ESWT History
Shockwaves were first identified during World
War II. Submarine crews exposed to
detonation of Hydrogen bombs incurred
shockwave induced injury to lungs.
By „accident“, Dornier Systems develop the basic
physical understanding for the
interaction of shockwaves with tissue, materials.
Observation of increasedbone density following
lithotripsy treatment leads to investigation of possible orthopedic applications.
1989 the first treatments of non-healing fractures
(pseudarthrosis).
ESWT treatment of mycardial Infarctionduring open heart
surgery
December 2007
1940 1966 1989 2007
Continued Application of
ESWT in Orthopedics
including frozen shoulder, tennis elbow, heel spur, bursitis, jumpers
knee and achillodynia
1992
Application of ESWT in Dermatology
including non-healing wounds, diabetic foot
ulcers, decubital ulcers and burns.
2004
On February 7th 1980 the first successful, non-invasiv
kidneystone treatment with shockwaves. Extracorporal
Shockwave Therapy (Lithotripsy) becomes Urologists treatment of
choice for Urolithiasis. To date > 30 Mio. lithotripsy procedures have
been performed.
1980
ESWT Introduction
The reflector geometry enables generation of either highly focused shock waves (Urolithiasis or Pseudarthrosis) or soft focused shock waves (for most soft tissue applications)
Electrohydraulic shockwaves are generated by an electrical discharge in water.(other means of shockwave generation include piezoelectric and electromagnetic principles)
Acoustic waves are pressure and density fluctuations and thus are also termed pressure waves ;
Shockwaves are pressure waves with a specific and characteristic pressure profile :• very short rise times (in the nanosecond range) • high amplitudes ( up to 100 MPa )• short pulse duration ( < 1 microsecond )
Biologic Effects of ESWT
• Change of cell membrane permeability• Release of neurotransmitters• Antibacterial effects• Release of NO (nitrogen oxyde)• Release of growth factors (VEGF, eNOS, BMP-2, PCNA)• Induction of vessel growth• Stem cell migration and differentiation
Regeneration of vessels, skin, bone and nerve tissue.In addition to orthopedic applications since 1992, ESWT is nowadays used in Dermatology.
ESWT Clinical Results
• Female patient• Age 94 • Chronic skin lesion withstaph. aureus infection
• Chronic leukemia• Chronic obstructive
pulmonary disease( COPD )
• Cortisone therapy
3 treatments with Soft Focus ESWT
without anesthesia
After 7 weeks
Pre-treatment
After 4 weeks
Chronic Infectious Skin UlcerAfter 2 weeks
Pre-treatment
After 4 weeks After 6 weeks3 treatments with soft focus ESWT without
anesthesia
Chronic Ulcer• Male patient• Age 57• >1 year conservative unsuccessful treatment
ESWT Clinical Results
After 2 weeks
3 treatments with soft focus ESWT without anesthesia
Chronic Ulcer• Male patient• Age 47• Trauma caused by
boating accident• Primary treatment with
ESWT
Pre treatment
After 5 weeks
After 2 weeks
After 11 weeks
ESWT Clinical Results
5 treatments with soft focus ESWT without anesthesia
Decubital Ulcer• Male patient• Age 20• Paraplegic due to bullet
wound incurred 2 yearsearlier
• Decubital ulcer since 5 months
Pre treatment
ESWT Clinical Results
After 1 week
After 5 weeksAfter 3 weeks
Pre treatment
Chronic infected ulcer
ESWT Clinical Results
After 6 weeks
Decubital ulcer
Pre-treatment
After 6 months
Burn wounds
Pre-treatment
After 6 months
Non-healing wound post fracture
Pre-treatment
After 6 months
PseudarthrosisPre-treatment
After 3 monthsAfter 5 months
After 1 year
• Male patient• Age 59• Talus fracture
Pre treatment
• Female Patient• Age 36• Sub-total amputation
• Replantation• K-Wire• Spongio-plasty• Plating• Ext. Fixator• After 4 years
ESWT application
After 3 months
After 6 months
Pseudarthrosis
Pre treatment
After 6 months
Pseudarthrosis
Pseudarthrosis
After 6 months
After 3 months
• Female patient• Age 59• Injury due to a fall• Diabetic
Pre treatment
Pseudarthrosis• Male Patient• Age 46• Motorcycle accident• Tibia fracture• External fixator• After 8 weeks removal offixator and cast
• After 9 months ESWTapplication
After 2 months After 4
months
CT 4 months post ESWT
Pseudarthrosis
CT pre treatment
• Male Patient• Age 46• Motorcycle accident• Tibia fracture• External fixator• After 8 weeks removaland cast
• After 9 months ESWT application
Study Results
Orthopedics
Over a period of 2 years, 409 patients were treated for a variety of sports related injuries at the sports medicine
clinic in Hellersen.
