MASTERPULS»Elite«LINE APPLICATION BROCHURE

Transcription

1 MASTERPULS»Elite«LINE APPLICATION BROCHURE

2 MAN IS THE MEASURE OF ALL THINGS PROTAGORAS 02 STORZ MEDICAL

3 Contents Non-invasive therapy 04 Physics of radial shock wave technology 05 System design 06 MASTERPULS MP50»Elite«and MASTERPULS MP100»Elite«System functions and use 07 MASTERPULS MP200»Elite«System functions and use 08 Loading and saving patient data and indications 09 Overview transmitters 10 Handpiece and transmitter handling 11 V-ACTOR Vibration therapy 12 Treatment 13 Application energy 14 Indications 15 Plantar fasciitis/heel pain/heel spur 16 Calcific tendonitis/shoulder pain 17 Radial/ulnar humeral epicondylitis 18 Achillodynia 19 Patellar tendonitis (Jumper s knee) 20 Tibial stress syndrome (Shin split) 21 Trochanter tendonitis 22 Acupuncture shock wave therapy (AkuST) 23 Myofascial pain syndrome 25 Quick reference guide MASTERPULS MP50»Elite«28 Quick reference guide MASTERPULS MP100»Elite«29 Quick reference guide MASTERPULS MP200»Elite«30 Global presence 31 STORZ MEDICAL 03

4 Non-invasive therapy Our objective Better therapies through new technologies. Established in 1987, STORZ MEDICAL AG is a Swiss member company of the KARL STORZ Group. The objective pursued by our physicists and engineers is to conduct ongoing research into shock wave technology and to develop new system concepts. Our products have proved their efficacy all over the world in the fields of urology, orthopaedics, rehabilitation, gastroenterology, cardiology and dermatology. New compact systems have recently been developed so that other medical disciplines can also gain access to the benefits of non-invasive shock wave technology. With its pioneering technological innovations, STORZ MEDICAL is setting new standards in aesthetic medicine and in the treatment of pain in close-to-bone soft tissue of the postural and locomotor systems. As a reliable partner of doctors, we are committed to making a vital contribution to medical progress in the service of new therapy methods. 04 STORZ MEDICAL

5 Physics of radial shock wave technology Radial shock waves (R-SW) are introduced into the body by means of a freely moved handpiece and cover the entire pain region. Radial shock waves are often referred to as radial pressure waves, which is the correct definition in physical terms. The radial therapy head of the MASTERPULS is a compressed air operated, ballistic shock wave generator. A projectile is accelerated by compressed air. The kinetic energy stored in the motion and weight of the projectile is converted into acoustic energy in the form of long-wave shock pulses when the projectile strikes a transmitter. These acoustic pulses are transmitted to the target tissue by means of a protective cap and gel. Radial shock waves propagate divergently after application and lose energy as the penetration depth increases. They are characterized by long-wave lengths and cannot be focused on deep target areas. Penetration depth is approximately 3 cm with the standard transmitter R15. Their maximum energy flux density is at the exit point from the transmitter. 500 µs Pressure rise: radial pressure wave Time Radial shock waves R-SW handpiece STORZ MEDICAL 05

6 System design Note This application brochure is not intended to replace the unit s instruction manual. Refer to the manual for more detailed information. The MASTERPULS MP200»Elite«, MASTERPULS MP100»Elite«and MASTER- PULS MP50»Elite«offer excellent therapeutic possibilities. What s more, they are a good investment into the future: simple transmitter replacement, easy-to-install retrofit options and software updates and other convincing features ensure that the MASTERPULS»Elite«systems always remain up to date to handle new applications or respond to clinical and technological progress. This information has been compiled in close cooperation with experienced users of radial shock waves. The treatment success achieved with the MASTERPULS will obviously increase the more experience the user gains with the operation and use of the system. MASTERPULS MP50»Elite«The most compact shock wave therapy system LED displays: pressure, frequency, applied shock number level control knob for extended pressure/frequency range: 8 Hz/4.0 bar, 11 Hz/3.4 bar, 15 Hz/2.8 bar setting buttons: 1 15 Hz»Silent«air compressor included Mobile use Transportation case/bag MASTERPULS MP100»Elite«The classic shock wave therapy method LED displays: pressure, frequency, applied shock number level control knob: bar setting buttons: 1 15 Hz»Silent«power air compressor included Mobile use Precision pressure adjustment Transportation case/bag MASTERPULS MP200»Elite«The high frequency shock wave therapy solution LCD display: pressure, frequency, applied shock number level control via touch screen: bar setting via touch screen: 1 21 Hz»Silent«air compressor, oil compressor at choice Visual treatment guide Two handpiece connectors Optional: V-ACTOR 35 Hz»Vibration-Therapy«06 STORZ MEDICAL

