Treatment for insertional Achilles tendinopathy: a systematic review

Purpose

Systematically search and analyse the results of surgical and non-surgical treatments for insertional Achilles tendinopathy.

Methods

A structured systematic review of the literature was performed to identify surgical and non-surgical therapeutic studies reporting on ten or more adults with insertional Achilles tendinopathy. MEDLINE, CINAHL, EMBASE (Classic) and the Cochrane database of controlled trials (1945–March 2011) were searched. The Coleman methodology score was used to assess the quality of included articles, and these were analysed with an emphasis on change in pain score, patient satisfaction and complication rate.

Results

Of 451 reviewed abstracts, 14 trials met our inclusion criteria evaluating 452 procedures in 433 patients. Five surgical techniques were evaluated; all had a good patient satisfaction (avg. 89 %). The complication ratio differed substantially between techniques. Two studies analysed injections showing significant decrease in visual analogue scale (VAS). Eccentric exercises showed a significant decrease in VAS, but a large group of patients was unsatisfied. Extracorporeal shockwave therapy (ESWT) was superior to both wait-and-see and an eccentric training regime. One study evaluated laser CO², TECAR and cryoultrasound, all with significant decrease in VAS.

Conclusions

Despite differences in outcome and complication ratio, the patient satisfaction is high in all surgical studies. It is not possible to draw conclusions regarding the best surgical treatment for insertional Achilles tendinopathy. ESWT seems effective in patients with non-calcified insertional Achilles tendinopathy. Although both eccentric exercises resulted in a decrease in VAS score, full range of motion eccentric exercises shows a low patient satisfaction compared to floor level exercises and other conservative treatment modalities.

Level of evidence

III.     

体外冲击波与小针刀疗法治疗肱骨内上髁炎疗效比较

 目的 比较体外冲击波疗法及小针刀疗法治疗肱骨内上髁炎的效果。方法 肱骨内上髁炎80例被随机分成两组, 每组40例, 分别行体外冲击波治疗和小针刀治疗, 计算并比较两组术前及术后的VAS疼痛评分、HSS肘关节功能评分。结果 小针刀及体外冲击波疗法均能明显缓解肱骨内上髁炎患者肘关节的疼痛, 两组治疗后VAS评分均低于治疗前, 差异有统计学意义(P<0.01);体外冲击波组治疗后VAS评分低于小针刀组治疗后[(1.07±0.66) vs (2.24±0.75)], 差异有统计学意义(P<0.01)。两组治疗后HSS评分均高于治疗前, 差异有统计学意义(P<0.01);体外冲击波组治疗后HSS评分高于小针刀组治疗后[(92.06±8.07) vs (83.71±7.65)], 差异有统计学意义(P<0.01)。结论 在治疗肱骨内上髁炎疼痛和恢复功能方面, 体外冲击波疗法比小针刀效果更明显。
     

体外冲击波治疗中老年女性膝关节炎的疗效观察

 目的 观察体外冲击波治疗中老年女性膝关节炎的疗效。方法 将2014-08至2014-12收集到的65例女性膝关节炎患者随机分为两组,氨糖组给予硫酸氨基葡萄糖胶囊口服, 1～2粒(0.314～0.628 g)/次,连续服用8周。冲击波组给予冲击频率为7 Hz,能量1～2 bar的发散式体外冲击波治疗,每个部位冲击2000下,1次/周,8次为一疗程。对两组患者治疗前及治疗一疗程后行视觉模拟疼痛评分(visual analog scale,VAS),膝关节功能评分(Western Ontario and McMaster University Osteoarthritis Index,WOMAC)及测量50 m快速走时间。结果 两组患者均未见严重不良反应,体外冲击波组患者疼痛缓解,平均VAS疼痛评分(3.2±2.4)较治疗前(6.8±2.2)明显下降,差异有统计学意义(P<0.05)。膝关节功能WOMAC指数均较治疗前有改善(P<0.05)。 50 m快速走平均时间(37.0±6.3)s较治疗前(39.9±7.7)s明显缩短,差异有统计学意义(P<0.05)。对照组VAS疼痛评分,膝关节功能WOMAC指数,50 m快速走时间变化无明显统计学意义。结论 相对于口服氨基葡萄糖,体外冲击波疗法治疗中老年女性膝骨关节炎无不良反应,能缓解疼痛,恢复关节功能,可作为治疗骨关节炎的新选择。     

