Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome

BACKGROUND Active myofascial trigger points(TrPs)often occur in the upper region of the upper trapezius(UT)muscle.These TrPs can be a significant source of neck,shoulder,and upper back pain and headaches.These TrPs and their related pain and disability can adversely affect an individual’s everyday routine functioning,work-related productivity,and general quality of life.AIM To investigate the effects of instrument assisted soft tissue mobilization(IASTM)vs extracorporeal shock wave therapy(ESWT)on the TrPs of the UT muscle.METHODS A randomized,single-blind,comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo.Forty patients(28 females and 12 males),aged between 20-years-old and 40-years-old,with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups(A and B).Group A received IASTM,while group B received ESWT.Each group was treated twice weekly for 2 weeks.Both groups received muscle energy technique for the UT muscle.Patients were evaluated twice(pre-and posttreatment)for pain intensity using the visual analogue scale and for pain pressure threshold(PPT)using a pressure algometer.RESULTS Comparing the pre-and post-treatment mean values for all variables for group A,there were significant differences in pain intensity for TrP1 and TrP2(P=0.0001)and PPT for TrP1(P=0.0002)and TrP2(P=0.0001).Also,for group B,there were significant differences between the pre-and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2(P=0.0001).There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1(P=0.9)and TrP2(P=0.76)and PPT for TrP1(P=0.09)and for TrP2(P=0.91).CONCLUSION IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs.There is no significant difference between either treatment method.

Extracorporeal shock wave for plantar flexor spasticity in spinal cord injury:A case report and review of literature

BACKGROUND Approximately 65%-78%of patients with a spinal cord injury(SCI)develop any symptom of spasticity.The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal shock wave therapy(r ESWT)on plantar flexor spasticity in a patient with incomplete SCI.CASE SUMMARY An 18-year-old man with an incomplete SCI completed five sessions of r ESWT.The primary outcomes were the changes in ankle-passive range of motion(APROM)and passive resistive force to ankle dorsiflexion.The outcomes were assessed at baseline(T0),immediately after treatment(T1)and 1 wk after the end of treatment(T2).The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0.The passive resistive force to ankle dorsiflexion at low velocity decreased by 33%at T1 and 55%at T2 in the gastrocnemius muscle and by 41%at T1 and 39%at T2 in the soleus muscle compared with T0.At high velocity,it also decreased by 44%at T1 and 30%at T2 in the gastrocnemius muscle compared with T0.However,in the soleus muscle,the change was minor,with a decrease of 12%at T1 and increased by 39%at T2 compared with T0.CONCLUSION In this patient,the findings showed that r ESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term.Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.

Ultrasonographic evaluation of the effect of extracorporeal shock wave therapy on calcific tendinopathy of the rectus femoris tendon:A case report

BACKGROUND Calcific tendinopathy denotes calcific deposits in a specific tendon.It is also known as calcifying tendinitis,calcifying periarticulitis,or periarticular apatite deposition disease.Recently,extracorporeal shock wave therapy(ESWT)has been reported to be effective in relieving and treating pain in calcific tendinopathy.CASE SUMMARY A 36-year-old female patient suffered from left hip joint pain for six months.The pain was increased during abduction of the hip,waking,and jumping.B-mode ultrasonography was performed by a physiatrist with an L12-5 linear transducer.A single session of ESWT was given in the marking area under ultrasound guidance at 4 Hz,2500 shots with intensity of stimulation using energy of 0.1 mJ/mm2.The hip pain of the patient slowly decreased within 4 wk after starting the ESWT.After six weeks of ESWT,her hip pain was completely resolved.However,the size of calcification showed almost no reduction in simple radiography at the final follow-up.CONCLUSION Ultrasonography is a very good modality not only for diagnosing calcified tendinitis by classical appearance,but also for evaluating the effect of ESWT during the follow-up period.