7 MASTERPULS MP50»Elite«and MASTERPULS MP100»Elite«System functions and use MASTERPULS MP50»Elite«1 2 3 MASTERPULS MP100»Elite« Settings 1 Display of selected energy level 2 Display of selected shock number 3 Display of pulse frequency 4 Adjusting knob pressure 5 Counter reset key 6 Adjusting frequency keys Procedure 1 Connect the R-SW handpiece. 2 Switch on the main switch on the rear panel beside the power connector. 3 Adjust the energy level with the pressure knob, start treatment at a pressure of bar. 4 Adjust the frequency by pressing the frequency keys, start treatment at a pressure of 8 Hz. 5 To start treatment, press the shock wave release button on the handpiece. 6 To stop shock wave application, press the shock wave release button. 7 To reset counter, press the counter reset key. Please refer to the MASTERPULS operating manuals for detailed information on the system design and operation. STORZ MEDICAL 07

8 MASTERPULS MP200»Elite«System functions and use Settings 1 Mode selector key 2 Display of selected energy level 3 Display of selected shock number per 4 Display of pulse frequency 5 Display of applied shock number 6 Patient report or indication key 7 Keys for increase / reduction of values 1 to 3 8 Menu access key 9 Language selection key (direct selection/display) 10 level selector key 11 Shock number selector key 12 selector key Touch screen Procedure The MASTERPULS MP200»Elite«is designed for maximum ease of use. Modern touch screen technology makes buttons obsolete. The menu-driven user interface guarantees reliable acquisition of R-SW parameters. During patient treatment, all essential parameters always remain under control. The energy level, frequency, shock counter and number of applied shock waves are displayed in a clearly structured manner, and treatment data can be saved directly in the system. 1 Connect the R-SW/V-ACTOR handpiece. 2 Switch on the main switch on the rear panel beside the power connector. 3 The screen turns on with a white display or shows the STORZ MEDICAL logo (depending on software version). 4 Confirm the displayed setting by pressing the blinking display. 5 Select the»operating mode«. 6 Select the»«,»shocks«and»«parameters with the up or down arrow. Start treatment at a pressure of bar and a frequency of 10 Hz. 7 Remove the handpiece from the holder and apply coupling gel. 8 Press the shock wave release button on the handpiece to start treatment. 9 Adjust the energy level and frequency with the arrows, if necessary. 10 Press the shock wave release button to stop shock wave application. 08 STORZ MEDICAL

9 Loading and saving patient data and indications Procedure The MASTERPULS MP200»Elite«allows you to load pre-configured indications and save patient data. 1 Press»Configuration«to load existing configurations. 2 The»Configuration«screen appears with indications and patient reports (indications are marked with a *). 3 Select the desired configuration and press»load«to confirm. 4 Press»Menu exit«to return to the start screen. Pre-configured settings are displayed on the screen.»configuration«screen with list of indications Indications Pain Points Muscles Plantar fasciitis 1 Plantar fasciitis 2 Calcific tendonitis 1 Calcific tendonitis 2 Epicondylitis 1 Epicondylitis 2 Achillodynia 1 Achillodynia 2 Patellar tendonitis 1 Patellar tendonitis 2 Shin splint 1 Shin splint 2 Trochanteric tendonitis 1 Trochanteric tendonitis 2 Myofascial trigger points 1 Myofascial trigger points 2 Acupuncture (AkuST) List of pre-configured indications STORZ MEDICAL 09

10 Overview transmitters Data Indications Geometry of waves/ Penetration depth A6, Ø 6 mm, Shock wave acupuncture Radial AkuSt transmitter, radial shock waves density at max. pressure 0.32 mj/mm mm C15, Ø 15 mm, CERAma-x, ESWT transmitter, radial shock waves Gel free shock wave therapy for all tendinopathies Radial 0.45 mj/mm mm R15, Ø 15 mm, ESWT transmitter, radial shock waves Radial shock wave therapy, all tendinopathies Radial 0.38 mj/mm mm DI15, Ø 15 mm, Deep Impact transmitter,» Beam«Deep-seated diseases, trigger, chronical diseases, high energy requirements, ideal combination with D20-S/D35-S transmitter for muscular problems 0 60 mm 0.63 mj/mm 2 F15, Ø 15 mm,»focus-lens«transmitter, energy focus area Close to surface pain areas, masticatory muscles, neck, individual triggers 0.16 mj/mm mm D20-S, Ø 20 mm, D-ACTOR transmitter, radial shock waves and vibration pulses, max. pressure up to 5 bar Myofascial trigger therapy, muscle- and connective tissue, dissolution of fibrosis (e. g. carpal tunnel syndrome), treatment of deep-seated muscles (e. g. piriformis muscle, gluteus minimus muscle) Cylindric 0 50 mm 0.48 mj/mm 2 D35-S, Ø 35 mm, D-ACTOR transmitter, radial shock waves and vibration pulses, max. pressure up to 5 bar Myofascial trigger therapy, muscle- and connective tissue back muscles, skin elasticity, triggerdiagnose, dissolution of fibrosis (e. g. carpal tunnel syndrome), treatment of deep-seated muscles ( e. g. piriformis muscle, gluteus minimus muscle) Cylindric 0 50 mm 0.46 mj/mm 2 10 STORZ MEDICAL

