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Sports Medicine and Orthopedics

Substantial Biomechanical Improvement by Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears - Characteristics of chronic rotator cuff tears include continuous loss of tendon structure as well as tendon elasticity, followed by a high failure rate after surgical reconstruction. Several studies have already shown the beneficial effect of extracorporeal shockwave therapy (ESWT) on tissue regeneration in tendon pathologies.

Acoustic stimulation and tropism on skeletal muscles: Tissue resilience & regeneration in sports and ageing - (Director Kompass Health Associates, Centre for Regenerative Health, Sports Performance & Research – Auckland, New Zealand; Director Shockwave & Isokinetic Centre – Melbourne, Australia; Sr. Surgeon & Adj. Prof. AUVA-Trauma Centre & Ludwig Boltzmann Institute of Experimental & Clinical Traumatology – Vienna, Austria;  Director Kinematics Centre – Victoria, Australia; Research Assistant BHSc.(Health Sciences) PG Dip. (Psychology) MHSc. University of Auckland, New Zealand; Sr. Lecturer,  Podiatric Surgery Dept., Auckland University of Technology, New Zealand.) - ECM components are considered essential mediators  in the niche for the maintenance of stem cell identity, expression, and activation. It simultaneously provides the niche structural integrity, and physically separates the stem cell pool from other tissue resident cells. Stem cells sense & respond to the composition, porosity & stiffness of the ECM directly interacting with it via integrin focal adhesions.

Sports medicine practitioners embrace benefits of extracorporeal shock wave therapy  - (Mayo Clinic) - Extracorporeal shock wave therapy (ESWT) is a noninvasive treatment that involves delivery of shock waves to injured soft tissue to reduce pain and promote healing. According to Jonathan T. Finnoff, D.O., medical director for Mayo Clinic Sports Medicine at Mayo Clinic Square in Minneapolis, ESWT is a viable option to consider for many patients who present with chronic tendinopathy that hasn't responded to more-conservative treatments. Often difficult to treat, chronic tendinopathy is characterized by localized pain and pathological changes to a tendon. The condition affects athletes and nonathletes alike.

Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis -  The purpose of this meta-analysis was to assess the effects of extracorporeal shock wave therapy (ESWT) on reducing spasticity immediately and 4 weeks after application of ESWT. [Subjects and Methods] We searched PubMed, TCL, Embase, and Scopus from their inception dates through June 2013. The key words “muscle hypertonia OR spasticity” were used for spasticity, and the key words “shock wave OR ESWT” were used for ESWT. Five studies were ultimately included in the meta-analysis. [Results] The Modified Ashworth Scale (MAS) grade was significantly improved immediately after ESWT compared with the baseline values (standardized mean difference [SMD], −0.792; 95% confidence interval [CI], −1.001 to −0.583). The MAS grade at four weeks after ESWT was also significantly improved compared with the baseline values (SMD, −0.735; 95% CI, −0.951 to −0.519). [Conclusion] ESWT has a significant effect on improving spasticity. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow up studies are needed.

Tissue Activation and Regeneration in Sports Medicine and Bone Pathologies - •The physical shaking of the tissue by the shock waves leads to a mechanotransduction; the conversion of mechanical signals (e. g. shear, compression, tension) into electrical or chemical signals responses in the tissue.

Cellular signaling pathways modulated by low-intensity extracorporeal shock wave therapy - Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a form of energy transfer that is of lower intensity (<0.2mJ/ mm2 ) relative to traditional Extracorporeal Shock Wave Lithotripsy (ESWL) used for management of urinary stones. At this intensity and at appropriate dosing energy transfer is thought to induce beneficial effects in human tissues. The proposed therapeutic mechanisms of action for Li-ESWT include neovascularization, tissue regeneration, and reduction of inflammation. These effects are thought to be mediated by enhanced expression of vascular endothelial growth factor, endothelial nitric oxide synthase, and proliferating cell nuclear antigen.

Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database - (Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Pettenkoferstr.)​ Extracorporeal shock wave therapy (ESWT) is an effective and safe noninvasive treatment option for tendon and other pathologies of the musculoskeletal system.

MTS Spark WavesTM – successfully treating indispositions of the musculoskeletal system - Pain of the musculoskeletal system can seriously restrict the mobility of the affected persons and their participation in daily life. With the Spark WaveTM Therapy an effective alternative for medicamentous and surgical therapy methods respectively has been established for various orthopaedic indications. Shock wave therapy represents a non-invasive therapy option. It is considered to be safe, easily tolerable and effective.

Successful treatment of nonunions with orthogold280 - A pseudarthrosis is defined as a non healing fracture from which a false joint develops. It is manifested if healing of a fracture has not been achieved within six months after fracture development. Nonunions occur in 5% to 10% of all fractur patients. They are usually very painful and limit the mobility of concerned patients. The current standard of care for the treatment of pseudarthrosis comprises debridement of the pseudarthrotic tissue, cleaning of the fragments edges, insertion of autologous spongiosa and stabilization with osteosynthesis material. However, these surgical procedurces are very costly as well as time consuming, are associated with a high complication rate and last but not least extremly traumatic for the patient. Consequently there is a high interest in a non-invasive, effective and efficient treatment option for pseudarthrosis. MTS’ Spark Wave™ therapy with orhtogold280 represents such a therapy method.

Athletic therapy - In modern society today, sport activity is becoming increasingly important. Reasons include more free time, increasing health awareness and a shifting biological age limit for sporty activities. Amateur sportsmen but especially high performance athletes are progressively affected by sport injuries.

The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders - Shockwave therapy was originally developed to disintegrate urinary stones 4 decades ago1 . Since then, there has been remarkable progress regarding the knowledge of its biological and therapeutic effects. Its mechanism of action is based on acoustic mechanical waves that act at the molecular, cellular, and tissue levels to generate a biological response.

Comparative study of shockwave therapy and low-level laser therapy effects in patients with myofascial pain syndrome of the trapezius. - The objective of the study was to compare the effects of shockwave therapy and laser therapy on pain, neck functionality, and quality of life in patients with myofascial pain syndrome of the trapezius. 61 patients (> 18 years) were randomly allocated to two treatment groups: (1) 31 patients received soft laser therapy once daily in a 3-week period for a total of 15 sessions, (2) 30 patients received shockwave therapy once in a week for 3 weeks, totalling 3 treatments.

Shockwave therapy in stress fractures Stress fractures are common painful conditions in athletes, usually associated to biomechanical overloads. Low risk stress fractures usually respond well to conservative treatments, but up to one third of the athletes may not respond, and evolve into high-risk stress fractures. Surgical stabilization may be the final treatment, but it is a highly invasive procedure with known complications. Shockwave treatments (ESWT), based upon the stimulation of bone turnover, osteoblast stimulation and neovascularization by mechanotransduction, have been successfully used to treat delayed unions and avascular necrosis.

Effects of ESWT on glycosaminoglycan expression during bone healing - Several cases of delayed bone consolidation have been treated with extracorporeal shock wave therapy (ESWT) to improve bone healing and a key role of the extracellular matrix glycosaminoglycans in osteogenesis has been suggested.

Influence of medical shock waves on healthy muscle tissue - Competitive sport requires each athlete to be at peak performance at all times. This is often a challenging task to manage, as overuse and fatigue syndromes often impede performance. For over a decade shockwave therapy (SWT) have been utilised successfully to manage sports injuries. 1 Our investigation aimed to determine the effects of SWT on muscle tissue of healthy subjects.