74% patients reported positive to very
positive therapeutic results
Achilles tendonBursitisFasciitis plantarisTendinosis calcareaNon-union (Pseudarthroses)PPS (Patella tip syndrom)Epicondylopathia humeri radialisEpicondylopathia humeri ulnaris
Study Results
Dermatology
Clinical studies conducted by Dr. Wolfgang Schaden, Vienna and Dr. Richard Thiele, Berlin
Total 200 patients
74,5% of the wounds healed completely within
2-12 weeks.
ESWT Indications
Orthopedics
Dermatology
Achilles tendonBursitisFasciitis PlantarisTendinosis calcareaPseudarthrosisPPSEpicondylopathia humeri radialisEpicondylopathia humeri ulnaris
Non-healing woundsPost-traumatic lesionsUlcersDecubitusBurns
ESWT forecast
Da Vinci projects
Dermatology
Orthopedics
Odontology
Neurology
Cardiology
ESWT forecast
Combat Wound Initiative 2007
• Extensive survey on ESWT • 3-years´study with wounded soldiers from Afghanistan and Iraque• Cooperation with the Army Research Center• Aim : Improve wound healing quality• Comparison “Standard of Care” vs. “Standard of Care + ESWT”• Budget: 10 Mio. USD• Data: 40.000 data elements per patient
Walter Reed Army Medical Center
Dermatology
Dermatology
Orthopedics
Odontology
Neurology
Cardiology
ESWT forecast
Dermatology
CelluliteCurrently numerous studies running regarding the effectivness of the ESWT in cellulite care
Adipocellular / LipolysisFirst, very positive results out of running studies in Korea and Italy
BurnsFirst, very positive results out of a running study at the Verbrennungszentrum in Berlin
Dermatology
Orthopedics
Odontology
Neurology
Cardiology
ESWT forecast
Orthopedics
ArthrosisIn a study in Berlin a patient´s knee was treated with ESWT
The knee was re-arthroscoped after 1 year. The cartilage was almost totally recovered.
Dermatology
Orthopedics
Odontology
Neurology
Cardiology
ESWT forecast
Dentistry
Bacterial Parodontitis
At the University of Kentucky rats were infected during 12 weeks with the bacteria Porphyromonas gingivalis.
After 12 weeks the animals were sacrificed, skeletonized, measured on bone reduction and compared with the control group. The bones of the ESWT-treated animals were almost totally reproduced.
Dermatology
Orthopedics
Odontology
Neurology
Cardiology
ESWT forecast
Neurology
Peripheral nerve system Spinal cord Brain
ESWT Work in Progress
Nerve transplantation
At the Ludwig-Boltzmann-Institut in Vienna rats were treated. The sciata nerve was cut, turned by 180° and reimplanted. After ESWT clear advantages of the treated animals in comparison with the control group were measured (Step-test, Catwalk, Plain-test).
Dermatology
Orthopedics
Odontology
Neurology
Cardiology
ESWT forecast
Cardiology
Heart surgery
At the Allgemeinen Krankenhaus Vienna an artificial infarction of the heart was induced with rats and pigs by blocking the coronary vessel.
All ESWT treated animals showed significant growth of new blood vessels in the infarct area. The remarkable results were shown officially at the ISMST-Congres in Toronto June 2007. First human treatment (open heart surgery) in December 2007.
Dermatology
Orthopedics
Odontology
Neurology
Cardiology
ESWT forecast
furthermore…
Plants
Soja bean sprouts were treated with ESWT. A clearly faster growth of the treated plants was registered in comparison to the control group.
In Kärnten currently wounds on trees are treated with ESWT, results in late summer 2007
Dermatology
Orthopedics
Dentistry
Neurology
Cardiology
furthermore…