11 Handpiece and transmitter handling s The MASTERPULS handpiece can be used with various transmitters. Each transmitter has its own characteristic effect (see page 10). The transmitters employed produce either shock waves or vibration waves or both. The R15, DI15 and F15 transmitters produce shock waves. These transmitters are generally used for the localization and treatment of insertional tendonitis, painful spots and trigger points. The D20-S and D35-S transmitters produce both shock waves and vibration pulses. These transmitters are used for the smoothing and treatment of muscles and connective tissue over large surface areas. In general, treatment should be started by using the R15, DI15 or F15 transmitters on painful spots and trigger points. Afterwards, the surrounding muscle tissue should be smoothed with the D20-S or D35-S transmitters Radial shock wave handpiece The handpiece is placed over the previously diagnosed pain region. To start and stop shock wave application, the trigger button provided on the handpiece must be briefly pressed. Hygiene caps Hygiene caps can be employed to ensure hygienic coupling to the patient s skin. Hygiene caps can be used with the A6, R15, DI15 and F15 transmitters. Different ways of holding the R-SW handpiece Like a pen The handpiece is held behind the transmitter screw cap. This way of holding the handpiece is recommended for tactile treatment. Like a bar The handpiece is grasped with the entire hand behind the transmitter screw cap. This way of holding the handpiece is recommended for the treatment of pain regions covering relatively large areas. Like a pistol This way of holding the handpiece is recommended for the treatment of pain confined to specific points. STORZ MEDICAL 11

12 V-ACTOR Vibration therapy The ideal complement to radial shock wave therapy»physiological intrinsic oscillations play a key role in muscular perfusion and lymphatic drainage.«(professor V. T. Nazarov, 1988) The V-ACTOR generates stimulating vibrations as a non-pharmacological method to reduce muscular strain and eliminate muscle triggers or disorders of tendon insertions caused by muscle triggers. Vibration therapy increases the blood circulation in the extracellular matrix of connective tissue and stimulates metabolic activities. Only with MASTERPULS MP200»Elite«Vibration: 1 35 Hz Vibration head stroke: 1 4 mm Available vibration head diameters: 25 or 40 mm 12 STORZ MEDICAL

13 Treatment Generally speaking, one has to bear in mind that shock wave therapy is experienced differently from patient to patient. Some people do not experience any discomfort at all, while others may feel slight pain. Close co-operation with the patient is required to achieve optimum therapy results. The painful spots are localized by palpation following the patient s indications of pain. In many cases, deep pain regions or areas of diffuse pain can be localized more rapidly by means of shock waves. Treatment is started at the point of maximum pain. Shock waves are applied to the target tissue by moving the handpiece in a slow circular motion over the entire pain region. A total number of 300 to 400 shocks per painful spot should not be exceeded. During the entire duration of the therapy, a constant dialogue with the patient is required to ensure precise localization of the painful spot(s). Once the primary point of pain has been eliminated by the analgesic effect of the shock waves, other painful spots appear that were previously covered up by the principal pain. The painful spot begins to migrate. The more painful spots are localized and eliminated in the course of the treatment, the better the therapy result. During the entire therapy period, only light training should be done and any strain on the treated body regions should be avoided. In most cases, 3 to 5 treatment at 7 to 10 days intervals are necessary. An initial therapy success is achieved after 3, additional improvements are noted after 3 months. Anaesthesia Anaesthesia for sensitive patients: In general, shock wave therapy can be performed without local anaesthesia. Anaesthesia would reduce the possibility of pain localization during treatment and has been found to adversely affect the therapy result. In most cases, shock wave therapy is well tolerated by patients if the energy level is gradually increased and the frequency and handpiece press-on force are adjusted to the patient s sensitivity to pain. If anaesthesia is necessary in exceptional cases, infiltrate a local anaesthetic into the pain region. Make sure to inject the anaesthetic outside the shock wave application points! Tip: cool the application area before you apply shock waves. This will substantially reduce the patient s pain sensation. Coupling Treatment efficacy is conditional upon good coupling! Always apply a sufficient amount of gel to ensure optimal shock transmission into the tissue. Make sure that the entire transmitter surface is in contact with the patient s skin. (Do not tilt the transmitter and check that not only the edge of the transmitter is in contact with the patient s body!) If you use a hygiene cap, apply sufficient gel to the cap to ensure reliable coupling with the transmitter. STORZ MEDICAL 13

