Review over the Therapeutic Benefit of Extracorporeal Shockwave Therapy in Orthopaedic Patients

Shockwaves can be defi ned as transient pressure oscillations which propagate in three dimensions and offer an increased pressure in a very short period of time. Biological effects of shockwave therapy have been proven to stimulate the release of angiogenic growth factors, and contribute to the improvement of blood supply which leads to the repair of bone and soft tissue. The role of ESWT in the treatment of chronic calcifying tendinitis of the rotator cuff has been evaluated in many studies. ESWT has been gaining attention as an alternative option to surgical excision of calcifi cation or when other conservative options have not proven effi cient. The main purpose for using ESWT in heel spur is to increase the local blood supply by inducing neovascularisation. This action influences the inflammatory process and furthermore stimulates the local metabolism. Also, shockwaves have been proposed as a possible treatment in early phases of femoral head necrosis in adults. In case of patellar tendinopathy in vitro studies have shown biological effects, while clinical effects remain unclear. Data suggests that ESWT associated with other physical modalities achieve realiable clinical importance of pain reduction in lateral epycondylitis. However there is still a lack of standardisation and a consensus is needed regarding frequency and intensity.