Medihub - Medical Information - Orthopedic Surgery - Extracoporeal Shock Wave Treatment (ESWT)

ESWT: Non Invasive Treatment for Soft Tissues and Bones

What is ESWT and how does it work?

ESWT stands for extracorporeal shock wave treatment. In the field of orthopaedic surgery, it utilizes high energy acoustic shock wave to treat sport injuries including both soft tissue and bone conditions.

It has been scientifically proven that shock waves can stimulate bone growth and promote the healing of diseased tendons. These waves alter cell metabolism and generate mechanical stimuli that cause new blood vessel formation. Calcified deposits are re-sorted and degenerative tissues are revitalized.

ESWT therapy is an attractive, cost-effective and non-invasive treatment for certain conditions that would otherwise have required open surgery.

What is ESWT used to treat?

Many of the soft tissue conditions present with severe pain and loss of function due to acute inflammation. For example, tennis elbow is a common condition resulting from overuse of the joint and the elbow pain can be so severe that the patient cannot even hold a cup of water to drink!

Similarly, the pain from plantar fasciitis (pain from heel of foot) often occurs at the base of the patients’ feet. It arises from excessive walking or running and can be so intense that the patient is not able to walk! These soft tissue conditions need anti-inflammatory medications, physiotherapy and cortisone injection as initial conservative management.

Before ESWT, those patients who fail these conservative treatments will usually require surgery. In addition, ESWT is particularly useful in the two areas where cortisone injection is contraindicated: the heel cord and the patellar ligament.

Hence, it is the substitute for surgery following four months of unsuccessful conservative therapy for the following conditions:

tendonitis in the shoulder with or without calcifications,
tennis or golfer’s elbow; inflammation at the insertion of the patellar ligament;
plantar fasciitis with bone spur and degeneration of the heel cord tendon.

With the increasing use of ESWT for these and other soft tissue inflammatory conditions, the rate of open surgery has reduced tremendously with increased patient satisfaction.

Expansion of use for ESWT

There are now current studies extending the uses of ESWT on bone, especially for non union conditions. In non union, there is a complete failure of a bone healing across a fracture or broken bone. ESWT has benefited many patients as their non united fracture healed with shock wave stimulation, hence avoiding the need for bone grafting, which is a major open surgery.

It can also be used to revascularize (regain blood flow) and facilitate avascular necrosis (death of bone tissue). These are conditions where the blood supply to the bones such as the hip becomes compromised and results in collapse of the bones and malformation of the joint.

Other advantages of ESWT

Shock wave treatment can be carried out on an outpatient basis without anesthesia. Improvement of the patient’s symptoms and even complete freedom from symptoms is achieved after one to two treatments. There is also a very low incidence of adverse reactions.