14 Application energy Shock wave application has an analgesic effect. Use this effect to minimize any discomfort the patient may experience: Begin with an initial energy level of approx. 1.8 to 2.0 bar. When the patient reports abatement of pain, you can gradually increase the energy level. Select the application energy according to the patient s sensitivity to pain. Energies up to 3.5 bar will generally be sufficient for standard indications. The denser the target tissue and the deeper the pain region, the higher the application energy can be selected. Note Please keep track of the latest medical publications and new information published by the manufacturer for details on additional indications approved after the date of printing of this brochure. 14 STORZ MEDICAL

15 Indications The MASTERPULS MP200»Elite«, MP100»Elite«and MP50»Elite«systems can be used for the following indications, among others: Plantar fasciitis/heel pain/heel spur Calcific tendonitis/supraspinatus tendon Radial/ulnar humeral epicondylitis Achillodynia Patellar tendonitis (Jumper s knee) Tibial edge syndrome (Shin splint) Trochanteric tendonitis Acupuncture shock wave therapy (AkuST) Myofascial pain syndrome Note Please keep track of the latest medical publications and new information published by the manufacturer for details on additional indications approved after the date of printing of this brochure. We recommend that the user and the patient should wear suitable hearing protection. Please offer always the patient hearing protection. Treatment with the MASTERPULS systems is not permitted in the following cases: Coagulation disorders (haemophilia) Use of anticoagulants, especially Marcumar Thrombosis Tumour diseases, carcinoma patients Pregnancy Children in growth (growth plates) Cortisone therapy up to 6 weeks before first ESWT treatment Generally speaking, shock waves must not be applied to target areas located above air filled tissue (lungs), large nerves, vessels, the spinal column or head. Treatment with the MASTERPULS systems may cause the following side effects: Swelling, reddening, haematomas Petechiae Pain Skin lesions after previous cortisone therapy Side effects generally abate after 2 to 5 days. Make sure that the above side effects have disappeared before starting the next therapy. These side effects should be avoided by using low energy levels and pressures. Bear in mind that a low shock wave dose has a beneficial effect on biological systems, whereas a high dose may cause damage. STORZ MEDICAL 15

16 Plantar fasciitis/heel pain/heel spur MASTERPULS MP200»Elite«(acute and chronic pain) 2. Muscles (acute and chronic pain) R15, DI D20-S Preliminary ultrasound examination, trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, localization with bio-feedback, smoothing of calf muscles and intrinsic foot muscles with V-ACTOR, treatment intervall 1 week MASTERPULS MP100»Elite«(acute and chronic pain) 2. Muscles (acute and chronic pain) R15, DI D20-S Preliminary ultrasound examination, trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, localization with bio-feedback, smoothing of calf muscles and intrinsic foot muscles with D20-S, treatment interval 1 week MASTERPULS MP50»Elite«(acute and chronic pain) 2. Muscles (acute and chronic pain) R15, DI D20-S Preliminary ultrasound examination, trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, localization with bio-feedback, smoothing of calf muscles and intrinsic foot muscles with D20-S, treatment interval 1 week 16 STORZ MEDICAL

17 Calcific tendonitis/shoulder pain MASTERPULS MP200»Elite«(Supraspinatus tendon/chronic pain) 2. Muscles (Surrounding muscles) R15, DI D20-S Preliminary ultrasound/x-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with V-ACTOR, treatment interval 1 week MASTERPULS MP100»Elite«(Supraspinatus tendon/chronic pain) 2. Muscles (Surrounding muscles) R15, DI D20-S Preliminary ultrasound/x-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with D20-S, treatment interval 1 week MASTERPULS MP50»Elite«(Supraspinatus tendon/chronic pain) 2. Muscles (Surrounding muscles) R15, DI D20-S Preliminary ultrasound/x-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with D20-S, treatment interval 1 week STORZ MEDICAL 17

18 Radial/ulnar humeral epicondylitis MASTERPULS MP200»Elite«(Tendon insertion) 2. Muscles (Adjacent upper arm and forearm muscles) R D20-S Bio-feedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with V-ACTOR, treatment interval 1 week MASTERPULS MP100»Elite«(Tendon insertion) 2. Muscles (Adjacent upper arm and forearm muscles) R D20-S Biofeedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with D-20-S, treatment interval 1 week MASTERPULS MP50»Elite«(Tendon insertion) 2. Muscles (Adjacent upper arm and forearm muscles) R D20-S Biofeedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with D-20-S, treatment interval 1 week 18 STORZ MEDICAL