体外冲击波治疗肩关节肌腱软组织损伤35例报道

目的:探讨体外冲击波治疗肩关节肌腱软组织损伤的技术及疗效。方法:使用放散状体外冲击波治疗机治疗35例肩关节损伤患者。治疗1个疗程后分别随访2、4、6周,使用复旦大学肩关节评分系统(FDSS)和VAS进行疗效评价。期间如有症状反复或疗效不佳者转为手术干预。治疗中采用动态VAS评价法调整能量输出。结果:32例肩伤患者完成冲击波治疗,3例肩袖撕裂患者因疗效不佳中转关节镜手术治疗。完成治疗患者的FDSS平均得分由治疗前的(44.7±7.1)分提高到治疗后6周的(92.9±2.5)分,VAS评分由治疗前的(8.1±0.9)分降到治疗后6周的(1.5±0.7)分。治疗后4周左右症状改善明显。结论:体外冲击波治疗肩关节肌腱软组织慢性损伤(如肩袖腱病、肩峰下滑囊炎、肱二头肌长头腱炎、钙化性冈上肌腱炎)效果满意。对于明显结构性损伤(如肩袖撕裂)效果不佳。     

A single application of low-energy radial extracorporeal shock wave therapy is effective for the management of chronic patellar tendinopathy

Purpose

Extracorporeal shock wave therapy (SWT) is effective for the management of chronic recalcitrant tendinopathy. The objective of the current study was to assess whether a standardized, single treatment SWT is effective for the management of chronic patellar tendinopathy

Methods

Thirty-three patients with chronic patellar tendinopathy received low-energy SWT. Thirty-three patients with chronic patellar tendinopathy received other forms of non-operative therapy (control group). Evaluation was by change in Visual Analogue Scale (VAS), Victoria Institute of Sport Assessment score for patellar tendinopathy (VISA-P) score and by Roles and Maudsley Score.

Results

Mean pre-treatment VAS scores for the control and SWT groups were 7.5 and 7.8, respectively. One month, 3 months, and 12 months after treatment, the mean VAS for the control and SWT groups were 6.7 and 4.3 (p < 0.001), 5.9 and 3.5 (p < 0.001), and 5.1 and 2.7 (p < 0.001), respectively. One month, 3 months, and 12 months after treatment, the mean VISA for the control and SWT groups were 50.7 and 65.5 (p < 0.001), 52.1 and 71 (p < 0.001), and 54.9 and 74.5 (p < 0.001), respectively. At final follow-up, the number of excellent, good, fair, and poor results for the SWT and control groups were 8 and 3 (p < 0.001), 17 and 10 (p < 0.001), 5 and 16 (p < 0.001), and 3 and 4 (p < 0.001), respectively. The percentage of patients with excellent (“1”) or good (“2”) Roles and Maudsley Scores (i.e. successful results) 12 months after treatment was statistically greater in the SWT group compared to the control group (p < 0.001).

Conclusion

A single application of radial SWT is an effective treatment for chronic patellar tendinopathy.

Level of evidence

III.     

Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes

BACKGROUND: Neovascularisation can be detected qualitatively by Power Doppler in Achilles tendinopathy. Quantitative data regarding tendon microcirculation have not been established and may be substantial. PURPOSE: To assess the microcirculation of the Achilles tendon and the paratendon in healthy volunteers as well as in athletes with either midportion or insertional tendinopathy. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In 66 physically active volunteers, parameters of Achilles tendon and paratendon microcirculation, such as tissue oxygen saturation, relative postcapillary venous filling pressures, and microcirculatory blood flow, were determined at rest at 2-mm and 8-mm tissue depths. Forty-one patients never had Achilles pain (25 men, 27 +/- 8 years), 14 patients had insertional pain (7 men, 29 +/- 8 years), and 11 patients had midportion tendinopathy (7 men, 38 +/- 13 years, not significant). RESULTS: Achilles tendon diameter 2 cm and 6 cm proximal to the insertion was increased in symptomatic tendons. Compared with the uninvolved opposite tendon, deep microcirculatory blood flow was significantly elevated at insertional (160 +/- 79 vs 132 +/- 42, P < .05) as well as in midportion tendinopathy (150 +/- 74 vs 119 +/- 34, P < .05). The microcirculation in the uninvolved opposite tendon and the normal athlete controls were not significantly different from each other (132 +/- 42 insertional asymptomatic vs 119 +/- 34 mid-portion vs 120 +/- 48 healthy tendon). Insertional paratendon deep microcirculatory flow was elevated in all groups, whereas tissue oxygen saturation and relative postcapillary venous filling pressures were not significantly different. CONCLUSION: Microcirculatory blood flow is significantly elevated at the point of pain in insertional and midportion tendinopathy. Postcapillary venous filling pressures are increased at both the midportion Achilles tendon and the midportion paratendon, whereas tissue oxygen saturation is not different among the studied groups. We found no evidence of an abnormal microcirculation of the asymptomatic limb in Achilles tendinopathy.     

Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: a randomized controlled trial

BACKGROUND: Extracorporeal shock wave therapy is a relatively new therapy used in the treatment of chronic tendon-related pain. Few randomized controlled trials have been performed on it, and no studies have examined the effectiveness of extracorporeal shock wave therapy as a frontline therapy for tendon-related pain. HYPOTHESIS: Subjects treated with active extracorporeal shock wave therapy will have higher rates of treatment success than subjects treated with sham extracorporeal shock wave therapy. DESIGN: Double-blind randomized controlled trial. METHODS: Sixty subjects who had previously untreated lateral epicondylitis for less than 1 year and more than 3 weeks were included in this study. Subjects were randomly allocated to receive 1 session per week for 3 weeks of either sham or active extra-corporeal shock wave therapy. Subjects in the active therapy group received 2000 pulses (energy flux density, 0.03-0.17 mJ/mm(2)). All subjects were provided with a forearm-stretching program. After 8 weeks of therapy, subjects were classified as either treatment successes or treatment failures according to fulfillment of all 3 criteria: (1) at least a 50% reduction in the overall pain visual analog scale score, (2) a maximum allowable overall pain visual analog scale score of 4.0 cm, and (3) no use of pain medication for elbow pain for 2 weeks before the 8 week follow-up. Visual analog scale scores were also collected for pain at rest, during sleep, during activity, at its worst, and at its least, as well as for quality of life (using the EuroQoL questionnaire) and grip strength. RESULTS: Success rates in the sham and active therapy groups were 31% and 39%, respectively. No significant difference was detected between groups (chi(2)(1)= 0.3880, P = .533). Mean change in quality of life over 8 weeks was an increase of 1.3 and 3.3 for sham and active therapy groups, respectively, and mean change in grip strength over 8 weeks was an increase of 7.4 kg and 6.8 kg for sham and active therapy groups, respectively. CONCLUSIONS: Despite improvement in pain scores and pain-free maximum grip strength within groups, there does not appear to be a meaningful difference between treating lateral epicondylitis with extracorporeal shock wave therapy combined with forearm-stretching program and treating with forearm-stretching program alone, with respect to resolving pain within an 8-week period of commencing treatment.     

冲击波疗法对训练伤冈上肌肌腱炎的疗效

 目的 探讨冲击波疗法对训练伤所致冈上肌肌腱炎的疗效。方法 回顾性分析武警特色医学中心骨科收治的236例训练伤冈上肌肌腱炎的病例,其中非钙化冈上肌肌腱炎158例(非钙化组),钙化冈上肌肌腱炎78例(钙化组),均行同样参数冲击波治疗,对比两组治疗前,治疗后6、12个月视觉模拟评分(VAS)、Constant肩关节评分。结果 与治疗前相比,治疗后6、12个月,两组VAS评分均明显降低,肩关节Constant评分显增加,差异有统计学意义(P<0.05);且治疗后6、12个月,钙化组与非钙化组比较,VAS评分更低、Constant评分更高,差异有统计学意义(P<0.05)。结论 冲击波疗法能够明显缓解训练伤冈上肌肌腱炎的疼痛症状,提高患侧肩关节功能;且对钙化性冈上肌肌腱炎疗效更好。     

移植术后早期股骨头坏死体外冲击波治疗的有效性

 目的 评估体外冲击波对移植术后单侧股骨头缺血性坏死患者减轻疼痛和减缓骨内损害进程的有效性。方法 临床评估包括VAS评分、Harris评分、RMS平片和髋关节磁共振。每个疗程包括4次治疗,每次治疗包括2400次脉冲,能量0.50 mJ/mm²,每次治疗间隔48~72 h。随访检查分别安排在第3、6、12、24个月。结果 36例(男23例,女13例)被纳入本研究,年龄45～65岁,体重45～101 kg,身高150～175 cm。共有10例治疗失败,26例症状不同程度改善。随访24个月,没有发现不良反应。在所有随访时间点上,ARCO Ⅰ期组和Ⅱ期组患者均明显优于ARCO Ⅲ期组患者(P<0.005)。结论 对于ARCO Ⅰ期和Ⅱ期的移植术后患者,ESWT可能有助于防止缺血性坏死区域的进展并控制疼痛。     