Acoustic stimulation and tropism on skeletal muscles: Tissue resilience & regeneration in sports and ageing - (Kenneth Craig Vincent, Wolfgang Schaden, Laupepa Aposetolo Karalus, Jacqueline Craig Huges, Daniel Poratt) - The ‘Niche’ is not merely an anatomical grid, but rather a dynamic communications conduit, sensing & transmitting signals (ie. biomechanical, chemical etc.) relaying the status & requirements of the tissue to its ‘Regenerative Cell’ source the Satellite Cells. Negative alterations or disruptions to the niche often result in defective regenerations in nearly every stem cell compartment of the region or body.

Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy - Extracorporeal shockwave therapy (ESWT) is used in a number of indications in the medical field. A number of tendinopathies show good and excellent results due to evidence based medicine. The treatment of lateral epicondylitis is known to show conflicting results. This overview of the published RCT's on ESWT for lateral epicondylitis tries to show the reasons for this conflicting data-base and point out, why we think that this is still a main indication for extracorporeal shockwave therapy.

Extracorporeal shockwave therapy (ESWT) ‒ First choice treatment of fracture non-unions - Fracture non-unions are still a challenging problem in orthopedics. The treatment of non-unions remains highly individualized, complex, and demanding. In most countries the surgical approach with debridement of the non-union gap, anatomical reduction and appropriate osteosynthesis along with autologous bone grafting is considered as the standard of care. One of the very first non-urologic applications of extracorporeal shockwave treatment (ESWT) concerned non-healing fractures. Since the early 1990ties the knowledge of the working mechanism has increased enormously. The purpose of this review article is to demonstrate by peer-reviewed literature in conjunction with our own experiences that ESWT can be an efficient, non-invasive, almost complication-free and cost effective alternative to surgical treatment of non-healing fractures.

Biological mechanism of shockwave in bone - Shockwave is a rapid, short duration acoustic wave that carries energy and can propagate through tissue medium. This kind of physical force can be a mechanical stimulus that induces biological effects in living tissue. Extracorporeal shockwave therapy (ESWT) acts as a mechanical stimulus which promotes biological healing processes through a mechanotransduction. The biological effects of ESWT are reported such as tissue regeneration, wound healing, angiogenesis, bone remodeling, and anti-inflammation. Until now, however, little is known about the basic mechanism of action of this type of therapy. This article describes the molecular mechanism on the current status of ESWT with pre-clinical and clinical applications for treating disorders in bone.

Extracorporeal shock wave therapy for nonunion of the tibia - Delayed and nonunion of the tibia are not uncommon in orthopaedic practice. Multiple methods of treatment have been developed with variable results. The objective of this study was to define disease-specific and treatment-related factors of prognostic significance in patients undergoing shock wave therapy for tibia nonunion

Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder - We prospectively studied extracorporeal shock wave therapy (ESWT) for calcific tendinitis of the shoulder in 46 consecutive patients. All patients were randomly divided into 2 groups: treatment and control. The 33 patients in the treatment group received 2 courses of ESWT at the energy density of 0.55 mJ/mm2 (1000 impulses). The control group underwent sham treatment with a dummy electrode (13 patients). 

Temporal and spatial expression of BMP-2 in sub-chondral bone of necrotic femoral heads in rabbits by use of extracorporeal shock waves - Extracorporeal shock wave treatment has been used successfully for the treatment of avascular necrosis of the femoral head. The pathway of biological events by which this is accomplished has not been fully elucidated. BMP-2 is a key mediator of bone development and repair, and is uniquely required for bone formation. We therefore examined the effect of extracorporeal shock waves on induction of BMP-2 in necrotic femoral heads.

Evaluation of extracorporeal shock wave therapy for osteoarthritis - Lameness, and more specifically, joint disease, causes significant loss of use of athletic horses and has a large economic impact on the horse industry. Despite numerous medical treatments, novel treatments are needed. Recent experimental evidence and anecdotal clinical impressions of extracorporeal shockwave therapy (ESWT) for the treatment of osteoarthritis (OA) have been reported.

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