19 Achillodynia MASTERPULS MP200»Elite«(Achilles tendon/directly to tendon) 2. Muscles (Surrounding muscles) R D20-S Trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, smoothing of surrounding muscles with V-ACTOR, treatment interval 1 week MASTERPULS MP100»Elite«(Achilles tendon/directly to tendon) 2. Muscles (Surrounding muscles) R D20-S Trigger point therapy of calf muscles and intrinsic foot muscles and smoothing of surrounding muscles with D20-S, treatment interval 1 week MASTERPULS MP50»Elite«(Achilles tendon/directly to tendon) 2. Muscles (Surrounding muscles) R D20-S Trigger point therapy of calf muscles and intrinsic foot muscles and smoothing of surrounding muscles with D20-S, treatment interval 1 week STORZ MEDICAL 19

20 Patellar tendonitis (Jumper s knee) MASTERPULS MP200»Elite«(Tendon insertion) 2. Muscles (Quadriceps, Musc. tensor fasciae latae) R R15, D20-S In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with V-ACTOR, treatment interval days MASTERPULS MP100»Elite«(Tendon insertion) 2. Muscles (Quadriceps, Musc. tensor fasciae latae) R R15, D20-S In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with D20-S, treatment interval days MASTERPULS MP50»Elite«(Tendon insertion) 2. Muscles (Quadriceps, Musc. tensor fasciae latae) R R15, D20-S In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with D20-S, treatment interval days 20 STORZ MEDICAL

21 Tibial stress syndrome (Shin splint) MASTERPULS MP200»Elite«(Medial, inner edge of shin bone) 2. Muscles (Surrounding muscles) R R15, D20-S Treatment of surrounding muscles with R15/D20-S, smoothing of surrounding muscles as well as instrinsic foot muscles with V-ACTOR, treatment interval 8 10 days MASTERPULS MP100»Elite«(Medial, inner edge of shin bone) 2. Muscles (Surrounding muscles) R R15, D20-S Treatment/Smoothing of surrounding muscles as well as instrinsic foot muscles with R15/D20-S, treatment interval 8-10 days MASTERPULS MP50»Elite«(Medial, inner edge of shin bone) 2. Muscles (Surrounding muscles) R R15, D20-S Treatment/Smoothing of surrounding muscles as well as instrinsic foot muscles with R15/D20-S, treatment interval 8-10 days STORZ MEDICAL 21

22 Trochanteric tendonitis MASTERPULS MP200»Elite«(Tendon insertion) 2. Muscles (Surrounding muscles) R15, DI D20-S, D35-S Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, biofeedback, referred pain, smoothing of surrounding muscles with V-ACTOR, treatment interval 1 week MASTERPULS MP100»Elite«(Tendon insertion) 2. Muscles (Surrounding muscles) R15, DI D20-S, D35-S Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, biofeedback, referred pain, smoothing of surrounding muscles with D20-S, treatment interval 1 week MASTERPULS MP50»Elite«(Tendon insertion) 2. Muscles (Surrounding muscles) R15, DI D20-S, D35-S Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, biofeedback, referred pain, smoothing of surrounding muscles with D20-S, treatment interval 1 week 22 STORZ MEDICAL

23 Acupuncture shock wave therapy (AkuST) Extension of Traditional Chinese Medicine according to Dr. Everke Acupuncture is one of the oldest forms of medical treatment. Based on the concepts of oriental medicine, acupuncture stimulates precisely identified sensitive points on the body surface to improve the most varied disorders. So far, this has been done by means of needle, heat, cold and, recently, electrical stimuli such as laser stimulation. Since many acupuncture points are characterized by groupings of pressure receptors in the tissue, shock waves applied by means of the MASTERPULS provide an additional method of stimulation. Local and distant points are selected according to the principles of Chinese medicine. Benefits of shock wave acupuncture over needle acupuncture Shock wave acupuncture is a non-invasive therapy method that requires extremely short treatment times of only few seconds per point and provides increased efficacy as high-intensity shock waves reach the entire target region at the same time. Blood circulation in the affected area is decisively improved and lymphatic drainage is accelerated. Provided that the specified contraindications are excluded from shock wave therapy, this treatment method causes virtually no pain or side effects. Therapy concept When the MASTERPULS is used for a well selected combination of acupuncture points, complex disorders and pain syndromes can now be treated with extracorporeal shock waves for the first time. Shock wave acupuncture therapy stimulates distant points, master points and local acupuncture points in order to make their effects additive. Indications for shock wave acupuncture The indications for shock wave acupuncture are basically the same as for classical acupuncture. Shock wave acupuncture has shown to be particularly beneficial in the treatment of osteoarthritis. This is due to the fact that the well-targeted stimulation of local and distant points in the presence of contracted muscle and tendon structures provides instant alleviation of pain. acupuncture indications such as ischialgia, tinnitus, vertigo, dry cough, constipation, irritable bladder, prostatitis, perfusion disorders, lymphatic edema etc. However, shock wave therapy perhaps combined with classical acupuncture is also a valuable addition to the treatment options currently available for standard STORZ MEDICAL 23

