Shock waves are high-energy acoustic waves that are introduced into bodily tissue via the surface of the skin. This increases metabolic activity in the treatment zone, and healing processes are stimulated or accelerated. Depending on the setting, solid structures (e.g. calcifications) can also be effectively treated this way.
In this article, Dr Nikolaos Barotsis treated a 55-year old lady who was suffering from lateral elbow pain when lifting or grasping heavy objects for several months. On clinical examination she presented typical signs of lateral epicondylitis of the elbow. The ultrasound examination revealed diffuse hypoechogenicity and thickening of the CET at its origin, the presence of an osteophyte and small intratendinous tears (fissures).
Prior to treatment with shockwave, the patient received non-steroidal anti-inflammatory drugs (NSAIDs) for one week, followed by a program of stretching and progressive strengthening exercises of the extensors of the wrist & fingers and applied a forearm counterforce brace.
After two weeks, the patient still complained of severe pain; the clinical examination and ultrasound scan did not present any improvement.
The patient underwent five ESWT sessions in weekly intervals. Dr Nikolaos Barotsis used a focused shockwave and (DUOLITH SD1 T-TOP »ultra« , manufactured by STORZ MEDICAL) & a stand-off 2. Ultrasound examination was performed before each session, the skin was marked over the area presenting pathological findings and ESWT was applied.
Trigger points were treated with approximately 400 pulses/point using the same settings as for the scanning. The focused shock wave therapy was complemented by D-Actor application (2500 pulses, 1.4-1.6bar, 18Hz) and V Actor treatment (3000pulses, 1.6bar, 31Hz) of the muscles presenting myofascial trigger points.
Results
At the last session, the ultrasound scan showed signs of milder tendinopathy in comparison with the first examination and complete healing of the tears. The pain also decreased from 9 on visual analogue scale (VAS) before the first treatment to 3 at the last session. The patient was also completely symptom free one month later.
