Chronic lateral epicondylitis of the elbow: A prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine.

Abstract Rompe JD, Riedel C, Betz U, Fink C. Chronic lateral epicondylitis of the elbow: a prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine. Arch Phys Med Rehabil 2001;82:578-82. Objective: To compare the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow. Design: Prospective, matched single-blind control trial. Setting: University hospital clinic. Patients: Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervi…

Shock-wave therapy for tennis and golfer's elbow - 1 year follow-up

Thirty patients with chronic medial epicondylitis were treated with low-energy shock waves. They received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. At 1 year follow-up examinations were performed. According to the Verhaar criteria, only seven patients reached excellent or good results. In eight cases a fair outcome was recorded, and in 14 patients the outcome was poor. Only six patients were satisfied with the treatment. The average relief of pain was 32%. These data were significantly worse than for identically treated patients with chronic tennis elbow. Thus, the question arises as to whether extracorporal shock-wave therapy is indicated in medial epicondylitis.

Sonography and MRI of experimental muscle injuries

After sonographical examination with a 7.5-MHz linear array scanner, we created an experimental muscle injury of known sitze and location on 28 New Zealand white rabbits by stabbing them with a scalpel in the supraspinatus muscle. The changes in the healing process were followed and documented by sonography and magnetic resonance imaging (MRI) before and 2, 5, 11, 14, 36 and 64 days after injury. The changes in sonography and MRI followed a regular course. Ultrasound revealed an echo-poor area after injury with ever increasing echogenicity from the 14th day. Strong reflexes were found after 2 months. MRI showed few changes, only a slight increase of signal intensity, but a characteristic cu…

Cell viability, osteoblast differentiation, and gene expression are altered in human osteoblasts from hypertrophic fracture non-unions

Recent studies have provided evidence that the number and proliferation capacity of bone marrow-derived mesenchymal stem cells, as well as the number of osteoprogenitor cells are reduced in patients with fracture non-unions. For fracture non-unions that do not heal after appropriate surgical intervention, the question arises as to what extent systemic cellular dysfunctions should be considered as being pathogenetic factors. For this purpose, we have examined the hypothesis that the cell function of osteoblasts isolated from patients with fracture non-unions may differ from those of normal control individuals in an identical and controlled in vitro situation. We analyzed the osteoblast cell …

The influence of bone allograft processing on osteoblast attachment and function

In order to assess the influence of eight different sterilisation and disinfection methods for bone allografts on adhesion, proliferation, and differentiation of human bone marrow stromal cells (BMSC), cells were grown in culture and then plated onto pieces of human bone allografts. Following processing methods were tested: autoclavation (AUT), low-temperature-plasma sterilisation of demineralised allografts (D-LTP), ethylene oxide sterilisation (EtO), fresh frozen bone (FFB), 80 degrees C-thermodisinfection (80 degrees C), gamma-irradiation (Gamma), chemical solvent disinfection (CSD), and Barrycidal-disinfection (BAR). The seeding efficiency was determined after one hour to detect the num…

High-energy extracorporeal shock wave treatment of nonunions.

Forty-three consecutive patients who did not have healing of tibial or femoral diaphyseal and metaphyseal fractures and osteotomies for at least 9 months after injury or surgery were examined prospectively for use of high-energy extracorporeal shock waves. Former treatment modalities (cast, external fixator, plate osteosynthesis, limitation of weightbearing) remained unchanged. In all cases a 99m Technetium dicarboxyphosphonate regional two-phase bone scintigraphy was performed before one treatment with 3000 impulses of an energy flux density of 0.6 mJ/mm 2 . Radiologic and clinical followups were done at 4-week intervals starting 8 weeks after shock wave treatment. The success criterion wa…

Metastatic spinal cord compression--options for surgical treatment.