24 Acupuncture shock wave therapy (AkuST) MASTERPULS MP200»Elite«1. Acupuncture Points (per point) 1 10 A6 Acupuncture: Qualified training in acupuncture and acupuncture shock wave therapy (AkuST) is required for therapeutic application, treatment interval 1 2 /week MASTERPULS MP100»Elite«1. Acupuncture Points (per point) 1 10 A6 Acupuncture: Qualified training in acupuncture and acupuncture shock wave therapy (AkuST) is required for therapeutic application, treatment interval 1 2 /week MASTERPULS MP50»Elite«1. Acupuncture Points (per point) 1 10 A6 Acupuncture: Qualified training in acupuncture and acupuncture shock wave therapy (AkuST) is required for therapeutic application, treatment interval 1 2 /week Indications asthma cervical syndrome coxarthrosis heel spur gonarthrosis lumbar spine syndrome lumbago irritable bladder tennis arm 24 STORZ MEDICAL

25 Myofascial pain syndrome Trigger points are groupings of microscopic muscular nodules (sarcomeres) that form into a palpable trigger node within a hardened muscle band. Active trigger points are sensitive and painful, causing radiating sensations and reflex pain when palpated with the fingers or with the handpiece. Latent trigger points only cause pain during palpation. Trigger point shock wave therapy eliminates end-plate dysfunction or contraction nodes and stimulates metabolism in the affected muscle fibers. Types of trigger points In order to ensure reliable trigger point diagnosis, one has to distinguish between distant and structural trigger points. Trigger point shock wave therapy can only be started after the trigger points have been precisely localized inside the muscle. Moreover, it is essential to find out whether the thickened or hardened muscle band is located in the pain region or whether pain is felt in an entirely different area distal from the trigger points. As trigger points cannot be diagnosed by means of imaging systems, manual examination is required for trigger point localization. Deep trigger points can also be diagnosed by shock wave application to the affected tissue. Pressure exerted on the trigger points in conjunction with shock wave application will cause exactly the kind of pain reported by the patient Treatment concept for trigger point shock wave therapy Shock waves are radially applied to the pain-producing trigger area within the affected muscle region. Treatment can be performed in one or several. Localization of trigger points: manually or with shock waves Apply gel»deep Impact«transmitter (DI15): recommended for precisely localized or deep trigger points Other transmitters: R15, D20-S/D35-S for smoothing the surrounding muscles Application: shocks; bar; Hz Smoothing and activation of the surrounding muscles with the V-ACTOR (only with the MASTERPULS MP200»Elite«) Re-treatment after 3 6 days 4 8 Note: A sound knowledge of trigger point therapy and trigger point shock wave therapy is required if the MASTERPULS MP50»Elite«/MP100»Elite«/ MP200»Elite«is used for the above applications. Indications for trigger point shock wave therapy Patients suffering from intervertebral disk disease, ischialgia, spinal disorders, neck/shoulder pain, tensed-up muscles, tendon and joint disorders or headache, who have undergone conventional or alternative therapies without any success, are the major target group for trigger point shock wave therapy. STORZ MEDICAL 25

26 Myofascial pain syndrome Upper and lower Cervical-Syndrome (Trapezius muscle) Trigger point treatment (per point) R15, D20-S Smoothing muscles over large area 2. Muscles R15, D20-S Eventual preliminary ultrasound examination, localization with biofeedback, marking of pain region, muscle smoothing/massaging of large area, after RSWT with D20-S or V-ACTOR (2 3 minutes, Hz), treatment interval: 1 2 per week Periarticular shoulder pain (Deltoid muscle) Trigger point treatment (per point) R15, D20-S Smoothing muscles over large area 2. Muscles R15, D20-S Eventual preliminary ultrasound examination, localization with biofeedback, marking of pain region, muscle smoothing/massaging of large area, after RSWT with D20-S or V-ACTOR (2 3 minutes, Hz), treatment interval: 1 2 per week Tendomyosis in the extensor and flexor region of the forearm (Forearm muscles) Trigger point treatment (per point) R15, D20-S Smoothing muscles over large area 2. Muscles R15, D20-S Eventual preliminary ultrasound examination, localization with biofeedback, marking of pain region, muscle smoothing/massaging of large area, after RSWT with D20-S or V-ACTOR (2 3 minutes, Hz), treatment interval: 1 2 per week Glutealgia (Gluteal muscles) Trigger point treatment (per point) 4 8 Smoothing muscles over large area 2. Muscles R15, DI15, D20-S, D35-S R15, D20-S, D35-S Eventual preliminary ultrasound examination, localization with biofeedback, marking of pain region, muscle smoothing/massaging of large area, after RSWT with D35-S or V-ACTOR (2 3 minutes, Hz), treatment interval: 12 per week 26 STORZ MEDICAL

