Extracorporeal shockwave therapy
Extracorporeal shock wave therapy (ESWT ) is a shock wave treatment, can be treated with the following diseases:
- Nonunion, non-healing bone fractures
- Painful calcification of the shoulder ( tendinitis calcarea )
- Painful heel spur formation ( plantar fasciitis )
- Painful Trizepssehnenansatzverkalkung at the elbow ( Olecranonsporn )
- Tennis or golf elbow ( epicondylitis radialis humeri ulnaris immersive )
- Leg ulcers and chronic open wounds
- Trigger point therapy
Method
Since 1980, kidney stones can be successfully treated with shock waves. Shock waves are high-energy shock waves, the sound waves are similar, but differ considerably in energy, rise and propagation speed. The same shock waves are used since 1989 for the treatment of delayed healing bone fractures ( non-unions ) and with less energy in tendon pain ( tennis elbow, heel spurs, calcific tendonitis and several other indications).
As well as in urology sound pressure waves are generated in the combined depth of the body ( focus ) can be. This compression of the shock waves can then be rhythmic and repetitive use for disruption of a solid, for example, cause a calcification. Calcification is pulverized by the shock wave treatment to the finest particles and can then be absorbed by the body and transported via the blood and excreted.
Originally shock waves were generated by an electric spark discharge under water and focused by means of a hemiellipsoid in the therapeutic area. This method of shock wave generation ( electrohydraulic shock wave generation ), goes back to the 1970s and today, in addition to the electromagnetic and piezoelectric shock wave generation, a standard established as.
Another method is to generate shock waves through the reversal of the piezoelectric effect ( inverse piezoelectric effect ): When applying an alternating current specific quartz crystals generate shape changes by mechanical vibrations. Arranged on a concavely curved support piezoceramic elements are momentarily by a high voltage pulse, at the same time extending in the micrometer range, and generating a pressure pulse. The piezoelectric elements are precisely aligned with the therapy focus. Through precise focusing and nonlinear propagation of the pulse occurs by steepening in the treatment focus to the shock wave formation. As the only Stoßwellenereugungsprinzip the piezo shockwave thus utilizes a direct focus and does not require a separate reflector. This technology enables a compact design of the therapy source, as well as a precise, well- formable focal zone. May be able to date only directed or defocused to a point focus forms generated by this production principle mint the shape of the sound field / focus also linear.
Implementation
Calcification is with fluoroscopy " located " and thereby set the focus. The patient lies on an examination table, the affected body region is located in a section of the table on a soft, semi- round plastic pillow that is filled with water. The measures introduced in this cushion shock waves that are introduced, for example, of semicircular arranged piezoelectric crystals or by wave reflection at a hemiellipsoid, continue in the aqueous medium and are bundled into a single point.
The energy compaction is then at the center of calcification. Other body structures that are located in the vicinity of the calcification ( for example, blood vessels, nerves, tendons ) are indeed detected by the shock wave, but not damaged, since they are not in the focus of the shock wave. A single shock wave is heard as a loud sound and is perceived as a shock, such as with a small hammer. The frequency of collisions is about 60-300 per minute, the shock strength can be adjusted to the calcification.
In near-surface treatments, such as when leg ulcers, the shock waves are not focused, but broad surface areas in the therapeutic area. This requires a strong source of energy, since the total energy of the shock wave is distributed over a larger area and thus becomes weaker. However, in order not to lose the effect, it must be ensured that the entire therapeutic area to shock waves with sufficient pressure to reach the diseased cells. In addition to the defocused shock waves here comes the linear focusing piezoelectric shock wave used.
Current research suggests that to about 50 to 100 shock waves per square centimeter treatment area be applied. Therapy, therefore, takes about two to five minutes and can be performed as an outpatient without anesthesia.
The shock waves are undergoing therapy in the tissue a " biomechanical feedback " and the " participation of mediators ' cause that initiate both repair processes and circulation-promoting processes. The cost 60-380 euros per session. The healing process is completed depending on the severity of the disease, in the majority of cases after a few weeks successfully.
Unwanted side effects
In addition to bruising may cause swelling or superficial bruising. Rare reports of a short-term increase in pain in the treatment area. Inappropriate handling may cause damage to the bony structures, blood vessels, nerves or tendons with early and late effects.
The perceived pain during treatment are differentially perceived willingness anesthesia is maintained, if the pain is too strong. If the initial symptoms have not become significantly better after three sessions, therapy should not be continued.
The ESWT as treatment of complaints in the field of orthopedics does not apply in Germany as a power of the statutory health insurance. The cost of treatment, the patient has to pay.
Also in the ESWT treatment failures and there are cases in which amplify the symptoms after treatment. It requires a careful indication.