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Patients with severe motor and intellectual disability (SMID) experience persistent spastic pain and severe malpositioning of the limbs, exacerbated by the lack of effective treatment for severe spastic palsy. This study (UMIN-CTR, UMIN000048842) aimed to evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for spastic palsy in these patients. rESWT was applied to the biceps brachii of 15 elbow joints with flexion pattern spastic palsy of Modified Ashworth Scale (MAS) grade 1+ or greater in 11 patients with SMID. The MAS score, elbow range of motion (ROM) and adverse events were monitored for up to 10 weeks. Electromyography signals at rest were recorded on 8 elbow joints. Following a single rESWT session, the spasticity of the elbow joint immediately decreased, the MAS score significantly decreased from 2 (range, 2–3) to 1 (range, 1–2), and the elbow ROM significantly increased by 10° (range, 0°–15°). Moreover, muscle activity decreased by 24% (range, 11–37%), being clinically meaningful in SMID. rESWT resulted in an immediate and clear improvement in the MAS score for approximately 8 weeks and in the elbow ROM, continuing even at 10 weeks. Our findings highlight rESWT as a non-invasive therapy for spastic palsy in patients with SMID.

Background. The superiority of focused shockwave therapy (F-SWT) versus radial shockwave therapy (R-SWT) for treating noncalcific rotator cuff tendinopathies remains controversial. This study is aimed at comparing the effectiveness of F-SWT versus R-SWT for the management of noncalcific rotator cuff tendinopathies. Methods. A total of 46 patients affected by noncalcific rotator cuff tendinopathies were randomly divided into 2 groups of 23 individuals. Patients in group A received 4 sessions of F-SWT, while patients in group B were treated by 4 sessions of R-SWT. In each session, mean energy flux density (EFD) for F-SW 3000 shots was 0.09±0.018 mJ/mm2 with 5.1±0.5 Hz, while average pressure for R-SW 3000 shots was 4.0±0.35 bar with 3.2±0.0 Hz. Pain level and shoulder function were assessed with the numerical rating scale (NRS) and Constant-Murley Scale (CMS). The primary endpoint was the change in the mean NRS pain score from baseline to 24 weeks after the intervention. Secondary endpoints were changes in the mean NRS pain scores at all other follow-up points, changes in the mean CMS scores, and radiographic findings. Results. There were no significant differences between the two groups regarding NRS pain score and CMS score within 24 weeks after intervention (all p>0.05). However, F-SWT resulted in significantly lower NRS compared with R-SWT at 24 weeks and 48 weeks after treatment (2.7±1.0 vs. 4.5±1.2 and 1.4±1.0 vs. 3.0±0.8, respectively, all p<0.001). Similar results were found in CMS changes and radiographic findings. Conclusions. Both F-SWT and R-SWT are effective in patients with noncalcific rotator cuff tendinopathy. F-SWT proved to be significantly superior to R-SWT at long-term follow-up (more than 24 weeks). This trial is registered with ChiCTR1900022932.

ObjectivesWhile extracorporeal shockwave therapy (ESWT) may be an efficacious adjunctive treatment option for musculoskeletal injuries, current research is limited by significant heterogeneity within treatment protocols. This study aims to establish international expert consensus recommendations on ESWT terminology, parameters, procedural considerations, contraindications and side effects in the application of ESWT to sports injuries.MethodsA systematic literature search was performed on the use of ESWT for musculoskeletal and sports medicine injuries to identify potential panellists, followed by the development of a steering committee-led questionnaire. A three-stage, modified Delphi questionnaire was provided to a panel of 41 international clinical and research experts across 13 countries. Panellists had the opportunity to suggest edits to existing statements or recommend additional statements in Round 1. Consensus was defined as≥75% agreement.ResultsAll 41 panellists completed Rounds 1, 2 and 3. Consensus was reached on 69/118 statements (58.5%), including recommendations on terminology and fundamental concepts, indications for use, procedural aspects for tendinopathy and bone pathologies, treatment correlations with imaging, periprocedural and postprocedural considerations, absolute and relative contraindications and potential side effects. Of the 49 statements that did not reach consensus, 17/49 (34.7%) were related to procedural aspects of bone pathology.ConclusionThis international panel presents recommendations on ESWT terminology, indications and treatment considerations to guide ESWT use and decision-making by sports medicine clinicians. While our panel supported the use of ESWT in the treatment of bone pathologies, certain procedural aspects of ESWT specific to these injuries did not reach consensus and require further investigation.