27 Shortenings in the femoral extensor and flexor muscles (Femoral muscles) Trigger point treatment (per point) 4 8 Smoothing muscles over large area 2. Muscles R15, DI15, D20-S, D35-S R15, D20-S, D35-S Eventual preliminary ultrasound examination, localization with biofeedback, marking of pain region, muscle smoothing/massaging of large area, after RSWT with D35-S or V-ACTOR (2 3 minutes, Hz), treatment interval: 1 2 per week Tibial anterior syndrome Trigger point treatment (per point) R15, D20-S, D35-S Smoothing muscles over large area 2. Muscles R15, D20-S, D35-S Eventual preliminary ultrasound examination, localization with biofeedback, marking of pain region, muscle smoothing/massaging of large area, after RSWT with D35-S or V-ACTOR (2 3 minutes, Hz), treatment interval: 1 2 per week Caution: Do not apply more than pulses (trigger shock wave therapy pulses) at one point of treatment. Move handpiece during pulse application. STORZ MEDICAL 27

28 Quick reference guide MASTERPULS MP50»Elite«Plantar fasciitis/heel pain/heel spur Heel (acute and chronic pain) R15, DI15 Calf muscles 2. Muscles D20-S Preliminary ultrasound examination, trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, localization with bio-feedback, smoothing of calf muscles and intrinsic foot muscles with D20-S, treatment intervall 1 week Calcific tendonitis/shoulder pain Supraspinatus tendon (chronic pain) R15, DI15 Surrounding muscles 2. Muscles D20-S Preliminary ultrasound/x-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with D20-S, treatment interval 1 week Radial/ulnar humeral epicondylitis Tendon insertion R Adjacent upper arm and forearm muscles 2. Muscles D20-S Biofeedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with D-20-S, treatment interval 1 week Achillodynia Achilles (tendon/directly to tendon) R15 Surrounding muscles 2. Muscles D20-S Trigger point therapy of calf muscles and intrinsic foot muscles and smoothing of surrounding muscles with D20-S, treatment interval 1 week Patellar tendonitis (Jumper s knee) Tendon insertion R15 Quadriceps, Musc. tensor fasciae latae 2. Muscles R15, D20-S In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with D20-S, treatment interval days Tibial stress syndrome (Shin splint) Medial, inner edge of shin bone R15 Surrounding muscles 2. Muscles R15, D20-S Treatment/Smoothing of surrounding muscles as well as instrinsic foot muscles with R15/D20-S, treatment interval 8 10 days Trochanteric tendonitis Tendon insertion R15, DI Surrounding muscles 2. Muscles D20-S, D35-S Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, biofeedback, referred pain, smoothing of surrounding muscles with D20-S, treatment interval 1 week Myofascial pain syndrome Trigger point treatment (per trigger point) 8 R15, DI15, D20-S Smoothing muscles over large area 2. Muscles D20-S, D35-S Palpation of the trigger points, no local anaesthetic, diagnosis in case of resistance to therapy, detailed knowledge of TrST (Trigger shock wave therapy) required, participation in seminars recommended, treatment interval 1 2 /week Acupuncture shock wave therapy (AkuST) Acupuncture 1. Points (per point) 1 10 A6 Acupuncture: Qualified training in acupuncture and acupuncture shock wave therapy (AkuST) is required for therapeutic application, treatment interval 1 2 /week Caution: Do not apply more than pulses (trigger shock wave therapy pulses) at one point of treatment, Timeline for improvements: 1. First improvements after 3, 2. Further noticeable improvements after 3 months 28 STORZ MEDICAL