Extracorporeal shockwave for chronic patellar tendinopathy

BACKGROUND: Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies. HYPOTHESIS: Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 2. METHODS: This study consisted of 27 patients (30 knees) in the study group and 23 patients (24 knees) in the control group. In the study group, patients were treated with 1500 impulses of extracorporeal shockwave at 14 KV (equivalent to 0.18 mJ/mm(2) energy flux density) to the affected knee at a single session. Patients in the control group were treated with conservative treatments including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise program, and the use of a knee strap. The evaluation parameters included pain score, Victorian Institute of Sports Assessment score, and ultrasonographic examination at 1, 3, 6, and 12 months and then once a year. RESULTS: At the 2- to 3-year follow-up, the overall results for the study group were 43% excellent, 47% good, 10% fair, and none poor. For the control group, the results were none excellent, 50% good, 25% fair, and 25% poor. The mean Victorian Institute of Sports Assessment scores were 42.57 +/- 10.22 and 39.25 +/- 10.85, respectively, before treatment (P = .129) and 92.0 +/- 10.17 and 41.04 +/- 10.96, respectively, after treatment (P < .001). Satisfactory results were observed in 90% of the study group versus 50% of the control group (P < .001). Recurrence of symptoms occurred in 13% of the study group and 50% of the control group (P = .014). Ultrasonographic examination showed a significant increase in the vascularity of the patellar tendon and a trend of reduction in the patellar tendon thickness after shockwave treatment compared with conservative treatments. However, no significant difference in the appearance, arrangement, and homogeneity of tendon fibers was noted between the 2 groups. There were no systemic or local complications or device-related problems. CONCLUSION: Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.     

Standardized pain mapping for diagnosing Achilles tendinopathy

ObjectivesTo assess the level of agreement between patient-reported pain using a standardized pain map and the physician-determined clinical diagnosis of Achilles tendinopathy.DesignCross-sectional study.MethodsEligible patients were adults visiting a sports physician for symptoms in the Achilles tendon region. Patients completed a digital questionnaire and indicated one location on a pain map where they experienced their pain. The primary outcome measure was level of agreement (% and Kappa coefficient) between patient-reported pain on the pain map and the physician-determined clinical diagnosis (defined as localized pain associated with tendon-loading activities and pain on palpation with or without tendon thickening). The secondary outcome measure was the agreement between the location on the pain map (midportion/insertional region) with the clinical diagnosis of midportion/insertional Achilles tendinopathy.Results110 patients (mean (SD) age 48 (13), 61% men) with pain in the Achilles region were included. In 102 (93%, Kappa = 0.86, CI 0.78–0.95) patients who indicated pain in the Achilles tendon region on the pain map, the clinical diagnosis of Achilles tendinopathy was made by the sports physician. 82% of the patients had the clinical diagnosis of tendinopathy in the specific region of the tendon they marked on the pain map (Kappa = 0.67, CI 0.54–0.79).ConclusionsThere is almost perfect agreement between patient-reported pain on a pain map and a physician-established clinical diagnosis of Achilles tendinopathy. There was substantial agreement between the localization of the pain that was selected by the patient and the diagnosis of insertional/midportion Achilles tendinopathy by the physician. This tool could potentially aid in adequate triage for specialized care and for researchers performing large epidemiological studies.     

Chondral metaplasia in calcific insertional tendinopathy of the Achilles tendon.

