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High-energy "II"

Posted by Jan R. on 11/30/04 at 11:28 (164956)

Have a look on what is really 'hig-energy':

(1)
New bone formation by extracorporeal shock wavesDependence of induction on energy flux density.

Maier M, Hausdorf J, Tischer T, Milz S, Weiler C, Refior HJ, Schmitz C.

Orthopade. 2004 Oct 13; [Epub ahead of print]

BACKGROUND. The purpose of this study was to test the hypothesis that shock waves can induce new bone formation even without cortical fractures and periosteal detachment as suggested in the literature.

METHODS. Extracorporeal shock waves with energy flux densities between 0 mJ/mm² (sham treatment) and 1.2 mJ/mm² were applied in vivo to the distal femoral region of rabbits (1500 pulses at 1 Hz frequency each). Oxytetracycline was injected on days 5-9 and the animals were sacrificed on day 10. Sections of both femora of all animals were investigated with broadband fluorescence microscopy and contact microradiography for new periosteal and endosteal bone, periosteal detachment, cortical fractures, and trabecular bone with callus.

RESULTS. Shock waves with high-energy flux densities of 0.9 mJ/mm² and 1.2 mJ/mm² resulted in new periosteal bone formation in the presence of cortical fractures and periosteal detachment. After application of shock waves with energy flux density of 0.5 mJ/mm², clearly detectable signs of new periosteal bone formation were observed without cortical fractures or periosteal detachment.

(2)
Detection of bone fragments in pulmonary vessels following extracorporeal shock wave application to the distal femur in an in-vivo animal model

Maier M, Freed JA, Milz S, Pellengahr C, Schmitz C.

Z Orthop Ihre Grenzgeb. 2003 Mar-Apr;141(2):223-6.

AIM: In urology, single cases of lethal pulmonary embolism following extracorporeal shock wave application to renal concrements have been reported. Therefore, lungs of rabbits were histopathologically investigated following extracorporeal shock wave application to the femur.

METHOD: In 8 mature Chinchilla-Bastard rabbits, shock wave application to one distal femur was performed with energy flux density of 0.9 mJ/mm². In another 6 rabbits, sham-treatment (0 mJ/mm²) to one distal femur was performed. 6 weeks later, the animals were sacrificed and their lungs were blindly investigated by an independent pathologist.

RESULTS: In 7 out of the 8 treated animals (0.9 mJ/mm²) but in none of the sham-treated controls, patchy discolorations of the surface of the lung were observed. Furthermore, in 6 out of the 8 treated animals but in none of the sham-treated controls, bony fragments with signs of resorption were observed in lung vessels.

(3)
Substance P and prostaglandin E2 release after shock wave application to the rabbit femur.

Maier M, Averbeck B, Milz S, Refior HJ, Schmitz C.

Clin Orthop. 2003 Jan;(406):237-45.

The biologic action of extracorporeal shock wave application on the musculoskeletal system is poorly understood. To prove the hypothesis that alterations of tissue concentrations of substance P and prostaglandin E(2) are involved in the biologic action of shock waves, extracorporeal shock waves with energy flux density of 0.9 mJ/mm² (1500 pulses at 1/second) were applied in vivo to the distal femur of rabbits. The concentrations of substance P and prostaglandin E2 eluted from the periosteum of the femur were measured.

Compared with the untreated contralateral hindlimbs, substance P release from the periosteum from the femur was increased 6 hours and 24 hours after extracorporeal shock wave application, but was decreased 6 weeks after extracorporeal shock wave application. By contrast, extracorporeal shock wave application did not result in altered prostaglandin E2 release from the periosteum from the femur. Remarkably, there was a close relationship between the time course of substance P release found here, and the well-known clinical time course of initial pain occurrence and subsequent pain relief after extracorporeal shock wave application to tendon diseases. Accordingly, substance P might be involved in the biologic action of extracorporeal shock wave application on tissue of the musculoskeletal system.

Re: High-energy "II"

Dr. Z on 11/30/04 at 11:53 (164958)

Dr. Rompe
Thanks for the article. Could you tell me if you treat Insertional tenopathy without calicification ie supraspinatis tendinosis with ESWT. What kind of results.?

Re: High-energy "II"

Jan R. on 12/01/04 at 03:59 (165009)

Sir:

No, I do not treat insertional tendopathies at the shoulder if there is no calcium deposit.
This diagnosis 'insertional tendopathies at the shoulder' is hard to verify, and there are probably multiple factors responsible for unspecific shoulder pain: rotator cuff, biceps tendon, subacromial space etc.

If you manage to rule out these differential diagnoses then ESWT may be beneficial.

For recalcitrant heel pain and tennis elbow I require x-rays and MRI for all patients before deciding that ESWT is a reasonable approach or whether surgery is my recommendation.

Regards

Re: High-energy "II"

Dr. Z on 12/01/04 at 15:31 (165031)

thanks