Low-intensity extracorporeal shock wave therapy for midshaft clavicular delayed union: A case report and review of literature

BACKGROUND One of the most common complications following surgery for midshaft clavicle fracture is nonunion/delayed union.Extracorporeal shock wave therapy(ESWT)is an alternative to promote new bone formation without surgical complications.To date,no literature has reported low-intensity ESWT(LI-ESWT)in delayed union of midshaft clavicle fracture.CASE SUMMARY We reported a 66-year-old Chinese amateur cyclist with clavicle delayed union treated with 10 sessions of LI-ESWT(radial,0.057 mJ/mm^(2),3 Hz,3000 shocks).No anesthetics were applied,and no side effects occurred.At the 4 mo and 7 mo follow-ups,the patient achieved clinical and radiographical recovery,respectively.CONCLUSION In conclusion,our findings indicated that LI-ESWT could be a good option for treating midshaft clavicular delayed union.

Extracorporeal shock wave therapy treatment of painful hematoma in the calf:A case report

BACKGROUND Extracorporeal shock wave therapy (ESWT) can be applied to variousmusculoskeletal conditions including calcific tendinitis. Muscle injuries can leadto hematomas, and unabsorbed hematomas sometimes cause pain. We report acase of painful hematoma successfully treated with ESWT. To our knowledge, thisis the first reported case of painful intramuscular hematoma treated with ESWT.CASE SUMMARY A 65-year-old man visited the outpatient department for left calf pain withswelling that had persisted since he slipped two weeks prior. The calf pain hadpersisted and was rated visual analog scale 7. On physical examination, there wasa localized, stiff, ovoid mass on his left upper posterior calf. The pain wasaggravated by dorsiflexion of the left ankle or weight-bearing on the left foot.Initial diagnostic ultrasonography showed a hematoma in the left gastrocnemiusmuscle;its texture was firm with low heterogeneity. We applied ESWT to thehematoma. His pain decreased immediately to a visual analog scale 3, and themass was softened. The texture of the hematoma became more heterogeneous onultrasonography. Due to planned overseas travel, he returned three months afterthe initial visit to report that the pain and swelling were dramatically relievedafter ESWT.CONCLUSION We propose that painful hematomas could be a new indication for ESWT. Furtherinvestigation on the effects of ESWT for hematomas is needed.

Selection of Reference Genes in Equine White Blood Cells for Real Time PCR Normalization Following Extracorporeal Shock Wave Therapy

Selection of proper reference genes (RGs) is an essential step needed for accurate normalization of results from genomic studies. Expression of RGs is regulated by many factors such as species, age, gender, type of tissue, the presence of disease, and the administration of therapeutic treatment. The aim of the present study was to identify optimal RGs in a set of blood samples collected at different time points (0, 24, 48, 72 h) from horses following administration of extracorporeal shock wave therapy (ESWT). The mRNA expression of twelve RGs: HPRT1, ACTB, HSP90A, SDHA, GUSB, B2M, UBC, NONO, TBP, H6PD, RPL32, GAPDH was determined using real time quantitative polymerase chain reaction (qPCR). An SAS program developed on the algorithm of geNorm, SASqPCR, was used to determine stability of the expression and the number of optimal RGs. The results showed that the range of quantification cycle (Cq) values of the evaluated genes varied between 17 and 26 cycles, and that one optimal RG, ACTB, was sufficient for normalization of gene expression. Results of stability of expression demonstrated that ACTB was the optimal choice for all the samples studied. Notably, in samples collected at 72 h post ESWT, TBP showed a significant change in the expression level, and was not suitable for use as a RG. These results substantiate the importance of validating and selecting an appropriate RG.

Can extracorporeal shock-wave therapy be used for the management of lateral elbow tendinopathy?

