 at 23:17 (147269)
I have read with great interest all of the research abstracts that Dr. Rompe has been so kind to provide. In the rabbit tendon abstract demonstrating that energy levels over 0.22mj/mm2 cause cell damage that may or may not be reversible it appears except for the ossatron lateral epicondylitis protocol/ and the latest shoulder calicification AMA article ( two session) that all treatment protocols are low energy, three session plus protocol
My question is this for anyone especially Dr. Rompe. Does the vitro studies correspond to the in vivo clinical outsome. I do know that the
AMA shoulder calcification article pointed out that there were no joint, tendon damage noted clinically. Why was a two session protocol chosen instead a one session?
Surgical treatment is much more traumatic then ESWT even with high energy ( 0.36mj.mm2 or 1080 mj/mm2 EFD) so why is there concern when using ESWT high energy protocol. A one session treatment protocol would appear to more practical and much more patient friendly then a 3-5 treatment sesssion.
I used the FDA one session dornier epos protocol for almost two years and I have seen no adverse complications such as rupture and or stress fracture. In fact the FDA original studies showed no adverse pf damage and or rupture.
So my questions if we apply the avascular,degenerative tissue causative hypothosis that is believed to be true then why aren't we using a one session medium energy 0,36mj/mm2 treatment protocol for all tendonosis pathology.
I hope and appreciate any comments.
Re: ESWT high energy discussion. anyone please commentEd Davis, DPM on 3/18/04 at 23:45 (147280)
Interesting thoughts. I think that depending on the level of tendinosis that, generally speaking, documented tendinosis would be treated at a somewhat lower energy level (eg. medium energy) than a tendinitis. Some of the cases of achilles tendinosis are essentially a pre-rupture state and as such require that the energy provided in one treatment be moderated, in my opinion.