Using Shock Waves in Orthopedics:
(ESWT – Extracorporal Shock Wave Therapy)
If the high frequency sound waves are applied at a certain energy and dosage, they may be used in healing some orthopedical diseases (non healing tendinitis and non healing broken bones). (Tendinitis: an inflammatory disease of the tissues which connect bones to muscles)
Some of the tendinitis cases are healed without any need for treatment. In treatment of non-healing tendinitis, restriction of movement, hot or cold compresses, stretching exercises, physical therapy, anti-inflammatory drug treatment and cortisone injection can be used
For tendinitis cases which do not have any treatment success with the a.m. treatment methods for 6 months, the alternative treatment to surgery is ESWT.
Application Method:
In ESWT, depending on the part of the body to be treated, the patients either sits or lies down. Schock waves starting from the lowest level and increasing to the highest level at which the patient will still be comfortable are applied to the part of the body which is determined by a doctor as the most painfull part. In order to easily transfer the schock waves to the body, a gel is applied to the treatment area. In rare cases, local anesthesia may be required at the treatment area. Usually, the treatment is applied in 3 sessions. Each session lasts 20 minutes and there is one week interval between the sessions.
During and after treatment, there may be a pain similar to tendinitis pain, a rash and small swelling in the area which the shock wave is applied and there may be sensititiviy in the surrounding muscles.
Before treatment (1 week before), the use of blood diluting drugs and aspirin should be stopped. This treatment method is not recommended to be used in pregnant women, in children under 18 years old and in patients who has acute inflammation.
If the patient had physical therapy, it is recommended that ESWT treatment is applied 4 weeks after physical therapy and if the patient had steroid (cortisone) injection, it is recommended that ESWT treatment is applied 6 weeks after steroid (cortisone) injection.
The Aim of Treatment:
To increase blood flow in the application area and start a new healing process by forming small traumas in these areas. In usually 4 – 6 weeks after the treatment, a considerable amount of decrease in pain and decrease in physical restriction is observed.
Treatment Results:
In a research study (North Carolina University Orthopedics Clinic) where 114 patients were asked to value the pain level before treatment between 0 and 100 (0 no pain, 100 severe pain), the average pain level was found to be 74. After treatment (12 weeks after), the average pain level was found to be 37.6 (49% decrease) and compared to placebo group 40% more healing is observed.
Clinical Applications:
E
lbow: (Tennis elbow, Golf elbow) It is used in treatment of chronic inflammation of tendons around the elbow.
Knee – Shoulder: It is used In treatment of chronic inflammation of tendons around knee and shoulder.
Foot: It is used In treatment of chronic inflammation of achilles tendon or foot sole and painful heel syndrome.
To speed up the healing in non-healing broken bones (pseudoarthrosis), it is used to stimulate the periost (bone membrane).