Lateral elbow tendinopathy(LET) is one of the two most common tendinopathies of the upper limb. The most effective treatment in the management of LET is the exercise program. Clinicians combine exercise program with other physiotherapy, electrotherapeutic and no, techniques. Extracorporeal shock wave therapy(ESWT) is one of the most common recommended electrotherapeutic modalities for the management of LET. Further research is needed to find out the optimal treatment protocol of ESWT in the management of

Indications and contraindications for shock wave lithotripsy and how to improve outcomes

For over 35 years shock wave lithotripsy has proven to be an effective,safe and truly minimally invasive option for the treatment of nephrolithiasis.Various technical factors as well as patient selection can impact the success of the procedure.We used published work focusing on outcomes of shock wave lithotripsy,risk of complications,and strategies for improving stone fragmentation to create this review.Multiple patient and technical factors have been found to impact success of treatment.Skin to stone distance,stone density and composition,size and location of the stone within the urinary system all influence stone free rates.A slower rate with a gradual increasing voltage,precise targeting,proper coupling will improve stone fragmentation and decrease risk of complications.The selection of appropriate patients through a shared decision making process and attention to the technical factors that improve stone free rates is key to providing an effective treatment and patient satisfaction.

基于PVDF柔性传感器的不同介质中冲击波波源测量与频谱分析

目的明确体外冲击波系统冲击头在不同介质界面产生的冲击波波源特征。方法采用冲击气压可调的体外冲击波产生与信号采集实验系统,结合聚偏二氟乙烯(PVDF)柔性传感器,通过实验测量方法研究冲击头在不同介质(仿体组织、水和空气)界面产生的冲击波形,分析波源的时域特征和频谱特性。结果在相同气压冲击下,冲击头在仿体界面和水界面产生的冲击波波形相似,二者与空气界面产生的冲击波波形存在较大差异,空气界面的正负压绝对值明显减小;不同介质中产生的冲击波频谱特性相似,都存在3个明显的峰值频率,仿体、水和空气中调制频率分别为12.2、8.5、7.2 kHz,载波频率基本无变化(82~83 kHz)。不同气压冲击下,冲击头在同一介质界面产生的冲击脉冲波波形差异不大,冲击气压仅影响冲击波幅度,不影响峰值频率。随着冲击气压的增大,介质界面正负压绝对值增大,变化基本呈线性。结论PVDF柔性传感器可以有效测量冲击波波源,不同介质界面产生的冲击波在时域和频域都存在一定差异,不能简单以空气或水中的冲击波传播特性代替生物组织中的传播特性。研究结果可以为冲击波设备的评估和临床冲击波治疗方案的制定提供重要信息。

Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein-2 and Osteoprotegerin in Osteoporotic Fracture in Rats

Background：Roughly focused extracorporeal shock waves therapy （ESWT） is characterized by a wide focal area,a large therapy zone,easy positioning,and less pain during treatment.The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin （OPG） and bone morphogenetic protein-2 （BMP-2） in osteoporotic fractures in rats.Methods：Seventy-two female Sprague-Dawley （SD） rats,3 months old,were divided into sham-operated group （n =6） and an ovariectomized （OVX） group （n =66）.Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation.The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm^2,60 doses/min,and 2000 pact quantities.The contralateral right tibia was left untreated and served as a control.Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry,real-time polymerase chain reaction （PCR）,and Western blotting analysis.Results：Bone mineral density （BMD） at the proximal tibia,femur,and L5 spine was significantly reduced after ovariectomy.BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group.Meanwhile,bilateral oophorectomy resulted in a lower trabecular bone volume fraction （BV/TV） in the proximal tibia of the sham-OVX animals.Three months after bilateral oophorectomy,BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs （P 〈 0.001）.These data showed that the SD rats became a suitable model of osteoporosis,3 months after they were OVX.Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group.Compared with the contralateral controls,decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT,followed by a later increase at 7 days,was indicated by real-time PCR and Western blotting analysis.The OPG messenger RNA （mRNA） expression levels peaked at 6 weeks after the shock wave treatment,paired with a much earlier （at 4 weeks） increase of BMP-2,and declined close to normal at 8 weeks.Conclusions：Roughly focused ESWT may promote the expression of OPG and BMP-2 in the osteoporotic fracture area in rats.BMP-2 and OPG may act synergistically and may lead to a significant enhancement of bone formation and remodeling.

