Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis

Objective: To evaluate the effectiveness of extracorporeal shockwave therapy compared with other interventions on pain, grip strength and disability in patients with lateral elbow tendinopathy. Data Sources: MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, Cochrane Library and clinical trial registries. Review methods: We included randomized controlled trials assessing the effectiveness of extracorporeal shockwave therapy alone or as an additive intervention compared with sham or other interventions. Pain intensity, grip strength and elbow disability were used as primary outcome measures. We assessed methodological quality with the PEDro score and quality of evidence with the GRADE approach. Results: Twenty-seven studies with 1871 patients were finally included. Extracorporeal shockwave therapy reduced pain intensity at mid-term follow-up (standardized mean difference: −1.21, 95% confidence interval:−1.53, −0.89, P < 0.001) and improved grip strength at very short- (mean difference:3.92, 95% confidence interval: 0.91, 6.94, P = 0.01) and short-term follow-up (mean difference:4.87, 95% confidence interval:2.24, 7.50, P < 0.001) compared with sham treatment. However, no clinically significant results were found between comparators in all outcomes and follow-up times. Extracorporeal shockwave therapy presented clinically better compared to Laser in grip strength at short-term (mean difference:3.50, 95% confidence interval:2.40, 4.60, P < 0.001) and ultrasound in pain intensity at very-short-term follow-up (standardized mean difference: −1.54, 95% confidence interval: −2.60, −0.48, P = 0.005). Conclusion: Low to moderate certainty of evidence suggests that there are no clinical benefits of extracorporeal shockwave therapy compared to sham interventions or corticosteroid injections. Based on very-low and moderate certainty of evidence, extracorporeal shockwave therapy outperforms against Laser and ultrasound, respectively. Level of Evidence: Therapy, level 1a.

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Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-020-00033-2 ◽

2020 ◽

Vol 47 (1) ◽

Author(s):

Reem EL-Mallah ◽

Enas A. Elattar

Keyword(s):

Treatment Options ◽

Visual Analogue Score ◽

Achilles Tendinopathy ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Tendon Thickness ◽

Vas Scores ◽

Tendon Pathology

Abstract Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

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Extracorporeal shockwave therapy in spinal cord injury, early to advance to clinical trials? A systematic review and meta-analysis on animal studies

The Neuroradiology Journal ◽

10.1177/19714009211026899 ◽

2021 ◽

pp. 197140092110268

Author(s):

Seyedeh Niloufar Rafiei Alavi ◽

Arian Madani Neishaboori ◽

Mahmoud Yousefifard

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Trials ◽

Animal Models ◽

Meta Analysis ◽

Mean Difference ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Cord Injury

Background As there is no consensus over the efficacy of extracorporeal shockwave therapy in the management of spinal cord injury complications, the current meta-analysis aims to investigate preclinical evidence on the matter. Methods The search strategy was developed based on keywords related to ‘spinal cord injury’ and ‘extracorporeal shockwave therapy’. A primary search was conducted in Medline, Embase, Scopus and Web of Science until the end of 2020. Studies which administered extracorporeal shockwave therapy on spinal cord injury animal models and evaluated motor function and/or histological findings were included. The standardised mean difference with a 95% confidence interval (CI) were calculated. Results Seven articles were included. Locomotion was significantly improved in the extracorporeal shockwave therapy treated group (standardised mean difference 1.68, 95% CI 1.05–2.31, P=0.032). It seems that the efficacy of extracorporeal shockwave therapy with an energy flux density of 0.1 mJ/mm2 is higher than 0.04 mJ/mm2 ( P=0.044). Shockwave therapy was found to increase axonal sprouting (standardised mean difference 1.31, 95% CI 0.65, 1.96), vascular endothelial growth factor tissue levels (standardised mean difference 1.36, 95% CI 0.54, 2.18) and cell survival (standardised mean difference 2.49, 95% CI 0.93, 4.04). It also significantly prevents axonal degeneration (standardised mean difference 2.25, 95% CI 1.47, 3.02). Conclusion Extracorporeal shockwave therapy significantly improves locomotor recovery in spinal cord injury animal models through neural tissue regeneration. Nonetheless, in spite of the promising results and clinical application of extracorporeal shockwave therapy in various conditions, current evidence implies that designing clinical trials on extracorporeal shockwave therapy in the management of spinal cord injury may not be soon. Hence, further preclinical studies with the effort to reach the safest and the most efficient treatment protocol are needed.

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Extracorporeal shockwave therapy (ESWT) for refractory Achilles tendinopathy: A prospective audit with 2-year follow up

The Foot ◽

10.1016/j.foot.2015.08.007 ◽

2016 ◽

Vol 26 ◽

pp. 23-29 ◽

Cited By ~ 22

Author(s):

James Taylor ◽

Sarah Dunkerley ◽

David Silver ◽

Andrew Redfern ◽

Nick Talbot ◽

...

