The application of shock waves in orthopedic and rheumatologic diseases

Abstract

The artgives a mini review of the application of shock waves in orthopedics. The basic physical principles, biological effects, mechanisms of operation and results of prospective investigations in the four main indications; i.e. non-union of fractures, calcareous tendinitis, lateral epicondylitis and plantar faciitis, will be presented. Shock wave application produces microfracturing of bony tissue. This effect has been used in non-unions since the early 1990s. Depending on the level of energy used and the sort of non-union, the rate of success varies between 56 and 90% of bony union. In patients with calcifications of the rotator cuff, shock wave therapy is used as a last step before operating. Microfracturing of the deposit and a rupture of the pseudomembrane surrounding the calcification explain this effect. Disintegration of the deposit can be seen in 73% 6 weeks following shock wave therapy. Differences exist concerning the type of calcification (type 2 is better than type 1). Positive effects in chronic cases of enthesopathies (plantar fasciitis, epicondylitis) are explained by improvement in blood supply, alterations in the neuronal cell membrane and the gate control theory. In chronic cases, when other conservative therapy modalities have failed and patients are sent to surgery, positive results can be achieved in 81% (heel spur) and 69% (epicondylitis).

Key words::

• Plantar fasciitis
• lateral epicondylitis
• calcareous tendinitis
• pseudarthrosies
• conservative therapy