Usefulness of radial extracorporeal shock wave therapy for the spasticity of the subscapularis in patients with stroke： a pilot study

Background There are not many studies about treatment of shoulder spasticity. Although botulinum toxin injection has been reported to be effective for shoulder spasticity, the effectiveness was judged by pain and limited motion change, but not the spasticity itself. Shoulder spasticity is considered to play an important role in hemiplegic frozen shoulder. However, the subscapularis muscle, unlike the pectoralis major muscle, is located deep beneath scapula, where conventional injection is difficult to perform. As extracorporeal shock wave therapy （ESWT） has been reported to be effective for spasticity relief, and we thought spasticity of subscapularis muscle located deep beneath the scapula would be a good candidate for ESWT treatment. This study was to evaluate the beneficial effects of radial ESWT （rESWT） on spastic subscapularis muscle in stroke patients. Methods This is an uncontrolled, prospective, unicenter, clinical pilot study. Stroke patients （n=57; mean age 55.4 years） with spastic shoulders were recruited between June 2011 and February 2012 at the University Rehabilitation Hospital. rESWT was administered to each patient every two or three days for two weeks （five total treatments）. Evaluation consisted of 11 measurements for each patient; at the start of each of the five treatments and once per week during the following six weeks. Spasticity was measured at external rotator muscles of the shoulder using the modified Ashworth scale （MAS）, and passive range of motion （ROM） of the shoulder in external rotation was recorded. Pain was measured using a visual analogue scale （VAS） during passive ROM of the shoulder in external rotation, and was additionally recorded for patients who preserved cognitive and communicative ability （Pain group）. Results Reduction in MAS and VAS and improvement of ROM during and after rESWT treatments were prominent compared to baseline. The reduction in MAS and VAS and improvement of ROM continued four weeks after the last treatment and the effects of the treatment decreased afterward. Conclusion rESWT will be able to provide stroke patients with an effective and safe procedure for the reduction of spasticity and pain as well as for the improvement of ROM of spastic shoulders.

Low-intensity extracorporeal shock wave therapy for Peyronie’s disease:a single-center experience

The aim of this article is to assess the outcomes of a low-intensity extracorporeal shock wave therapy(LiESWT)protocol for the treatment of Peyronie’s disease(PD).Patients treated for PD were prospectively recorded,and data were retrospectively reviewed.Age,characteristics of fibrous plaques,concomitant treatments,International Index of Erectile Function(IIEF-5),Lue score,and pain score on Likert scale were collected.Patients in acute phase of PD and an angulation of<40°were included.The protocol consisted of 6 weekly sessions of 4000 pulses each,applied from different directions,with a maximal power of 20 W and 8 Hz frequency.We included 39 patients(median age:56.8 years,interquartile range[IQR]:35.8–62.2 years).The median number of sessions received per patient was 7.2.After treatment,the median Lue score decreased from 6.8 initially to 3.3(P=0.003),the median Likert pain score dropped from 1.8 to 0.7(P=0.004),the median plaque size was reduced from 2 cm to 1.2 cm(P=0.08),and the median penile curvature diminished from 31°to 17°(P=0.07).On univariate and multivariate analysis,the only predictors of success were younger age(odds ratio[OR]=0.95,P=0.03 and OR=0.91,P=0.04,respectively)and concomitant use of phosphodiesterase-5 inhibitors(PDE5i;OR=0.92,P=0.02 and OR=0.93,P=0.01,respectively).LiESWT had a favorable impact on Lue score and notably penile pain,curvature,plaque size,and erectile function in patients treated for PD during the early inflammatory phase,with no side effects.Younger age and concomitant use of PDE5i were the only success predictors.

