Radial Shockwave Therapy

Transcription

1 Radial Shockwave Therapy New Uses for Old Technology Nick Savva FRCS(Tr&Orth) Consultant Orthopaedic Surgeon

2 Radial Shockwave Therapy What is a shockwave?

3 Radial Shockwave Therapy What is a shockwave?

4 Radial Shockwave Therapy Lithotripsy of Kidney Stones Focused shockwaves General anaesthesia

5 General Principles Creation Spark discharge Piezoelectric Electromagnetic Pneumatic Propagaiton Focussed Radial! Hard Shock wave! Soft Shockwave

6 Pneumatic Radial Shockwave Production Projectile Hand piece Probe Stone Stone fragments Guiding tube Compressed air inlet

7 Swiss Dolorclast Shockwave

8 Transfer of Energy: Direct Effect d f, d+l^^+r^16 I\\/IIV\/UTt,I.l ) Boundary layer picture Muscle L72 glcm2ls

9 Transfer of Energy: Direct Effect

10 Wave Characteristics

11 Wave Characteristics: Cavitation Effect

12 Wave Characteristics: Cavitation Effect

13 Analgesic Effects Transient analgesic effect on afferent nerves Non-myelinated C fibres Maier et al CORR ; Induces release and down regulates Substance P and Histamine Centrally and peripherally Capaiscin Duggan et al Brain Res 1988 Inhibits Cox II enzyme Harrison et al Int J Biochem Cell Biol 2001

14 Molecular Effects Effects Neo-angiogenesis Wang et al J Orthop Res 2003; 21: Growth factor up regulation (Fibroblast growth factor, TGFB1, IGF) Dose dependant changes in Rabbit Achilles Chen et al, J Orthop Res 2004;22: ) Stimulates osteoblasts to produce new bone Burkitt et al

15 Treatable Conditions Lateral Epicondylitis Calcific Tendonitis Trochanteric Bursitis Medial Epicondylitis Patella Tendonitis Anterior Tibial Periostitis Achilles Tendonitis Plantar Fasciitis

16 Evidence: Plantar Fasciitis Gerdesmeyer et al Am J of Sports Med 2008 Study Placebo controlled, randomised, double blind, multi-centre trial for chronic plantar fasciitis> 6 months Study Design 18 years and over Symptoms > 6 months Completed unsuccessful conservative treatment Tried anti-inflammatories and at least one injection Outcome Measure VAS scores at 3 months and 12 months Roles and Maudsley score SF-36

17 Evidence: Plantar Fasciitis 90" 80" % reduction in pain scores 70" 60" 50" 40" 30" 3"Months" 12"Months" 20" 10" 0" ESWT" Placebo" p>0.025

18 Evidence: Plantar Fasciitis Bone Oedema is best predictor of good outcome Maier JBJS(Br) 2002,4: New American study results Approved by NICE and FDA

19 Shockwaves Evidence: Achilles Tendinitis Eccentric loading programme compared to shockwave therapy in patients with chronic insertional Achilles tendinopathy JBJS 2008 Maffuli et al Study Design Study number 50 Failed conservative treatment At least 18 years old Study Design Visual analogue score SF 36

20 Evidence: Achilles Tendinitis Significant difference in all outcome measures (p=0.002)

21 Our Audit 100 patients All pathologies 80% of patients get 80 % improvement ASSERT Trial National trial Radiological confirmation of diagnosis Standardised treatment protocol

22 Complications/Contra-indications Complications Petechiae Bruising Pain Contra-Indications Infection Lung tissue Tumours Open growth plates Neural structures Bleeding diatheses Pregnancy

23 Other Users Used by many Premiership football and rugby clubs Beijing Olympics London Olympics Veterinary practice Ulcers Non-unions Peyronie s disease

24 Thank You