Keyword(s):

Achilles Tendinopathy ◽

Prospective Audit ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy

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(8) EXTRACORPOREAL SHOCKWAVE THERAPY IN THE TREATMENT OF LATERAL EPICONDYLITIS: LONG-TERM FOLLOW-UP

Clinical Journal of Sport Medicine ◽

10.1097/00042752-200411000-00023 ◽

2004 ◽

Vol 14 (6) ◽

pp. 377

Author(s):

B. Chung ◽

P. W. Wiley

Keyword(s):

Lateral Epicondylitis ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Long Term Follow Up

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Effects of Adjuvant Low-Dye Kinesio Taping, Adjuvant Sham Taping, or Extracorporeal Shockwave Therapy Alone in Plantar Fasciitis: A Randomized Double-Blind Controlled Trial

10.22541/au.160666759.97602989/v1 ◽

2020 ◽

Author(s):

Yeliz Bahar-Ozdemir ◽

TUĞBA ATAN

Keyword(s):

Plantar Fasciitis ◽

Activity Limitation ◽

Double Blind ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Kinesio Taping ◽

Foot Function ◽

Group 1

Aim Extracorporeal shockwave therapy (ESWT) is known as one of the most effective treatment methods in plantar fasciitis (PF). Low-dye taping, which is the most preferred method of banding treatments, provides an analgesic effect by correcting biomechanics. It was aimed to compare the efficacy of adjuvant low-dye kinesio-taping (KT), sham-taping, or extracorporeal shockwave therapy (ESWT) alone in plantar fasciitis (PF). Methods In this double-blind, sham-controlled study, forty-five patients with PF were randomized to 3-group (Group 1: ESWT plus low-dye KT, n=15; Group 2: ESWT plus Sham-taping, n=15; and Group 3: ESWT only, n=15) five-session ESWT were administrated. KT was performed and changed every 1-week for the ESWT sessions in Groups 1 and 2. The main outcome measures were the visual analog scale (VAS) change, the heel tenderness index (HTI), foot function index (FFI). The patients were evaluated at the beginning and end of the treatment and the 4-week follow-up. Results The demographic characteristics and baseline outcomes between groups were similar (p>0.05). VAS and HTI changes were observed in all three groups, there was no difference between groups. Repeated-measures ANOVA showed a significant interaction between the time and the groups in FFI-total (F3.919= 2.607; p=.043). At the 4-week follow-up, when Groups 1 and 2 were evaluated, the lower FFI-total, FFI-disability, and FFI-activity limitation were statistically significant in Group 1 (p=0.027; p=0.026; p=0.029, respectively). When Group 1 and 3 were compared, the decrease in FFI-pain and FFI-activity limitation were significant in Group 1 (p=0.042; p=0.035, respectively). Conclusions Low-dye KT, in addition to ESWT, is more effective than sham-taping and ESWT in pain relief and foot function improvement due to PF at a 4-week follow-up.

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Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction—12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study

Sexual Medicine ◽

10.1016/j.esxm.2017.09.002 ◽

2018 ◽

Vol 6 (1) ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

Grzegorz Lukasz Fojecki ◽

Stefan Tiessen ◽

Palle Jørn Sloth Osther

Keyword(s):

Erectile Dysfunction ◽

Controlled Study ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Low Intensity ◽

Double Blinded

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Extracorporeal Shockwave Therapy for Shoulder Lameness in Dogs

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6175 ◽

2015 ◽

Vol 51 (1) ◽

pp. 15-19 ◽

Cited By ~ 5

Author(s):

Willem Becker ◽

Michael P. Kowaleski ◽

Robert J. McCarthy ◽

Cara A. Blake

Keyword(s):

Medical Records ◽

Short Term ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Inflammatory Conditions ◽

Final Treatment ◽

Negative Side Effects ◽

Improved Function

The purpose of this article was to describe the outcome of dogs with instability, calcifying, and inflammatory conditions of the shoulder treated with extracorporeal shockwave therapy (ESWT). Medical records for 15 dogs with lameness attributable to the shoulder that failed previous conservative management were retrospectively reviewed. ESWT was delivered to those dogs q 3–4 wk for a total of three treatments. Short-term, in-hospital subjective lameness evaluation revealed resolution of lameness in three of nine dogs and improved lameness in six of nine dogs available for evaluation 3–4 wk following the final treatment. Long-term lameness score via telephone interview was either improved or normal in 7 of 11 dogs (64%). ESWT may result in improved function based on subjective patient evaluation and did not have any negative side effects in dogs with lameness attributable to instability, calcifying, and inflammatory conditions of the shoulder.

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