extracorporeal shockwave therapy

File:Kidney stone fragments.png stone that was smashed using lithotripsy]]

The most common use of extracorporeal shockwave therapy (ESWT) is for lithotripsy to treat kidney stones{{cite journal |vauthors = Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P |title = Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones |journal = The Cochrane Database of Systematic Reviews |volume = 2023 |issue = 8 |pages = CD007044 |date = August 2023 |pmid = 37526261 |pmc = 10392035 |doi = 10.1002/14651858.CD007044.pub4 }} (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver) using an acoustic pulse. It is also reported to be used for salivary stones{{cite encyclopedia|url=https://www.nlm.nih.gov/medlineplus/ency/article/001039.htm|title=Salivary duct stones |encyclopedia = MedlinePlus Medical Encyclopedia |publisher = U.S. National Library of Medicine }} and pancreatic stones.{{cite journal |vauthors = Hayes JM, Ding SL |title = Pancreatic stone and treatment using ERCP and ESWL procedures: a case study and review |journal = The New Zealand Medical Journal |volume = 125 |issue = 1361 |pages = 89–97 |date = September 2012 |pmid = 22960720 |url = https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2012/vol-125-no-1361/cc-hayes }}

In the UK, the National Institute for Health and Care Excellence (NICE) found that the evidence for ESWT in the majority of indications is conflicting, and therefore ESWT should only be used where there are special arrangements for clinical governance and audit. Two 2017 reviews had similar findings, with moderate level evidence at best.{{cite journal |vauthors = Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N |title = The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction |journal = British Journal of Sports Medicine |volume = 52 |issue = 6 |pages = 387–407 |date = March 2018 |pmid = 28954794 |doi = 10.1136/bjsports-2016-097347 |doi-access = free }}{{cite journal |vauthors = Steuri R, Sattelmayer M, Elsig S, Kolly C, Tal A, Taeymans J, Hilfiker R |title = Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs |journal = British Journal of Sports Medicine |volume = 51 |issue = 18 |pages = 1340–1347 |date = September 2017 |pmid = 28630217 |pmc = 5574390 |doi = 10.1136/bjsports-2016-096515 }}

Extracorporeal shockwave therapy is used as a second line measure to treat tennis elbow,{{Cite web |title=Tennis Elbow Treatment Shockwave Therapy |url=https://boardman-wellness.com/blog/574990-tennis-elbow-treatment-shockwave-therapy}}{{cite web |url=https://www.nice.org.uk/guidance/ipg313 |work=Interventional procedures guidance |id=IPG313 |date=August 2009 |title=Extracorporeal shockwave therapy for refractory tennis elbow |publisher=National Institute for Health and Clinical Excellence}}{{cite journal |vauthors = Thiele S, Thiele R, Gerdesmeyer L |title = Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy |journal = International Journal of Surgery |volume = 24 |issue = Pt B |pages = 165–170 |date = December 2015 |pmid = 26455532 |doi = 10.1016/j.ijsu.2015.09.034 |doi-access = free }} shoulder rotator cuff pain,{{cite web |url=https://www.nice.org.uk/guidance/ipg21 |work=Interventional procedures guidance |id=IPG21 |date=November 2003 |title=Extracorporeal shockwave lithotripsy for calcific tendonitis (tendinopathy) of the shoulder |publisher=National Institute for Health and Clinical Excellence}}{{cite journal |vauthors = Louwerens JK, Sierevelt IN, van Noort A, van den Bekerom MP |title = Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis |journal = Journal of Shoulder and Elbow Surgery |volume = 23 |issue = 8 |pages = 1240–1249 |date = August 2014 |pmid = 24774621 |doi = 10.1016/j.jse.2014.02.002 }} Achilles tendinitis,{{cite web |url=https://www.nice.org.uk/guidance/ipg312 |work=Interventional procedures guidance |id=IPG312 |date=August 2009 |title=Extracorporeal shockwave therapy for refractory Achilles tendinopathy |publisher=National Institute for Health and Clinical Excellence}}{{Update inline|date=July 2023 |reason=It has been replaced by https://www.nice.org.uk/guidance/ipg571}}{{cite journal |vauthors = Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, Sierevelt IN, van Dijk CN |title = Treatment for insertional Achilles tendinopathy: a systematic review |journal = Knee Surgery, Sports Traumatology, Arthroscopy |volume = 21 |issue = 6 |pages = 1345–1355 |date = June 2013 |pmid = 23052113 |doi = 10.1007/s00167-012-2219-8 |s2cid = 2214735 }} plantar fasciitis,{{cite web |url=https://www.nice.org.uk/guidance/ipg311 |work=Interventional procedures guidance |id=IPG311 |date=August 2009 |title=Extracorporeal shockwave therapy for refractory plantar fasciitis |publisher=National Institute for Health and Clinical Excellence}}{{cite journal |vauthors = Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, Tong ZY, Wu XQ, Ma JM, Mo W |display-authors = 6 |title = Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials |journal = Archives of Physical Medicine and Rehabilitation |volume = 95 |issue = 8 |pages = 1585–1593 |date = August 2014 |pmid = 24662810 |doi = 10.1016/j.apmr.2014.01.033 }} and greater trochanteric pain syndrome.{{cite web |url=https://www.nice.org.uk/guidance/ipg376 |work=Interventional procedures guidance |id=IPG376 |date=January 2011 |title=Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome |publisher=National Institute for Health and Clinical Excellence}}

