Extacorporeal shock wave therapy unsuccessful for chronic medial epicondylitis |
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Authors: | P Grala R Dadej |
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Institution: | (1) Department of Trauma Burns and Plastic Surgery, Karol Marcinkowski Medical University, 61-059 Poznan, Poland;(2) Department of Urology, Karol Marcinkowski Medical University, Poznan, Poland |
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Abstract: | Medial epicondylitis is a chronic noninflammatory condition resulting from mechanical injury. Despite many treatment options,
including rest, medications, physiotherapy and operative interventions, the results are too often poor; thus new treatment
options are sought. We treated 4 men with chronic epicondylitis (5 affected joints) with extracorporeal shock wave therapy
after failed attempts of other treatments. The patients’ complaints were graded with the Nirschl scoring system prior to and
six months after therapy. The treatment consisted of three sessions, at 20-day intervals, of 3000 pulses of ultrasonic shock
waves from a Piezolith 3000 unit (energy dosage was gradually increased to reach step 10 equaling 0.9 mJ/mm2). At the 6-month follow-up, no patient was pain free. Three cases had slightly lower Nirschl scores than prior to the procedure
but the patients rated this difference as insignificant; two cases were unchanged. No complications were observed but all
patients rated the procedure as very unpleasant. The well recognized biologic effects of ultrasonographic waves (heat generation,
oscillations, cavitation, etc.) that result in functional and structural changes of cellular membranes with sonochemical reactions
(acceleration of normal metabolism, oxygenation and reduction in water solutions, polymer degradation, etc.), even if present
in our cases, did not result in a noticeable decrease of symptoms, even though we used high energy and more impulses per session.
Significant variations in methodology make inconclusive the results of numerous reports on the use of extracorporeal shock
waves in epicondylar degenerative problems, although ineffectiveness of such therapy is the conclusion of a review by Haake
and colleagues. |
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Keywords: | Extracorporeal shock wave therapy Medial epicondylitis Nirschl scoring system |
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