Low-intensity extracorporeal shock wave therapy promotes recovery of sciatic nerve injury and the role of mechanical sensitive YAP/TAZ signaling pathway for nerve regeneration

Background:Histological and functional recovery after peripheral nerve injury(PNI)is of significant clinical value as delayed surgical repair and longer distances to innervate terminal organs may account for poor outcomes.Low-intensity extracorporeal shock wave therapy(LiESWT)has already been proven to be beneficial for injured tissue recovery on various pathological conditions.The objective of this study was to explore the potential effect and mechanism of LiESWT on PNI recovery.Methods:In this project,we explored LiESWT’s role using an animal model of sciatic nerve injury(SNI).Shockwave was delivered to the region of the SNI site with a special probe at 3 Hz,500 shocks each time,and 3 times a week for 3 weeks.Rat Schwann cells(SCs)and rat perineurial fibroblasts(PNFs)cells,the two main compositional cell types in peripheral nerve tissue,were cultured in vitro,and LiESWT was applied through the cultured dish to the adherent cells.Tissues and cell cultures were harvested at corresponding time points for a reverse transcription-polymerase chain reaction,Western blotting,and immunofluorescence staining.Multiple groups were compared by using one-way analysis of variance followed by the Tukey-Kramer test for post hoc comparisons.Results:LiESWT treatment promoted the functional recovery of lower extremities with SNI.More nerve fibers and myelin sheath were found after LiESWT treatment associated with local upregulation of mechanical sensitive yes-associated protein(YAP)/transcriptional co-activator with a PDZ-binding domain(TAZ)signaling pathway.In vitro results showed that SCs were more sensitive to LiESWT than PNFs.LiESWT promoted SCs activation with more expression of p75(a SCs dedifferentiation marker)and Ki67(a SCs proliferation marker).The SCs activation process was dependent on the intact YAP/TAZ signaling pathway as knockdown of TAZ by TAZ small interfering RNA significantly attenuated this process.Conclusion:The LiESWT mechanical signal perception and YAP/TAZ upregulation in SCs might be one of the underlying mechanisms for SCs activation and injured nerve axon regeneration.

Efficacy of radial extracorporeal shock wave therapy compared with botulinum toxin type A injection in treatment of lower extremity spasticity in subjects with cerebral palsy: A randomized, controlled, cross-over study

Objectives To investigate whether botulinum toxin type A (BTX-A) injection is more effective than radial extracorporeal shock wave therapy in reducing plantar flexor muscle spasticity in subjects with cerebral palsy.Methods A total of 68 subjects with cerebral palsy were randomly allocated to BTX-A injection (Group 1) or radial extracorporeal shock wave therapy (Group 2) (first experiment;E1). Outcome was evaluated using the Tardieu V1 and V3 stretches, at 3 weeks, 2 months (M2) and M3 after baseline. At M6 subjects in Group 1 received radial extracorporeal shock wave therapy and subjects in Group 2 received BTX-A injection (second experiment;E2);outcome was evaluated as in E1. Treatment success was defined as improvement in foot dorsiflexion ≥10° when performing the V3 stretch at M2 in both experiments.Results In both experiments mean V1 and V3 significantly improved over time. In E1 both treatments resulted in similar treatment success. In E2 fewer subjects treated with BTX-A injection reached the criteria of treatment success than did subjects treated with radial extracorporeal shock wave therapy, which was due to a carry-over effect from E1. No significant complications were observed.Conclusion BTX-A injection is not superior to radial extracorporeal shock wave therapy in the treatment of plantar flexor muscle spasticity in subjects with cerebral palsy.

