Extracorporeal Shockwave Therapy PDF

Ext racor por eal Shockwav eTher apy Def ini ti on Extracor porealshock wavether apy ist he appl...

Ext racor por eal Shockwav eTher apy Def ini ti on Extracor porealshock wavether apy ist he appl i cat ion ofhi gh- pressur e mechanicalwavesoutsi deofthebody(extracor por eal )thatvi olentl yimpact (shock)biol ogi cti ssuesfort her apeut icpurposes. Shockwav eisa“mechanical ”wave,whoseshapeischaract eri zedbyanini tial posit ivev eryrapi d phase,ofhi gh ampli tude,foll owed,af t erveryfew microseconds,bya sudden phaseofmi ld negat ivepressur e,aft erwards ret urningtotheambient( basic)v alues. Thiswaveformischaracter izedbyacompr essi vephase(causesshearstress i nt het i ssue)duri ngposi t ivepressureperi odf ol l owedbyat ensil ephase (causescavi tat ionbubblesintheti ssue)duri ngthenegat ivepressureper iod. Ty pesofShockwav es Focusedshockwavesaregener atedinsi det heappl i cat orandt henf ocusedby alensandtransmi ttedi ntothet issue. Radi alshockwavesar egenerat edbyaccel erat ingaproj ect il e,bymeansof compressedair ,throughatube,att heendofwhichi thit sanappli cat ort hat makescontactwiththeski n. Theconv er gentnatureoff ocusedshockwav esallowst hem t openet rat e deepintotheti ssues.I ncont rast,t hediv ergentnat ureofr adi alwav esli mit s them t oamor esuperfi cial penet r ati ondepth. ESWTGener ator s Fourt ypesofgener ator sar eusedt opr oduceext racor por eal shockwav es:  El ect rohy draul i c.  El ect ro- magnet ic.  Pi ezoel ect ri c.  Bal l ist ic( pneumat ic). Phy siol ogi cal Eff ect sofESWT Whenashockwav epassest hroughhumant issues, ther ear etwobasi c ef fect s:  Thedir ectmechani cal for ceswher ethepul seener gyconcent rat edat thet argetpoi nt.  Theindir ectmechani calf orcesbycavi tat ion( bubbl es)i sinpar t responsi blef ortheef fi cacyofthether apy. Thedi rectmechani calef fectsoftheshockwav escausemi crotr aumawhi ch createsf reshmi cro-injuri eswi thi nt het argeted softti ssue.Thesemi cro- i njuries ar e presumed t o st i mulate an i nfl ammat oryr esponse t hat it effecti velytakesat issuef rom amor echronictoamor eacutestate.Also,this micr oi njurystimulatest heexpr essi onofangi ogenicgrowthf actor sandt he i ngr owth of neov ascul ar izati on. Toget her,t hese bi ologic effects ar e presumedt oincreaset hebl oodsuppl y ,whi chpr omotessof t -ti ssuerepairi n casesofchr oni ccondi t ion. Thr ought hei ndi recteff ect ,ESWTi oni zesthemol ecul esthr oughcavit ati on andmi cr ostreaming.Thereisani ncr easeofmembranepermeabi l ityand i ncreasecel lularacti vi ty.  Commoni ndi cat ionsofESWTf ormuscul oskel etal condi ti ons  Pai nful shoul der( cal cif icat ion, tendoni ti s,i mpi ngementsy ndr ome).  Pl ant arf asci i tis.  Radi al/ ulnarepi condy li ti s.  Pat ell art endi nopat hy( orj umper ´sknee).  Tr iggerPoi nts.  Car pal tunnel syndr ome.  Achi l lest endi nit is. I li oti bial bandsy ndr ome. Cont rai ndi cat ionsofESWT  Ov ergas- fi ll edt issuessuchasl ungandi ntest ine—sev eret issuedamage.  Ov erut erus—di srupt sfet aldev elopment.  Ov erel ect roni cimpl ant —el ect roni cint erf erence.  Bl oodcoagul ati ont her apy —sev erebl eedi ng.  Ov eracut einj ury —incr easesi nfl ammat orypr ocess.  Ov erepi phy seal plat es—al ter snor mal bonegr owt h. Adv erseEf fect sofESWT Therecanbemi norski nirr it ati on,andsomet imesnumbnessorparest hesi a, butallar etemporary.thi susuall ysubsi dewit hinarel ati vel yshor tperi od(1- 2 days). Possi bleAdv erseEv ent s  Swel l ing.  Reddeni ng.  Hemat omas.  Petechi a(smallr edorpur plespotont heski ncausedbyami norbl eed fr om brokencapi ll ary.   Pai n. Tr eat mentDose  Theappl i edener gyf luxdensi ty( EFD).  Numberofshocks.  Number soft reat mentsessi ons. Ener gyf luxdensi ty Ener gy( E)cont ainedi nashockwav eisexpr essedi nmi l li joul es( mJ). TheEnergyf luxdensit ymeanst heamountofmechani calacoust icenergyper uni tarea(A)EDF=E/ A.EFDi smeasuredi nmil li joul espersquaremi l l imeter (mJ/mm2).ESWTar eclassi fi edaccor dingt oEFDinto:  LowEFD( upt o0. mm2) 08mJ/  Medi um EFD( upt o0. mm2) 28mJ/  Hi ghEFD( over0. mm2) 6mJ/ I nr ehabi l itat ionbot hlow( 0. mm2)andmedi 08mJ/ um ( 0. mm2)EFDar 28mJ/ e used. Numberofshocks 1000- 2000shockspersessi oni sthemostcommonl yappl i edr ange. Numbersessi ons  Mostcl i nical resear chusedbet ween3- 5sessi ons.  Sessi onsshoul dbespacedt olett het issuer eact iont osubsi de.