PurposeThe extracorporeal shockwave lithotripsy (ESWL) remains the most common first line of treatment for renal stones in the pediatric population. The purpose of this study is to evaluate and compare the outcomes of the ESWL and mini-percutaneous nephrolithotomy (mini-PCNL).Patients and methodsA total of 108 patients younger than 12 years of age with 1–2 cm single renal stone (pelvic or calyceal) were randomized into two groups, each containing 54 patients. Patients in group A were subjected to mini-PCNL using 16.5 Fr percutaneous sheath while those in group B underwent ESWL using Dornier Compact Sigma.ResultsThe stone-free rate (SFR) after first session was 88.9% (48 cases) and 55.6% (30 cases) for groups A and B, respectively. The difference is highly statistically significant P = 0.006. Two patients (3.7%) in group A needed 2nd session of PCNL, while 18 patients (33.3%)in group B needed a 2nd session, of theses 18 patients six patients needed a 3rd session of ESWL. After the third session of ESWL and second look PCNL the stone-free rates were 92.59% (50 cases) and 88.89% (48 cases) for groups A and B, respectively, (P = 0.639), which is statistically insignificant. The mean hospital stay and fluoroscopy exposure were significantly longer in the mini-PCNL group. The complication rate in groups A and group B were (22.2%) and (14.8%), respectively, which is statistically insignificant (P = 0.484).ConclusionsAccording to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.

Objectives:To report the one-year results of ESWT on CPPS patients and the possible clinical characteristics that may affect its efficacy.Patients & methods:A prospective randomized clinical study between January 2017 and January 2021 on 155 adult patients with chronic pelvic pain syndrome. All patients were initially evaluated with a thorough history and physical examination. Baseline symptoms evaluation of each participant was assessed using NIH-CPSI score, IPSS, VAS, and IIEF-5 score. Patients were randomized into two groups: a verum treatment group and a placebo treatment group. Patients of verum group in the lithotomy position received a perineally applied ESWT treatment once a week for four weeks with 3000 impulses each. Patients of placebo group received the same therapy head of the same device with a layer of air-filled microspheres to absorb the shock waves. The previously mentioned validated scores were reassessed on regular follow-up visits at one, three, six, and 12 months after the completion of ESWT.Results:A statistically significant improvement was noticed in the mean values of NIH-CPSI, IPSS, VAS, and IIEF-5 of the patients of verum group over the follow-up period with also statistically significant difference between both groups. At the first visit of follow-up after ESWT, 63 (82.8%) patients had ≥6 points decrease in the NIH-CPSI total score, while 13 (17.2%) patients did not. Univariate and multivariate analyses of the clinical characteristics between the responders and non-responders showed that those patients with history of psychological disorders or had higher initial NIH-CPSI score had a significantly lower response rate to ESWT (p = 0.005, 0.02 & p = 0.002, 0.004 respectively). ROC curve of NIH-CPSI score showed that a score of 32 was the cut-off point above which the response to ESWT decreased.Conclusion:ESWT is an effective treatment option for CPPS. Its efficacy remained throughout long-term follow up. High initial NIH-CPSI score and history of psychological problems are significant predictors for it.