OBJECTIVE: To ascertain whether tendon samples harvested from patients with calcific insertional Achilles tendinopathy showed features of failed healing response, and whether abnormal quantities of type II collagen had been produced in that area by these tenocytes. DESIGN: Comparative laboratory study. DESIGN: University teaching hospitals. PATIENTS: Tendon samples were harvested from eight otherwise healthy male individuals (average age 47.5+/-8.4 years, range 38 to 60) who were operated for calcific insertional Achilles tendinopathy and from nine male patients who died of cardiovascular events (mean age 63.1+/-10.9 years) while in hospital. INTERVENTIONS: Open surgery for calcific insertional Achilles tendinopathy. MAIN OUTCOME MEASURE: Semi-quantitative histochemical, immunohistochemical, and immunocytochemical methods to ascertain whether tendinopathic tendons were morphologically different from control tendons, and whether abnormal types of collagen were produced. RESULTS: Tenocytes from tendons from patients with calcific insertional Achilles tendinopathy exhibit chondral metaplasia, and produce abnormally high quantities of collagen type II and III. CONCLUSIONS: The altered production of collagen may be one reason for the histopathological alterations described in the present study. Areas of calcific insertional Achilles tendinopathy have been subjected to abnormal loads. These tendons may be less resistant to tensile forces. Further studies should investigate why some tendons undergo these changes.     

跟腱Haglund病的手术治疗

目的:研究跟腱Haglund病的手术治疗效果。方法:21例跟腱Haglund病患者保守治疗无效后采用切开或关节镜手术治疗。术前测量Fowler-Phillip角和斜平行线,术前术后分别进行VAS评分、Tegner评分和VISA-A评分。结果:术后平均随访(47.5±16.7)个月(23-72个月),与术前相比,VAS评分显著降低,Tegner评分和VISA-A评分显著提高,优良率95.2%。结论:跟腱Haglund病手术治疗可获得良好的临床效果,但需根据跟腱的病变情况确定采取关节镜或切开手术。     

Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy.

OBJECTIVE: To compare the efficacy of low-energy extracorporeal shock wave therapy (ESWT) and intralesional corticosteroid injection (CSI) for the treatment of plantar fasciopathy present for at least 6 weeks. DESIGN: A prospective, randomized, controlled, observer-blinded study over a period of 12 months. SETTING: Primary care and hospital setting. PATIENTS: A total of 132 patients were enrolled in the study, and 125 completed the study. Nineteen nonrandomized patients acted as a surrogate control group. INTERVENTIONS: All patients performed a standardized Achilles tendon and plantar fascia stretching program. The patients were randomly allocated to either treatment group A or B. Group A received a single CSI, while group B were referred for a course of low-dose ESWT comprising 3 treatments over a period of 3 weeks. Group C consisted of 19 nonrandomized patients who performed the standardized stretching program only. MAIN OUTCOME MEASUREMENTS: The worst daily pain recorded on a visual analogue scale (VAS), and the tenderness at the plantar fascia insertion as determined by an algometer. These measures were recorded immediately prior to the commencement of treatment and 3 months and 12 months posttreatment. RESULTS: With regard to VAS pain scores, values for the CSI (1.48; 0-7) were significantly lower than both ESWT (3.69; 0-8), and controls (3.58; 2-5) at 3 months. At 12 months, VAS scores for CSI (0.84; 0-7) and ESWT (0.84; 0-4) were both significantly lower than controls (2.42; 1-4). The tenderness values at 3 months were significantly higher for CSI (9.42; 7-11) than both ESWT (6.72; 4-11) and controls (7.63; 6-9). P < 0.05 was used throughout. CONCLUSIONS: Corticosteroid injection is more efficacious and multiple times more cost-effective than ESWT in the treatment of plantar fasciopathy that has been symptomatic for more than 6 weeks.     

悬吊运动疗法结合体外冲击波治疗肩周炎的疗效观察

目的：观察悬吊运动疗法（SET）结合体外冲击波（ESWT）治疗肩周炎的疗效。方法按照随机数字表法,将56例肩周炎患者随机分为两组,观察组和对照组各28例。观察组采用SET结合ESWT治疗,对照组单纯采用ESWT治疗,疗程3周,治疗前后进行VAS评分及肩关节ROM测量评分。结果观察组和对照组VAS评分和肩关节ROM均有改善,其中观察组总有效率为92.86%,对照组总有效率为78.57%;观察组VAS评分和肩关节ROM改善程度明显好于对照组,两组疗效比较差异有统计学意义（P＜0.05）。结论在ESWT治疗基础上结合SET可显著改善肩周炎患者的疼痛及运动功能受限等症状。     

Do physical tests have a prognostic value in chronic midportion Achilles tendinopathy?

