| Extracorporeal shockwave therapy | |
|---|---|
| Intervention | |
| ICD-10-PCS | 6A93 |
Extracorporeal Shockwave Therapy or ESWT is a method of treatment for multiple tendonopathies, derived from lithotripsy[1].
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The procedure used to be performed in an out-patient setting, under local anesthesia , taking up to 30 minutes. Now with newer technology it can be done without anesthesia in the physician's office in less than 10 minutes. Research indicates that there is significant reduction in intensity of application pain with the use of castor oil rather than ultrasound jelly[2]. The positive effect of castor oil can be explained by its cavitation-free quality. The patient is afterwards able to walk out, the major complaint being of a thumping feeling on the heel. Because re-inflammation is being introduced, the patient cannot take anti-inflammatory medication afterward, nor should they ice the area. Acetaminophen with codeine may be utilized.
Contraindications for this procedure include: neurological and vascular disease of the foot, history of rupture of the plantar fascial ligament, open bone growth plates, pregnancy, implanted metal in the area (bone screws and pins) and people on medication that interferes with blood clotting such as coumadin and prophylactic aspirin.
The medical value of extracorporeal shockwave therapy is disputed. A number of both favorable and unfavorable studies exist, some utilizing deficient research practices.[1] However the use of ESWT continues to expand across medical disciplines, such as cardiology, urology (erectile dysfunction), and wound applications.
Presently this technology is only approved in the US by the Food and Drug Administration (FDA) for treatment of plantar fasciitis and tennis elbow. In the future possible approvals may be given to treat patella tendinitis, shoulder tendinitis, achilles tendinitis, pseudoarthrosis, stress fractures and shoulder calcification. There is also an FDA study to treat recalcitrant diabetic wounds.
There are several theories as to how ESWT may or may not help promote better healing. The most accepted one is that the microtrauma of the repeated shock wave to the affected area creates neo-vascularization (new blood flow) into the area. It is this new blood flow that promotes tissue healing. The second theory is that in chronic pain, the brain has "forgotten" about the pain and is doing nothing to heal the area. By having shockwave therapy a new inflammatory process is created and the brain can react to it by sending the necessary body nutrients to the area to promote healing.
For treatment of heel pain the FDA study criteria are quite specific. A person has to have experienced heel pain for at least six months and had at least three other types of treatments (cortisone injections, oral anti-inflammatory medication, orthotics, physical therapy, etc.) without relief.