29 Quick reference guide MASTERPULS MP100»Elite«Plantar fasciitis/heel pain/heel spur Heel (acute and chronic pain) R15, DI15 Calf muscles 2. Muscles D20-S Preliminary ultrasound examination, trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, localization with bio-feedback, smoothing of calf muscles and intrinsic foot muscles with D20-S, treatment intervall 1 week Calcific tendonitis/shoulder pain Supraspinatus tendon (chronic pain) R15, DI15 Surrounding muscles 2. Muscles D20-S Preliminary ultrasound/x-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with D20-S, treatment interval 1 week Radial/ulnar humeral epicondylitis Tendon insertion R Adjacent upper arm and forearm muscles 2. Muscles D20-S Biofeedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with D-20-S, treatment interval 1 week Achillodynia Achilles (tendon/directly to tendon) R15 Surrounding muscles 2. Muscles D20-S Trigger point therapy of calf muscles and intrinsic foot muscles and smoothing of surrounding muscles with D20-S, treatment interval 1 week Patellar tendonitis (Jumper s knee) Tendon insertion R15 Quadriceps, Musc. tensor fasciae latae 2. Muscles R15, D20-S In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with D20-S, treatment interval days Tibial stress syndrome (Shin splint) Medial, inner edge of shin bone R15 Surrounding muscles 2. Muscles R15, D20-S Treatment/Smoothing of surrounding muscles as well as instrinsic foot muscles with R15/D20-S, treatment interval 8 10 days Trochanteric tendonitis Tendon insertion R15, DI Surrounding muscles 2. Muscles D20-S, D35-S Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, biofeedback, referred pain, smoothing of surrounding muscles with D20-S, treatment interval 1 week Myofascial pain syndrome Trigger point treatment (per trigger point) R15, DI15, D20-S Smoothing muscles over large area 2. Muscles D20-S, D35-S Palpation of the trigger points, no local anaesthetic, diagnosis in case of resistance to therapy, detailed knowledge of TrST (Trigger shock wave therapy) required, participation in seminars recommended, treatment interval 1 2 /week Acupuncture shock wave therapy (AkuST) Acupuncture 1. Points (per point) 1 10 A6 Acupuncture: Qualified training in acupuncture and acupuncture shock wave therapy (AkuST) is required for therapeutic application, treatment interval 1 2 /week Caution: Do not apply more than pulses (trigger shock wave therapy pulses) at one point of treatment, Timeline for improvements: 1. First improvements after 3, 2. Further noticeable improvements after 3 months STORZ MEDICAL 29

30 Quick reference guide MASTERPULS MP200»Elite«Plantar fasciitis/heel pain/heel spur Heel (acute and chronic pain) R15, DI15 Calf muscles 2. Muscles D20-S Preliminary ultrasound examination, trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, localization with bio-feedback, smoothing of calf muscles and intrinsic foot muscles with V-ACTOR, treatment intervall 1 week Calcific tendonitis/shoulder pain Supraspinatus tendon (chronic pain) R15, DI15 Surrounding muscles 2. Muscles D20-S Preliminary ultrasound/x-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with V-ACTOR, treatment interval 1 week Radial/ulnar humeral epicondylitis Tendon insertion R Adjacent upper arm and forearm muscles 2. Muscles D20-S Bio-feedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with V-ACTOR, treatment interval 1 week Achillodynia Achilles (tendon/directly to tendon) R15 Surrounding muscles 2. Muscles D20-S Trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, smoothing of surrounding muscles with V-ACTOR, treatment interval 1 week Patellar tendonitis (Jumper s knee) Tendon insertion R15 Quadriceps, Musc. tensor fasciae latae 2. Muscles R15, D20-S In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with V-ACTOR, treatment interval days Tibial stress syndrome (Shin splint) Medial, inner edge of shin bone R15 Surrounding muscles 2. Muscles R15, D20-S Treatment of surrounding muscles with R15/D20-S, smoothing of surrounding muscles as well as intrinsic foot muscles with V-ACTOR, treatment interval 8 10 days Trochanteric tendonitis Tendon insertion R15, DI Surrounding muscles 2. Muscles D20-S, D35-S Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, bio-feedback, referred pain, smoothing of surrounding muscles with V-ACTOR, treatment interval 1 week Myofascial pain syndrome Trigger point treatment (per trigger point) R15, DI15, D20-S Smoothing muscles over large area 2. Muscles D20-S, D35-S Palpation of the trigger points, no local anaesthetic, diagnosis in case of resistance to therapy, detailed knowledge of TrST (Trigger shock wave therapy) required, participation in seminars recommended, treatment interval 1 2 /week Acupuncture shock wave therapy (AkuST) Acupuncture 1. Points (per point) 1 10 A6 Acupuncture: Qualified training in acupuncture and acupuncture shock wave therapy (AkuST) is required for therapeutic application, treatment interval 1 2 /week Caution: Do not apply more than pulses (trigger shock wave therapy pulses) at one point of treatment, Timeline for improvements: 1. First improvements after 3, 2. Further noticeable improvements after 3 months 30 STORZ MEDICAL

31 Global presence Worldwide services Based in Tägerwilen/Switzerland, the company operates around the globe through its branch offices and partners, making sure that qualified service personnel is always near at hand. Creating synergies The customer is the focus of everything we do! Complex technology is only as good as the skills of the people who use it. Our training concepts are geared to the interaction between doctors, systems and patients. We provide on-the-spot training to our medical partners to ensure efficient use and operation of our systems right from the very start. Quality Our products are designed to satisfy all requirements in terms of quality, safety, ease of use and service life. STORZ MEDICAL 31

32 HUMANE TECHNOLOGY TECHNOLOGY FOR PEOPLE STORZ MEDICAL AG Lohstampfestrasse Tägerwilen Switzerland Tel. +41 (0) fax +41 (0) SM E 0710/SIH Subject to change without notice.