Clinical efficacy evaluation of body acupuncture and scalp acupuncture combined with extracorporeal shock wave for scapulohumeral periarthritis

Objective:To observe the short-and long-term clinical efficacy differences of body acupuncture and scalp acupuncture combined with extracorporeal shock wave and simple extracorporeal shock wave.Methods:Sixty patients with scapulohumeral periarthritis were randomly divided into two groups:the treatment group and control group,30 cases in each one.Both groups underwent basic rehabilitation training.Patients in the treatment group were treated with body acupuncture and scalp acupuncture combined with extracorporeal shock wave.Yújì(鱼际 LU10),Hégǔ(合谷L14),Zhōngzhǔ(中渚TE3),Hòuxī(后溪SI3).There were three needles for the scalp acupuncture with the first between Shéntíng(神庭 GV24)and Yìntáng(印堂 EX-HN3),and the other two straightly through the inner canthus and parallel to the first needle.Shock wave treatment was intensively applied in some pressure points around shoulder joint.The control group used the same shock wave therapy as the treatment group.Both groups were all treated once a day,6 times a week.Patients were treated for one course which lasted for 4 weeks.VAS score,the Constant-Murley score and the HAMA(the Hamilton Anxiety Scale)are as therapeutic effect index.30 days telephone investigation followed-up after the treatment course was evaluated.Results:Totally 28 cases completed the clinical observation in the treatment group,and 29 cases in the control group.The total effective rate of the treatment group was 85.7%(24/28),which was higher than 69.0%(20/29)of the control group(P<0.05).VAS score:There were significant statistical differences before and after the treatment in the two groups(the treatment group:6.67 ± 1.43 vs 3.47 ± 1.35,the control group:7.57 ± 1.31 vs 5.36 ± 1.45,both P<0.05).There were significant statistical differences before the treatment and at the follow-up in the two groups(the treatment group:6.67 ± 1.43 vs2.68±0.81,the control group:7.57±1.31 vs 4.56±1.35,both P<0.05).The VAS scores of the treatment group after treatment and at the follow-up were respectively lower than those of the control group(both P<0.05).Shoulder joints activity score:There were significant statistical differences before and after the treatment in the two groups(the treatment group:54.65±1.65 vs 65.54±2.19,the control group:54.32 ± 2.31 vs 61.01 ± 0.95,both P<0.05).There were significant statistical differences before treatment and at follow-up in the two groups(the treatment group:54.65 ± 1.65 vs 66.18± 1.35,the control group:54.32 ± 2.31 vs 62.11 ± 1.49,both P<0.05).The shoulder activity scores of the treatment group after treatment and at follow-up were respectively higher than those of the control group(both P<0.05).HAMA scores:There were singificant statistical differences before and after treatment in the two groups(the treatment group:16.83 ± 1.56 vs 13.26 ± 2.36,the control group:17.04 ± 1.84 vs 15.23 ±3.17,both P<0.05).There were significant statistical differences before treatment and at follow-up in the two groups(the treatment group:16.83 ± 1.56 vs 11.01 ± 3.20,the control group:17.04 ± 1.84 vs 13.68 ± 2.49,both P<0.05).The HAMA scores of the treatment group after treatment and at follow-up were lower than those of the control group(both P<0.05).Conclusion:Body acupuncture and scalp acupuncture combined with extracorporeal shock wave can relieve the clinical symptoms of patients with scapulohumeral periarthritis,ease anxiety and improve daily life activities.

Long-term efficacy of extracorporeal shock wave therapy on lower limb post-stroke spasticity: a systematic review and meta-analysis of randomized controlled trials