ESWT is also used to promote bone healing and treat bone necrosis.{{cite journal |vauthors = Cheng JH, Wang CJ |title = Biological mechanism of shockwave in bone |journal = International Journal of Surgery |volume = 24 |issue = Pt B |pages = 143–146 |date = December 2015 |pmid = 26118613 |doi = 10.1016/j.ijsu.2015.06.059 |doi-access = free }} It is an effective alternative to surgical treatment of non-healing fractures.{{cite journal |vauthors = Kong FR, Liang YJ, Qin SG, Li JJ, Li XL |title = [Clinical application of extracorporeal shock wave to repair and reconstruct osseous tissue framework in the treatment of avascular necrosis of the femoral head (ANFH)] |language = zh |journal = Zhongguo Gu Shang = China Journal of Orthopaedics and Traumatology |volume = 23 |issue = 1 |pages = 12–15 |date = January 2010 |pmid = 20191955 }}

ESWT is used for wound healing and has shown positive results in short-term and long-term outcomes in diabetic patients with foot ulcers.{{cite journal |vauthors = Wang CJ, Cheng JH, Kuo YR, Schaden W, Mittermayr R |title = Extracorporeal shockwave therapy in diabetic foot ulcers |journal = International Journal of Surgery |volume = 24 |issue = Pt B |pages = 207–209 |date = December 2015 |pmid = 26079500 |doi = 10.1016/j.ijsu.2015.06.024 |doi-access = free }} Randomised controlled trials into the use of ESWT for healing venous leg ulcers are needed as there is a lack of evidence in this area.{{cite journal |vauthors = Cooper B, Bachoo P |title = Extracorporeal shock wave therapy for the healing and management of venous leg ulcers |journal = The Cochrane Database of Systematic Reviews |volume = 2018 |issue = 6 |pages = CD011842 |date = June 2018 |pmid = 29889978 |pmc = 6513251 |doi = 10.1002/14651858.CD011842.pub2 }}

Low-intensity extracorporeal shock wave therapy has been used as a treatment for erectile dysfunction.{{cite web |title=Low-intensity extracorporeal shockwave therapy for erectile dysfunction: an overview of systematic reviews|url=https://tau.amegroups.org/article/view/79463/html |website=Translational Andrology and Urology |date=2024-10-09 |access-date=2024-10-09}} It differs from palliative options by aiming to restore natural erectile function by inducing cellular microtrauma, triggering the release of angiogenic factors and promoting neovascularization in treated tissue. This mechanism is distinct from the high-intensity shock waves used in lithotripsy and medium-intensity shock waves used for anti-inflammatory purposes in orthopedics. Clinical studies, including double-blind randomized trials, have demonstrated LI-ESWT's ability to significantly improve erectile function and penile hemodynamics in men with vasculogenic ED.{{Cite journal |last1=Bocchino |first1=Alessia Celeste |last2=Pezzoli |first2=Marta |last3=Martínez-Salamanca |first3=Juan Ignacio |last4=Russo |first4=Giorgio Ivan |last5=Lo Giudice |first5=Arturo |last6=Cocci |first6=Andrea |date=March 2023 |title=Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities |journal=Investigative and Clinical Urology |volume=64 |issue=2 |pages=118–125 |doi=10.4111/icu.20220327 |issn=2466-0493 |pmc=9995960 |pmid=36882170}}{{Cite journal |last1=Gruenwald |first1=Ilan |last2=Appel |first2=Boaz |last3=Kitrey |first3=Noam D. |last4=Vardi |first4=Yoram |date=April 2013 |title=Shockwave treatment of erectile dysfunction |journal=Therapeutic Advances in Urology |volume=5 |issue=2 |pages=95–99 |doi=10.1177/1756287212470696 |issn=1756-2872 |pmc=3607492 |pmid=23554844}}

The lithotripter attempts to break up the stone with minimal collateral damage by using an externally applied, focused, high-intensity acoustic pulse. The patient is usually sedated or anesthetized for the procedure in order to help them remain still and reduce possible discomfort.[https://www.kidney.org/atoz/content/lithotripsy "Lithotrypsy"] National Kidney Foundation, Accessed February 6, 2017 Sedation is not required in its application for soft tissue injuries.