Background Knee osteoarthritis (KOA) is the most common degenerative joint disease. It is characterized by pain, stiffness, reduced joint motion, and muscle weakness. It also has the potential for long-term disability. Radial extracorporeal shock wave therapy (rESWT) is a noninvasive therapeutic modality widely used for the treatment of musculoskeletal disorders. However, the role of rESWT in the treatment of knee osteoarthritis remains controversial in previous clinical trials. This trial will investigate the efficacy of rESWT in improving the symptoms, function, and bone metabolic status of participants with knee osteoarthritis. Methods The study is a randomized, double-blind, controlled trial. Thirty participants with knee osteoarthritis will be randomized to receive either rESWT or sham rESWT on the affected knee once per week for 4 weeks. All participants will undergo professional physiotherapy once a week during the treatment period. The primary outcome is the visual analogue scale score for pain. Secondary outcomes include the Western Ontario and McMaster Universities Osteoarthritis Index score, knee range of motion, the 10-m walk test results, and bone metabolism biochemical indicators. Outcomes will be measured at baseline (T0), 5 weeks post-intervention (T1), and 8 weeks post-intervention (T2). Discussion This study will investigate the effects of rESWT on pain, physical function, and bone metabolism biochemical indicators in participants with knee osteoarthritis, which is expected to reduce the pain of participants, improve the function of participants, and improve bone metabolism biochemical indicators. The information obtained will enhance our understanding of rESWT for the treatment of knee osteoarthritis and may be used to standardize clinical treatment protocols for knee osteoarthritis. Trial registration Chinese Clinical Trial Registry ChiCTR2300069997. Registered on 30 March 2023.

SummaryIt has been proved that extracorporeal shock wave therapy (ESWT) could promote new bone formation. Therefore, we designed an experiment to test the efficiency of ESWT on BMD in postmenopausal osteoporotic patients. The results showed that ESWT could effectively improve the local bone mass of the treated bone area within a short duration.IntroductionThis study evaluated the short-term effectiveness of extracorporeal shock wave therapy (ESWT) on bone mineral density (BMD).MethodsA total of 64 postmenopausal osteoporotic patients were recruited and randomized into 3 groups in 2015. Groups A (n = 20) and B (n = 21) patients received a single-session of low- or high-energy flux density (EFD) ESWT in the left hip, respectively, whereas group C (n = 23) patients served as controls without the ESWT treatment. All patients self-administered alendronate sodium tablets orally for a year. The BMD of the lumbar spine (L2-L4), femoral neck, great tuberosity, and total left hip was measured before ESWT treatment and at 3, 6, and 12 months using dual energy X-ray absorptiometry (DEXA).ResultsAt 12 months, the lumbar spine, femoral neck, great tuberosity, and total left hip BMD in all patients had increased (p < 0.01). The increase in lumbar spine BMD in group A patients was higher than that in group B patients (p = 0.03); other between-group differences were not observed (p = 0.73, group A vs. C; p = 0.06, group B vs. C). The femoral neck, great tuberosity, and total left hip BMD increases in group B patients were higher than that in either group A or C (p < 0.01, group B vs. A; p < 0.01, group A vs. C).ConclusionThis study showed that ESWT could efficiently improve the local BMD; relatively, the high dosage was effective.

Background Myofascial pain syndrome (MPS) is a common, costly, and often persistent musculoskeletal condition. Radial shockwave therapy (RSWT) is one of the most frequently used treatments for MPS. However, there is limited evidence to support its short-term effectiveness, primarily due to the poor methodological quality of the studies. This study aimed to determine the effectiveness of radial shockwave therapy, compared with placebo treatment, in patients with MPS in the neck and upper back. Method A two-armed, randomized, double-blind, placebo-controlled trial was carried out in an outpatient physical rehabilitation department in a tertiary hospital. The sample comprised 70 adults aged 18 years or above with MPS. The intervention group received six treatment sessions. These consisted of RSWT: 1.5 bars (0.068 mJ/mm 2 ), 2000 pulses, and a frequency of 15 Hz; and standard physical therapy stretches and exercises, including therapeutic home exercises. The control group received an identical treatment regime, except that they received a no-energy shock (nontherapeutic dose) of 0.3 bar (0.01 mJ/mm 2 ). The outcome measures were the numeric pain score (NPS), neck disability index (NDI), pressure pain threshold (PPT) and SF-12 score at the 4-, 8- and 12-week follow-ups. Results The study revealed a significant improvement ( p  < 0.05) in the NPS and PPT at the follow-up assessments (0–4, 0–8, and 0–12 weeks). The placebo group showed a significant difference in NDI scores at all intervals, whereas the shockwave group only showed significant improvement at 0–4 weeks. The shockwave group did not have significant changes in SF-12 scores, whereas the placebo group showed significant improvement in the SF physical score between 0–8 weeks ( p  = 0.01) and 0–12 weeks ( p  = 0.02). No statistically or clinically significant differences were observed between the placebo and shockwave groups across all outcomes at 4, 8, and 12 weeks. Conclusion No significant differences were found between the placebo and shockwave groups at 4, 8, and 12 weeks. However, both groups showed statistically and clinically significant improvements in the NPS and PPT. Both groups showed improvements in the NPS and PPT scores; therefore, we recommend using radial RSWT as an adjunct to standard care, which includes therapeutic home exercises for individuals with MPS. Trial registration The trial was prospectively registered on 19 April 2022 with https://clinicaltrials.gov/study/NCT05381987 and conducted according to Consolidated Standards of Reporting Trials (CONSORT) guidelines.

