Regenerative therapy is one of the most challenging and intriguing branches of modern medicine. Basic research has demonstrated the effectiveness of extracorporeal shockwaves (ESWT) in stimulating biological activities that involve intra-cell and cell-matrix interactions. These interactions are at the basis of the current clinical applications, and open the horizons to new applications in tissue regeneration. It is also feasible that shock waves could be used to treat various orthopaedic pathologies, removing the need for surgery. However, suitable translational studies need to be performed before ESWT can become a valid alternative to surgery.

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Extracorporeal Shock Wave Therapy in Musculoskeletal Disorders: A Review

Purpose
The aim of this study is to better inform the sports surgeon of current evidence for the treatment of Jones fractures of the base of the 5th metatarsal. The study aimed to establish what the outcomes were for different treatments modalities. By doing this, the clinician will be better prepared to institute a logical, evidence-based approach to the treatment of their patients with this injury.

Treatment and return to sport following a Jones fracture of the fifth metatarsal: a systematic review

Extracorporeal Shock Wave Therapy (ESWT) for the treatment of musculoskeletal diseases is a field that is developing rapidly and attracting increasing attention. In the last 10 years, ESWT has become the treatment of choice for many orthopaedic disorders such as plantar fasciitis, lateral epicondylitis of the elbow, calcific tendinopathy of the shoulder and nonunion of long bone fractures. Evidence from basic research accredits the therapeutic outcome to biological effects. Most research into shock waves is focussed on understanding the mechanisms which result in a mechanosensitive feedback between the acoustic impulse and the stimulated cells, involving specific transduction pathways and gene expression. These concepts legitimate the potential role of ESWT in regenerative therapy and in treating other, new pathological conditions in which both incisive metabolic stimulation and angiogenesis are required, such as skin ulcers and “difficult” wounds, osteonecrosis or myocardial ischemia. Other research looks at further, more advanced clinical applications for ESWT, such as treating pathologies like muscle spasticity from neurological lesions, parodontopathies and cellulitis.

C linical Application of Extracorporeal Shock Wave Therapy in Musculoskeletal Disorders: A Review

Although phosphodiesterase type 5 inhibitors (PDE5Is) are a revolution in the treatment of erectile dysfunction (ED) and have been marketed since 1998, they cannot restore pathological changes in the penis. Low-energy shock wave therapy (LESWT) has been developed for treating ED, and clinical studies have shown that LESWT has the potential to affect PDE5I non-responders with ED with few adverse effects. Animal studies have shown that LESWT significantly improves penile hemodynamics and restores pathological changes in the penis of diabetic ED animal models. Although the mechanisms remain to be investigated, recent studies have reported that LESWT could partially restore corpus cavernosum fibromuscular pathological changes, endothelial dysfunction, and peripheral neuropathy. LESWT could be a novel modality for treating ED, and particularly PDE5I non-responders with organic ED, in the near future. However, further extensive evidence-based basic and clinical studies are needed. This review intends to summarize the scientific background underlying the effect of LESWT on ED.

Low-intensity shock wave therapy and its application to erectile dysfunction.

Shortest time to union, and to return to sporting activity, are the goals of management of fifth metatarsal fractures in the athlete. Whereas zone 1 injuries are largely treated conservatively, zone 2 and 3 injuries are best treated with surgical fixation in athletes, most commonly with intramedullary screw fixation. Fixation with the addition of bone graft has also yielded good results. In the chronic setting, good results have been shown with intramedullary screw fixation, surgical debridement and bone grafting alone, and tension band wiring. Shock wave therapy and pulsed electromagnetic fields may have a place in chronic and acute injury.

Fifth Metatarsal Fractures in the Athlete: Evidence for Management

Background:Nonunion or delayed union of fractures in the proximal aspect of metatarsals 1 to 4 and Zone 2 of the fifth metatarsal were treated by high energy extracorporeal shock wave treatment (ESWT) to study the safety and efficacy of this method of treatment in a FDA study of the Ossatron device.Materials and Methods:In a prospective single-arm, multi-center study, 34 fractures were treated in 32 patients (two subjects had two independent fractures) with ESWT. All fractures were at least 10 (range, 10 to 833) weeks after injury, with a median of 23 weeks. ESWT application was conducted using a protocol totaling 2,000 shocks for a total energy application of approximately 0.22 to 0.51 mJ/mm2 per treatment. The mean ESWT application time for each of the treatments was 24.6 ± 16.6 minutes, and anesthesia time averaged 27.1 ± 10.4 minutes. All subjects were followed for 1 year after treatment at intervals of 12 weeks, 6, 9, and 12 months.Results:The overall success rate at the 12-week visit was 71% with lo...

Robert Schulte

Papers

Extracorporeal shock wave treatment of non- or delayed union of proximal metatarsal fractures.