ESWT for Soft Tissue Pathologies: Case Review

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Clarissa Elliott
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1 ESWT for Soft Tissue Pathologies: Case Review 7 th International Congress April 1 st -4 th 2004 Kaohsiung, Taiwan ESWT for Soft Tissue Pathologies: Case Review Paulo Roberto Pires Rockett Porto Alegre Ana Cláudia Souza Rio de Janeiro Paulo Roberto dos Santos São Paulo BRAZIL 1

2 Objective Retrospective study Electro hydraulic high-energy device REFLECTRON HMT 3 Brazilian Centers BRAZIL São Paulo Rio de Janeiro Porto Alegre 2

3 Materials and Methods March 2001 to May 2003 X-rays and ultrasound: before treatment, 3 and 6 months after Indication with minimum of 6 months of unsuccessful conservative treatment Patients were reviewed at 1, 3 and 6 months Materials and Methods March 2001 to May 2003 Epicondylitis Plantar fasciitis Total of patients Pathologies Tendinosis calcarea of the shoulder Tendinosis of the shoulder Trochanteric bursitis Achilles tendon calcifying (or not) tendinosis Treated with Follow-up

4 Number of treatments Treatments Number of Patients pulses E3 (3.32 mj) to E7 (3.60 mj) HMT Parameters Results Roles and Maudsley score Grade 1 Grade 2 Grade 3 Grade 4 Excellent Good Acceptable Poor no pain, full movement and activity occasional pain, full movement and activity some discomfort after prolonged activity pain limiting activity 4

5 Tendinosis calcarea of the shoulder Treatments Cases 1 month 3 months 6 months % 76% 77% % 48% 68% Tendinosis calcarea of the shoulder 5

6 Tendinosis calcarea of the shoulder before ESWT 3 months after ESWT calcified deposit with shade hyperechogenic focus with no shade Tendinosis calcarea of the shoulder before ESWT 3 months after ESWT 6

4% Roles and Maudsley score Grade 1 Excellent Grade 2 Good Grade 3 Acceptable Grade 4 Poor no pain,

7 Tendinosis calcarea of the shoulder before ESWT 3 months after ESWT Tendinosis calcarea of the shoulder 5 - Poor 8,5% 8 - Acceptable 13.6% 35.6% 21 - Excellent 25 - Good 42.4% Roles and Maudsley score Grade 1 Excellent Grade 2 Good Grade 3 Acceptable Grade 4 Poor no pain, full movement and activity occasional pain, full movement and activity some discomfort after prolonged activity pain limiting activity 7

, 4 years pain Poor result: undergone to surgery lder

8 Tendinosis calcarea of the shoulder Male, 56 y.o., 4 years pain Poor result: undergone to surgery Tendinosis calcarea of the shoulder Subacromial decompression Planning surgical procedure: Draw a line from the front tip to the back edge Draw another line along the posterior undersurface The distance between these lines is the amount of bone that will be resected 8

9 Tendinosis calcarea of the shoulder Tendinosis calcarea of the shoulder before 6 months after surgery 9

10 Tendinosis calcarea of the shoulder 6 months after surgery Tendinosis calcarea of the shoulder 6 months after surgery 10

11 Tendinosis calcarea of the shoulder 6 months after surgery Tendinosis calcarea of the shoulder 6 months after surgery 11

12 Tendinosis of the shoulder Indication: late Stage II (Neer) Subacromial Impingement Tendinosis Tendinosis of the shoulder Treatments Cases 1 month 3 months 6 months % 74% 82% % 100% 100% 12

13 Tendinosis of the shoulder Male, 50 y.o., swimmer, 6 months pain Acromio Type II - curved Tendinosis of the shoulder Stage II: fibrosis and tendinitis 13

14 Tendinosis of the shoulder 3 months after ESWT Tendinosis of the shoulder before ESWT 1 year after ESWT 100% improvement 14

15 Tendinosis of the shoulder 0 - Acceptable 3 - Poor 11.5% 34.6% 53.8% 14 - Excellent 9 - Good Roles and Maudsley score Grade 1 Excellent Grade 2 Good Grade 3 Acceptable Grade 4 Poor no pain, full movement and activity occasional pain, full movement and activity some discomfort after prolonged activity pain limiting activity Epicondylitis Treatments Cases 1 month 3 months 6 months % 72% 76% % 65% 70% 15

