Clinical Application of the EMS Swiss DolorClast

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1 Chapter 12.fm Page 119 Tuesday, November 21, :38 PM 12 Clinical Application of the EMS Swiss DolorClast L. Gerdesmeyer, M. Henne, P. Diehl, H. Gollwitzer, M. Göbel In general, the following recommendations apply when using the Swiss DolorClast : In all indications, patient biofeedback is used to localize the region of interest. The treatment area is determined by palpating the relevant pain region and a skin marker could be used to verify the previous defined area during the treatment. A coupling medium such as ultrasound gel or certain oils (e.g. castor oil) must be used to ensure delivery of the shock wave to the treatment region without a significant loss of enegy between skin and applicator. Disconnection must be avoided. Local anesthesics are not recommended and should be administered based on patient demand and indicated and performed by a physician. A gradual pressure increasing application of 500 shock wave impulses may be appropriate to patients pain adaptation. The applied energy should be increased slowly during this initial phase. Clinical applications have shown a significant reduction in pain perception after a brief application period. Minor side effects may occur but without clinical relevance. Published minor adverse events were described as local swelling, hematoma, petechial bleeding and pain during the treatment. In general, all side effects disappear in just a few days without the need for specific treatment. Based on the consensus of radial shock wave therapy practitioners, treatment parameters were dicussed and defined later on (2002). Decisions were based on technical and physical parameters, clinical experience of the practitioners as well as on published data (listed in Table 1).

2 Chapter 12.fm Page 120 Tuesday, November 21, :38 PM 120 EXTRACORPOREAL SHOCK WAVE THERAPY Nomenclature Recommended treatment parameters Medical indication Synonym Note Frequency Pressure (bar) Application force Impulses Sessions Applicator Interval Plantar fasciitis Heel pain ,5 4 strong mm weekly Lateral epicondylitis Tennis elbow 4 8 2,5 4 light mm weekly Rotator cuff tendinopathy Shoulder pain, impingement syndrome If calcification exists, success can be verified by X-ray or ultrasound 4 8 2,5 4 medium mm weekly Patella tendiopathy Jumpers knee medium mm weekly Tibial edge syndrome Shin splints ,5 2,5 soft mm weekly Iliotibial band friction syndrome ,5 3,5 strong mm weekly Achillodynia Treatment proximal and/ or distal soft mm weekly Table 1. Nomenclature and treatment parameters

APPLICATION OF THE EMS SWISS DOLORCLAST 121 Treatment of tennis

injuries (near elbow) Apophyseal disorders Osteochondrosis Loose

Fracture of the radius head Supinator slit syndrome Pronator

3 Chapter 12.fm Page 121 Tuesday, November 21, :38 PM CLINICAL APPLICATION OF THE EMS SWISS DOLORCLAST 121 Treatment of tennis elbow (Epicondylopathia humeri radialis) Acute tendon and muscle injuries (near elbow) Apophyseal disorders Osteochondrosis Loose bodies Elbow arthrosis A vascular bone necrosis (Morbus Panner) Fracture of the radius head Supinator slit syndrome Pronator teres syndrome The treatment area is localized by palpation (biofeedback). A 15 mm applicator is applied with soft application pressure.

$syndrome Calcaneal stress fracture Coalition,$ $fracture The treatment area is localized by$

4 Chapter 12.fm Page 122 Tuesday, November 21, :38 PM 122 EXTRACORPOREAL SHOCK WAVE THERAPY Treatment of heel spur (plantar fasciitis) Tarsal tunnel syndrome Calcaneal stress fracture Coalition, calcaneo navicular Anterior calcaneal stress fracture The treatment area is localized by palpation (biofeedback). treatment area with strong application pressure. Application pressure 4 bar.

enthesiopathy CLINICAL APPLICATION OF THE EMS SWISS DOLORCLAST 123 Subacromial

biceps tendon disorders Frozen shoulder Nerval disorders Arthrosis of the

5 Chapter 12.fm Page 123 Tuesday, November 21, :38 PM Treatment of rotator cuff enthesiopathy CLINICAL APPLICATION OF THE EMS SWISS DOLORCLAST 123 Subacromial bursitis AC joint arthrosis Shoulder joint instability Degenerative damage and long biceps tendon disorders Frozen shoulder Nerval disorders Arthrosis of the glenohumeral joint The treatment area is localized by radiology or sonography and by palpation (biofeedback). During localization the skin is marked over the treatment area. EMS Swiss DolorClast coupling gel treatment area with high application pressure. Application pressure 4 bar. If calcification is present, x-rays or ultrasound should be used for reexamination.