Beginning in 1969 and funded by the German Ministry of Defense, Dornier began a study of the effects of shock waves on tissue. In 1972, on the basis of preliminary studies performed by Dornier Medical Systems, an agreement was reached with Egbert Schmiedt, director of the urologic clinic at the University of Munich. The development of the Dornier lithotripter progressed through several prototypes, ultimately culminating in February 1980 with the first treatment of a human by shockwave lithotripsy (SWL). The production and distribution of the Dornier HM3 lithotripter began in late 1983, and SWL was approved by the U.S. Food and Drug Administration in 1984.{{cite web |url=https://www.fda.gov/ohrms/dockets/98fr/020899a.txt |title=Gastroenterology and Urology Devices; Reclassification of the Extracorporeal Shock Wave Lithotripter AGENCY: Food and Drug Administration, HHS ACTION: Proposed rule |publisher=Federal Register (US Government) |date=February 8, 1999 |access-date=February 6, 2017}}

In the 1980s people using ESWT for kidney stones noticed that it appeared to increase bone density in nearby bones, leading them to explore it for orthopedic purposes.

In response to concerns raised by NICE, in 2012 a study called the Assessment of the Effectiveness of ESWT for Soft Tissue Injuries was launched (ASSERT).{{cite journal | vauthors = Maffulli G, Hemmings S, Maffulli N | title = Assessment of the Effectiveness of Extracorporeal Shock Wave Therapy (ESWT) For Soft Tissue Injuries (ASSERT): An Online Database Protocol | journal = Translational Medicine @ UniSa | volume = 10 | pages = 46–51 | date = September 2014 | pmid = 25147767 | pmc = 4140430 }}

As of 2018 use of ESWT had been studied as a potential treatment for chronic prostatitis/chronic pelvic pain syndrome in three small studies; there were short-term improvements in symptoms and few adverse effects, but the medium-term results are unknown, and the results are difficult to generalize due to the low quality of the studies.{{cite journal | vauthors = Franco JV, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, Vietto V | title = Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 5 | pages = CD012551 | date = May 2018 | pmid = 29757454 | pmc = 6494451 | doi = 10.1002/14651858.CD012551.pub3 }}

ESWT is commonly used for treating orthopedic problems in horses, including tendon and ligament injuries, kissing spine, navicular syndrome, and arthritis. The evidence for these uses is weak.{{cite journal | vauthors = Chamberlain GA, Colborne GR | title = A review of the cellular and molecular effects of extracorporeal shockwave therapy | journal = Veterinary and Comparative Orthopaedics and Traumatology | volume = 29 | issue = 2 | pages = 99–107 | date = 2016 | pmid = 26846274 | doi = 10.3415/VCOT-15-04-0057 | s2cid = 19280257 }} {{open access}}

ESWT is used in physical therapy for pain reduction, increase in metabolism at the cellular level, revascularisation, and recovering normal muscle tone following various disorders.{{cite journal | vauthors = Gündüz R, Malas FÜ, Borman P, Kocaoğlu S, Özçakar L | title = Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical and ultrasonographical comparison | journal = Clinical Rheumatology | volume = 31 | issue = 5 | pages = 807–812 | date = May 2012 | pmid = 22278162 | doi = 10.1007/s10067-012-1939-y | s2cid = 13109216 }} The use of ESWT was demonstrated in patients with frozen shoulders compared to therapeutic ultrasound with exercises.{{cite journal | vauthors = Muthukrishnan R, Rashid AA, Al-Alkharji F | title = The effectiveness of extracorporeal shockwave therapy for frozen shoulder in patients with diabetes: randomized control trial | journal = Journal of Physical Therapy Science | volume = 31 | issue = 7 | pages = 493–497 | date = July 2019 | pmid = 31417208 | pmc = 6642889 | doi = 10.1589/jpts.31.493 }}

Research suggests that ESWT can accelerate the blood flow, facilitating the healing of the inflamed Achilles tendon.{{citation needed|date=August 2021}} In one study involving 23 patients with chronic Achilles tendinopathy, 20 reported improvement in their condition and pain scores after ESWT; three saw no change, and none reported any worsening.{{cite journal | vauthors = Fridman R, Cain JD, Weil L, Weil L | title = Extracorporeal shockwave therapy for the treatment of Achilles tendinopathies: a prospective study | journal = Journal of the American Podiatric Medical Association | volume = 98 | issue = 6 | pages = 466–468 | date = November–December 2008 | pmid = 19017855 | doi = 10.7547/0980466 }}

• Laser lithotripsy

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Category:Medical treatments