Objectives The purpose of this systematic review and meta-analysis is to evaluate the long-term efficacy of Extracorporeal Shock Wave Therapy (ESWT) on reducing lower limb post-stroke spasticity in adults.Methods A systematic electronic search of PubMed/ MEDLINE, Physiotherapy Evidence Database (PEDro), Scopus, Ovid MEDLINE(R), and search engine of Google Scholar was performed. Publications that ranged from January 2010 to August 2020, published in English, French, Spanish, Portuguese, and Italian language and available as full texts were eligible for inclusion and they were searched without any restrictions of country. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Two authors screened the references, extracted data, and assessed the risk of bias. The primary outcome was spasticity grade mainly assessed by the Modified Ashworth Scale (MAS). Secondary outcomes were passive range of motion (PROM), pain intensity, electrophysiological parameters, gait assessment, and adverse events.Results A total of seven recent randomized controlled trials (RCTs) were included in the systematic review and meta-analysis, and a beneficial effect on spasticity was found. The high level of evidence presented in this paper showed that ESWT ameliorates spasticity considering the parameters: MAS: standardized mean difference (SMD)=0.53;95% confidence interval (95% CI): (0.07-0.99);Modified Tardieu Scale (MTS): SMD=0.56;95% CI: (0.01-1.12);Visual Analogue Scale (VAS): SMD=0.35;95% CI: (-0.21-0.91);PROM: SMD=0.69;95% CI: (0.20-1.19).Conclusions ESWT presented long-term efficacy on lower limb post-stroke spasticity, reduced pain intensity, and increased range of motion. The effect of this novel and non-invasive therapy was significant and the intervention did not present adverse events, proving a satisfactory safety profile.

Synergic use of botulinum toxin injection and radial extracorporeal shockwave therapy in Multiple Sclerosis spasticity

Background and aim In Multiple Sclerosis(MS)spasticity worsen patient′s quality of life.Botulinum NeuroToxin TypeA(BoNT-A)is extensively used in focal spasticity,frequently combined with physical therapies.Radial extracorporeal shock waves(rESW)were already used in association with BoNT-A.Considering that loss of efficacy and adverse events are determinants of BoNT-A treatment interruption,this study aimed to evaluate the possibility to prolong BoNT-A′s effect by using rESW in MS focal spasticity.Methods Sixteen MS patients with spasticity of triceps surae muscles were first subjected to BoNT-A therapy and,four months later,to 4 sections of rESWT.Patients were evaluated before,30,90 days after the end of the treatments,by using Modified Ashworth Scale(MAS),Modified Tardieu Scale(MTS)and kinematic analysis of passive and active ankle ROM.Results BoNT-A determined a significant reduction of spasticity evaluated by MAS with a reduction of positive effects after 4months(P<0.05);MTS highlighted the efficacy only 90 days after injection(P<0.05).rESWT decreased MAS values at the end and 30 days later the treatment(P<0.01);MTS values showed instead a prolonged effect(P<0.01).BoNT-A determined a gain of passive and active ankle ROM,persisting along with treatment and peaking the maximum value after rESWT(P<0.05).Conclusions rESWT can prolong BoNT-A effect inducing significant reduction of spasticity and improvement in passive and active ankle ROM in MS patients.The use of rESWT following BoNT-A injection is useful to avoid some limitations and to prolong the therapeutic effects of BoNT-A therapy.

体外冲击波治疗脑卒中后功能障碍的研究进展

体外冲击波疗法(ESWT)由于其安全、无创、方便及疗效好等特点,一直以来被广泛应用于康复医学中,特别是肌肉骨骼康复的骨科术后或外伤炎症康复当中,而相比之下,ESWT在神经康复中的应用较少。神经系统疾患中的脑卒中,已成为我国居民的第一位死亡原因,具有高发病率、高死亡率和高致残率等特点。脑卒中后遗留的功能障碍,给无数患者及其家庭造成了极大的困扰。近些年来,越来越多的研究者开始尝试把体外冲击波应用在脑卒中后功能障碍的康复治疗中,本文对其近十年的相关临床应用进行统合、对比及分析,希望能为未来的脑卒中康复提供新的思路与应用依据。

