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Shockwave therapy

What is the best parameters for radical Shockwave therapy in treating calcified tendinitis? Thanks

Kelvin Tam

1 year ago

Back to General Electrotherapy

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Thanks so much for all the replies. This is super useful for my clinical decision.

Cliff Eaton
Cliff Eaton

Kelvin The issue with dosage is further complicated when we consider the attenuation of the pressure waves attenuating as it travels through tissue. So there is the other factor of the patient's build Albeit in Rabbits Achilles tendon Rompe (1998) showed we could cause tendon cell damage at >0.6mjmm2. As current Radial ESWT machines cannot produce these values, you should be confident to use the maximum pressure tolerable by the patient Cliff

Dinesh Verma
Dinesh Verma

Truly said Prof Watson. Also based on my discussions with manufacturing industry experts - BAR pressure indicated on the SCREEN of existing devices is actually the PRESSURE that is measured at device Outlet ( inside the applicator Gun where the pressure is reaching from generator and about to Hit the projectile ) ... it is NOT the pressure that is delivered from applicator surface TO the body - Hence Actual pressure delivered to individual with again vary based on device and type of applicator attached.

Other range of devices in Market - offer production of Shockwave via Electromagnetic mechanism - They usually offer display in Joules / sqcm

I guess as a FIRST step - We should look at how devices can deliver energy in consistent manner - and measure output in same way ... if possible... Most Energies delivered we are measuring in Joules / sq cm.

Prof Tim Watson
Prof Tim Watson

There are several other papers which might help. Will paste refs below. Difficult to transfer doses directly as 2 bar on machine XX will not deliver same 'dose' as 2 bar on machine YY. Best way to assess dose is to use energy density (mJ/mm^2) which should be in each published paper though often not in abstract

This is not a complete list - I have over n=60 in database - just a selection

Avancini-Dobrovic, V., et al. (2011). "Radial extracorporeal shock wave therapy in the treatment of shoulder calcific tendinitis." Coll Antropol 35 Suppl 2(2): 221-225.

Cosentino, R., et al. (2003). "Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study." Ann Rheum Dis 62(3): 248-250.

Lee, S. Y., et al. (2011). "The midterm effectiveness of extracorporeal shockwave therapy in the management of chronic calcific shoulder tendinitis." J Shoulder Elbow Surg 20(5): 845-854.

Loew, M., et al. (1995). "Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: a preliminary report." J Shoulder Elbow Surg 4(2): 101-106.

also a sys review which supports shockwave use: Yu, H., et al. (2015). "Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration." Phys Ther 95(3): 306-318.

Dr Sandy Rennie
Dr Sandy Rennie

Hi Kelvin. At this point I'm not certain there are best parameters for radial extracorporeal shockwave therapy for calcific tendinitis. I can give you a recent review that gives some guidelines. Iopollo et al: Clinical improvement and resporption of calcifications in calcific tendinitis of the shoulder after shockwave therapy at 6 months follow-up: a systematic review and meta-analysis. Arch Phys Med Rehabil 2013;94:1699-1706.

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