16 Epicondylitis Male, 40 y.o., tennis player and amateur boxer, 15 years pain Epicondylitis 6 months after ESWT 100% improvement 16

17 Epicondylitis 4 - Poor 4 - Acceptable 10.0% 10.0% 20 - Excellent 50.0% 12 - Good 30.0% Roles and Maudsley score Grade 1 Excellent Grade 2 Good Grade 3 Acceptable Grade 4 Poor no pain, full movement and activity occasional pain, full movement and activity some discomfort after prolonged activity pain limiting activity Trochanteric bursitis Treatments Cases 1 month 3 months 6 months % 84% 89% % 80% 75% 17

Trochanteric bursitis with calcification Female, 53 y.o., 3 years pain 2 months after ESWT Trochanteric bursitis 1 - Acceptable 4.2% 4.2% 1 - Poor 37.5% 9 - Excellent 54.

18 Trochanteric bursitis with calcification Female, 53 y.o., 3 years pain 2 months after ESWT Trochanteric bursitis 1 - Acceptable 4.2% 4.2% 1 - Poor 37.5% 9 - Excellent 54.2% 13 - Good Roles and Maudsley score Grade 1 Excellent Grade 2 Good Grade 3 Acceptable Grade 4 Poor no pain, full movement and activity occasional pain, full movement and activity some discomfort after prolonged activity pain limiting activity 18

67% 71% 2 3 50% 53% 52% 3 1 80% 30% 80% Male, 59 y.o.

19 Achilles tendon calcifying (or not) tendinosis Treatments Cases 1 month 3 months 6 months % 67% 71% % 53% 52% % 30% 80% Achilles tendon calcifying (or not) tendinosis Male, 59 y.o., 5 years pain 19

Achilles tendon calcifying (or not) tendinosis 5 months after ESWT 95% improvement Achilles tendon calcifying (or not) tendinosis 2 - Poor 10 - Acceptable 27.8% 5.6% 19.4% 7 - Excellent 47.

20 Achilles tendon calcifying (or not) tendinosis 5 months after ESWT 95% improvement Achilles tendon calcifying (or not) tendinosis 2 - Poor 10 - Acceptable 27.8% 5.6% 19.4% 7 - Excellent 47.2% 17 - Good Roles and Maudsley score Grade 1 Excellent Grade 2 Good Grade 3 Acceptable Grade 4 Poor no pain, full movement and activity occasional pain, full movement and activity some discomfort after prolonged activity pain limiting activity 20

21 Achilles tendon calcifying tendinosis Male, 50 y.o., 2 years pain Poor result: undergone to surgery Achilles tendon calcifying tendinosis 21

22 Achilles tendon calcifying tendinosis Deposits of calcium Achilles tendon calcifying tendinosis 22

23 Achilles tendon calcifying tendinosis Plantar fasciitis Treatments Cases 1 month 3 months 6 months % 69% 77% 2 2 0% 90% 90% % 50% 30% 23

24 Plantar fasciitis Female, 53 y.o., 3 years pain 3 months after ESWT 100% improvement Plantar fasciitis Female, 65 y.o., 13 years pain 24

25 Plantar fasciitis Plantar fasciitis 1 year after ESWT 25

4% Roles and Maudsley score Grade 1 Excellent Grade 2 Good Grade 3 Acceptable Grade 4 Poor

26 Plantar fasciitis 1 year after ESWT Plantar fasciitis 6 - Poor 10 - Acceptable 14.7% 8.8% 44.1% 30 - Excellent 22 - Good 32.4% Roles and Maudsley score Grade 1 Excellent Grade 2 Good Grade 3 Acceptable Grade 4 Poor no pain, full movement and activity occasional pain, full movement and activity some discomfort after prolonged activity pain limiting activity 26

Results Epicondylitis Plantar fasciitis Pathologies Tendinosis calcarea of the shoulder Tendinosis of the shoulder Trochanteric bursitis Achilles tendon

27 Results Epicondylitis Plantar fasciitis Pathologies Tendinosis calcarea of the shoulder Tendinosis of the shoulder Trochanteric bursitis Achilles tendon calcifying (or not) tendinosis patients Excellent and Good (Grade 1-2) % 88.46% 80% 91.66% 66,66% 74.47% Follow-up 6 14 months Thank You 27

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