体外冲击波治疗通过激活Wnt5a/Ca^(2+)信号通路改善大鼠股骨牵张成骨的分子机制

目的 探究体外冲击波治疗通过激活Wnt5a/Ca^(2+)信号改善大鼠股骨牵张成骨的机制。方法 60只8周龄Sprague Dawley雄性大鼠分为对照组、股骨牵张模型组和体外冲击波疗法(extracorporeal shock wave therapy,SWT)组(n=20)。使用Cat Walk XT系统测量大鼠步态参数。通过显微CT(Micro-CT)扫描分析大鼠股骨形态。组织病理学分级采用Mankin评分标准,并分析软骨下骨各区域Wnt5a阳性细胞百分比。实时聚合酶链反应分析大鼠股骨Ⅰ型胶原和骨桥蛋白mRNA表达。免疫组织化学染色分析骨形态发生蛋白2(bone morphogenetic protein 2,BMP2)、血管内皮生长因子(vascular endothelial growth factor,VEGF)和增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)的表达。蛋白印迹分析Wnt5a/Ca^(2+)信号通路蛋白表达。结果 模型组摆动速度、最大接触面积、单站姿、占空比和支架摆动时间低于对照组,ESWT组摆动速度、最大接触面积、单站姿、占空比和支架摆动时间高于模型组(P<0.05)。模型组骨小梁体积分数、小梁厚度和骨密度小于对照组,ESWT组骨小梁体积分数、小梁厚度和骨密度大于模型组(P<0.05)。模型组股关节病理组织学(Mankin)评分高于对照组,Wnt5a阳性细胞数量少于对照组,ESWT组股关节Mankin评分低于模型组,Wnt5a阳性细胞数量多于模型组(P<0.05)。与对照组相比,模型组大鼠软骨下骨板浅表区可见骨细胞陷窝,ESWT组股关节面损伤程度明显减轻(P<0.05)。ESWT诱导模型大鼠Wnt5a标记明显增加(P<0.05)。模型组Ⅰ型胶原和骨桥蛋白mRNA表达低于对照组,ESWT组Ⅰ型胶原和骨桥蛋白mRNA表达高于模型组(P<0.05)。模型组BMP2、VEGF和PCNA染色阳性细胞少于对照组,ESWT组BMP2、VEGF和PCNA染色阳性细胞多于模型组(P<0.05)。模型组CaMKⅡ、PLC、Wnt5a蛋白表达高于对照组,PKC蛋白表达高于对照组,ESWT组CaMKⅡ、PLC、Wnt5a蛋白表达低于模型组,PKC蛋白表达低于模型组(P<0.05)。结论 体外冲击波治疗通过激活Wnt5a/Ca^(2+)信号通路促进大鼠股骨牵张成骨新生血管形成、细胞增殖和成骨生长因子的表达,改善骨力学性能和骨矿化加速。

关刺结合体外冲击波治疗卒中后下肢痉挛的疗效观察

目的观察关刺结合体外冲击波治疗卒中后下肢痉挛的疗效并探寻其作用机制。方法70例患者随机分为观察组(35例,脱落2例)与对照组(35例,脱落1例)。两组均予以常规内科治疗及常规康复训练,对照组进行体外冲击波治疗,观察组在对照组基础上联合关刺治疗,治疗前和治疗3周后分别评定两组患者改良Ashworth量表(MAS)、Fugl-Meyer运动功能评分下肢部分(FMA-LE)、改良Barthel指数(MBI),并运用超声评估偏瘫侧腓肠肌的肌肉厚度(MT)、肌纤维长度(FL)、羽状角(PA),最后进行临床疗效评定。结果两组治疗后MAS评分与治疗前比较均下降,FMA-LE评分、MBI评分则均提高,且观察组均优于对照组(P<0.05)。两组治疗后患者腓肠肌超声各指标MT、FL、PA均改善,且观察组均优于对照组(均P<0.05)。观察组总有效率为81.82%,高于对照组的58.82%(P<0.05)。两组均未出现严重不良反应。结论关刺结合体外冲击波治疗能够改善卒中后下肢痉挛状态,可提高下肢运动功能与日常生活活动能力,有利于卒中后下肢痉挛的恢复。