EXTRACORPOREAL SHOCK WAVE THERAPY Treatment of

damage and arthrosis Bursitis prepatellar or pes

6 Chapter 12.fm Page 124 Tuesday, November 21, :38 PM 124 EXTRACORPOREAL SHOCK WAVE THERAPY Treatment of patella tip syndrome Femoropatellar cartilage damage and arthrosis Bursitis prepatellar or pes anserinus Osgood-Schlatter Morbus Sinding-Larsson Bipartite Patella Plica (= med. shelf) syndrome Meniscal tears The treatment area is localized by palpation. treatment area with soft application pressure.

Osteochondritis dessicans (OCD) of the talus Nerve entrapment syndromes

$fracture Osteomyelitis Radiculopathy L4 Compartment syndrome Chronic$

7 Chapter 12.fm Page 125 Tuesday, November 21, :38 PM Treatment of tibialis anterior syndrome Tib. post. and flexor hallucis longus lesion Arthrosis of the ankle joint Osteochondritis dessicans (OCD) of the talus Nerve entrapment syndromes Tarsal tunnel syndrome Muscle hernias Arterial vessel disease Stress fracture Osteomyelitis Radiculopathy L4 Compartment syndrome Chronic venous insufficiency CLINICAL APPLICATION OF THE EMS SWISS DOLORCLAST 125 The treatment area is localized by palpation. treatment area with medium dorsal, soft medial and lateral application pressure.

$Bursitis subachilleal Partial Achilles tendon ruptures Stress fracture$ (MT III, calcaneus) Radiculopathy L5 Osteochondritis dessicans (OCD) of

(MT III, calcaneus) Radiculopathy L5 Osteochondritis dessicans (OCD) of

of the ankle joint Os trigonum Posterior heel spur Snow board ankle The

8 Chapter 12.fm Page 126 Tuesday, November 21, :38 PM 126 EXTRACORPOREAL SHOCK WAVE THERAPY Treatment of achillodynia Posterior ankle cartilage damage Bursitis subachilleal Partial Achilles tendon ruptures Stress fracture (MT III, calcaneus) Radiculopathy L5 Osteochondritis dessicans (OCD) of the talus HLA B27 positive (rheumatoid arthritis) Tendon insufficiency of the ankle joint Os trigonum Posterior heel spur Snow board ankle The treatment area is localized by palpation. treatment area with medium dorsal, medial and lateral application pressure (continuous impulse mode).

illiotibial band enthesiopathy CLINICAL APPLICATION OF THE

or pseudo-radicular syndromes Hernia inguinalis or femoralis

$syndrome Stress fracture Epihyseolysis capitis femoris Hip$

9 Chapter 12.fm Page 127 Tuesday, November 21, :38 PM Treatment of illiotibial band enthesiopathy CLINICAL APPLICATION OF THE EMS SWISS DOLORCLAST 127 Coxarthrosis High lumbar radicular or pseudo-radicular syndromes Hernia inguinalis or femoralis N. cutaneous fem. syndrome Stress fracture Epihyseolysis capitis femoris Hip dysplasia The treatment area is localized by palpation. treatment area with modeate to strong application pressure. The handpiece is positioned vertically on the skin.

10 Chapter 12.fm Page 128 Tuesday, November 21, :38 PM

Overuse Injuries & special skeletal injuries Dr M.Taghavi Director of sport medicine center of olympic academy

Overuse Injuries & special skeletal injuries Dr M.Taghavi Director of sport medicine center of olympic academy Prevalence of Overuse Injuries 30 to 50% of all sport injuries are from overuse In some sports