ObjectivesTo assess whether radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses is more effective than advice plus customised foot orthoses alone in alleviating heel pain in patients with plantar fasciopathy.Methods200 patients with plantar fasciopathy were included in a four-arm, parallel-group, sham-controlled, observer-blinded, partly patient-blinded trial. At baseline, before randomisation, all patients received advice plus customised foot orthoses. Patients were randomised to rESWT (n=50), sham-rESWT (n=50), exercise (n=50) or advice plus customised foot orthoses alone (n=50). Patients in the rESWT and sham-rESWT groups received three treatments. The exercise programme comprised two exercises performed three times a week for 12 weeks, including eight supervised sessions with a physiotherapist. Patients allocated to advice plus customised foot orthoses did not receive additional treatment. The primary outcome was change in heel pain during activity in the previous week per Numeric Rating Scale (0–10) from baseline to 6-month follow-up. The outcome was collected at baseline, and 3, 6 and 12 months.ResultsThe primary analysis showed no statistically significant between-group differences in mean change in heel pain during activity for rESWT versus advice plus customised foot orthoses (−0.02, 95% CI −1.01 to 0.96), sham-rESWT versus advice plus customised foot orthoses (0.52, 95% CI −0.49 to 1.53) and exercise versus advice plus customised foot orthoses (−0.11, 95% CI −1.11 to 0.89) at 6 months.ConclusionIn patients with plantar fasciopathy, there was no additional benefit of rESWT, sham-rESWT or a standardised exercise programme over advice plus customised foot orthoses in alleviating heel pain.Trial registration number NCT03472989.

Tendinopathy is a common musculoskeletal condition that impairs body function and quality of life. Extracorporeal shockwave therapy is a widely used non-invasive treatment method. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of radial shockwave therapy (RSWT) and focused shockwave therapy (FSWT) in the treatment of upper and lower limb tendinopathies, based on randomized controlled trials (RCTs) assessing pain intensity, physical function, muscle strength, and adverse effects. The review protocol was registered in the PROSPERO database under the registration number CRD420251011209. A comprehensive search of PubMed, EBSCOhost, Ovid MEDLINE, and Embase was conducted to identify RCTs. Databases were searched from their inception until the last update—26 March 2025 for PubMed, EBSCOhost and Ovid MEDLINE, and 27 March 2025 for Embase. Review methods: Risk ratios and mean differences (MD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I 2 statistic. The risk of bias and methodological quality of the included studies were evaluated using the Cochrane Risk of Bias tool and the Physiotherapy Evidence Database scale. The overall quality of the body of evidence was assessed using the GRADE approach. Of the 102 records identified, 9 articles met the inclusion criteria, comprising a total of 530 patients with upper or lower limb tendinopathy. No clear superiority of RSWT or FSWT was observed for pain or functional outcomes, owing to low or very low certainty of evidence. Moderate-quality evidence indicated that RSWT significantly improved wrist extensor strength in patients with tennis elbow compared to FSWT (MD: 1.81; 95% CI 0.97 to 2.64; p  < 0.001; I 2  = 0%), while grip strength did not differ significantly between the modalities (MD: 0.57; 95% CI −1.68 to 2.82; p  = 0.62; I 2  = 0%). Both treatments were similarly safe, but conclusions are limited by low-quality evidence.