ObjectivesTo determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy.DesignProspective cohort study, secondary analysis of data from a randomized trial.MethodsPatients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24 weeks, patients completed the Victorian Institute of Sports Assessment—Achilles questionnaire and performed the following physical tests: ankle dorsiflexion range of motion with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (Visual Analogue Scale; 0–100) and after 10 hops (Visual Analogue Scale-10-hops). Associations between baseline test results and improvement (Victorian Institute of Sports Assessment—Achilles scores) were determined using a Mixed Linear Model.Results80 patients were included. The mean Victorian Institute of Sports Assessment—Achilles score improved 20 points (95 % confidence interval, 16–25, P < .001) after 24 weeks. There were significant associations between the baseline ankle dorsiflexion range of motion with a bent knee (β 0.2, 95 % confidence interval 0.001 to 0.3, P = .049), the baseline pain provocation tests (Visual Analogue Scale palpation: β − 0.2; 95 % confidence interval: − 0.4 to − 0.1; P < .001, Visual Analogue Scale-10-hops: β − 0.3; 95 % confidence interval: − 0.4 to − 0.2; P < .001) and the change in the Victorian Institute of Sports Assessment—Achilles score.ConclusionsIn patients with chronic midportion Achilles tendinopathy, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities after 24 weeks than patients with high baseline pain scores.     

Repetitive low-energy shock wave treatment for chronic lateral epicondylitis in tennis players

BACKGROUND: There is conflicting evidence regarding extracorporeal shock wave treatment for chronic tennis elbow. HYPOTHESIS: Treatment with repetitive low-energy extracorporeal shock wave treatment is superior to repetitive placebo extra-corporeal shock wave treatment. METHODS: Seventy-eight patients enrolled in a placebo-controlled trial. All patients were tennis players with recalcitrant MRI-confirmed tennis elbow of at least 12 months' duration. Patients were randomly assigned to receive either active low-energy extracorporeal shock wave treatment given weekly for 3 weeks (treatment group 1) or an identical placebo extracorporeal shock wave treatment (sham group 2). Main outcome measure was pain during resisted wrist extension at 3 months; secondary measures were >50% reduction of pain and the Upper Extremity Function Scale. RESULTS: At 3 months, there was a significantly higher improvement in pain during resisted wrist extension in group 1 than in group 2 (mean [SD] improvement, 3.5 [2.0] and 2.0 [1.9]; P =.001 for between-group difference of improvement) and in the Upper Extremity Function Scale (mean [SD] improvement, 23.4 [14.8] and 10.9 [14.9]; P <.001 for between-group difference of improvement). In the treatment group, 65% of patients achieved at least a 50% reduction of pain, compared with 28% of patients in the sham group (P =.001 for between-group difference). CONCLUSION: Low-energy extracorporeal shock wave treatment as applied is superior to sham treatment for tennis elbow.     

Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes

Purpose  

The aim of this study was to investigate whether the effects of extracorporeal shock wave therapy (ESWT) could affect the behavior of primary cultured human tenocytes over a 12-day period.     

Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff

BACKGROUND: Low-energy extracorporeal shock wave therapy is an alternative treatment, with limited evidence for effectiveness, for calcific tendinitis of the rotator cuff. HYPOTHESIS: Objective localization of the calcium deposit by 3-dimensional, computer-assisted navigation reveals superior clinical and radiographic outcomes compared to localization through patient-to-therapist feedback. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: A prospective, randomized, single-blind study was carried out on 50 patients. The population was divided into 2 groups of equal numbers (navigation group and feedback group). In all patients, treatment-resistant pain was evident for longer than 6 months. A total of 3 therapy sessions of constant low-energy focused shock wave therapy was administered in weekly intervals in both groups. Local anesthesia was not applied. Radiographs and clinical assessment, including the Constant and Murley shoulder scoring system and the visual analog scale for pain, were performed both before therapy and after 12 weeks. In the navigation group, the calcium deposit was localized using a radiographically guided, 3-dimensional, computer-assisted device. The feedback group was treated after locating the point of maximum tenderness through palpation by the therapist with feedback from the patient. RESULTS: Both groups had significant improvements in the Constant and Murley score and the visual analog scale after 12 weeks. The results from the navigation group were statistically significantly superior to those of the feedback group. In the navigation group, 6 calcium deposits disappeared and 9 altered, compared to 1 disappearance and 12 alterations in the feedback group. No severe complications occurred. CONCLUSION: Three-dimensional, computer-assisted navigation reveals significantly better results and is therefore recommended when extracorporeal shock wave therapy is used in the treatment of calcific tendinitis of the rotator cuff.