Fourty-three cases with metastatic spinal cord compression were reviewed post-operatively to clarify the usefulness of the procedures concerning restoration of neurological function, and pain relief. Only patients with pathological spinal instability and neurological sequelae were included. Posterior decompression and stabilization was performed in all but six patients. All but four patients (91%) reported decrease of pain symptoms. Amelioration of neurological function was achieved in 58%. Re-establishment of walking ability was obtained in 57%. Post-surgery life expectancy averaged 11 months. In patients with widespread metastatic disease and/or multi-level instability of the spine restri…

Die BWS-Beweglichkeit von Impingementpatienten im Vergleich zu Gesunden - eine inklinometrische Studie

AIM The aim of this study was to analyse the relation between the mobility of the thoracic spine and an impingement syndrome of the shoulder. METHOD In a prospective study, 50 patients with an impingement syndrome and 50 healthy test subjects were examined for the mobility of their thoracic spines. All patients and test subjects were examined according to a standardized protocol. The experiments were carried out in the biomechanical laboratory of our clinic with the Plurimetercompass and the Inclinometer of Rippstein. RESULTS In 23 patients a tendinosis calcarea was diagnosed radiologically, 27 patients suffered from a plain impingement without calcification, hence both groups were analyzed…

EVALUATION OF LOW-ENERGY EXTRACORPOREAL SHOCK-WAVE APPLICATION FOR TREATMENT OF CHRONIC PLANTAR FASCIITIS

Background: Although the application of low-energy extracorporeal shock waves to treat musculoskeletal disor- ders is controversial, there has been some limited, short-term evidence of its effectiveness for the treatment of chronic plantar fasciitis. Methods: From 1993 to 1995, a prospective, two-tailed, randomized, controlled, observer-blinded pilot trial was performed to assess whether three applications of 1000 impulses of low-energy shock waves (Group I) led to a su- perior clinical outcome when compared with three applications of ten impulses of low-energy shock waves (Group II) in patients with intractable plantar heel pain. The sample size was 112. The main outcome measure was patien…

Side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of tennis elbow

Apart from a few observational reports, there are no studies on the side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of insertion tendopathies. Within the framework of a randomised, placebo-controlled, single-blind, multicentre study to test the effectiveness of ESWT in the case of lateral epicondylitis (LE), side-effects were systematically recorded. A total of 272 patients from 15 centres was allocated at random to active ESWT (3 x 2000 pulses, energy flux density ED(+) 0.04 to 0.22 mJ/mm(2) under local anaesthesia) or placebo ESWT. In all, 399 ESWT and 402 placebo treatments were analysed. More side-effects were documented in the ESWT group (OR = 4.3, CI = [2.9; …

Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study.

The aim of this prospective single-blind pilot study was to explore the pain-alleviating effect of low-energy extracorporeal shock wave therapy (ESWT) in painful heel associated with inferior calcaneal spurs. Thirty patients who suffered from persistent symptoms for more than 12 months qualified for low-energy ESWT and were assigned at random to two groups, real or simulated ESWT. Before beginning the treatment, any other therapy was stopped for a period of 6 weeks. The shock waves were applied by an experimental device allowing exact localization through an integrated fluoroscopy unit. Patients were treated three times at weekly intervals. Each time 1000 impulses of 0.06 mJ/mm2 were given …

Changes of sonographic, magnetic resonance tomographic, electromyographic, and histopathologic findings within a 2-month period of examinations after experimental muscle denervation

This study compares sonographical, histopathological, magnetic resonance imaging (MRI), and electromyographical (EMG) findings following acute muscle denervation. We performed an experimental denervation of the supraspinatus and infraspinatus muscles on 35 New Zealand white rabbits by segment resection of the suprascapular nerve. The sonographical appearance of the supraspinatus muscle was followed and documented at short time intervals within a 2-month follow-up period. The sonographical, histopathological, and MRI changes due to denervation suggest a regular pattern. Apart from the reduction of the muscle diameter, there were considerable sonographical signs of denervation with an increas…

Chronische Insertions- tendopathie am lateralen Epicondylus humeri

Fragestellung: Seit Beginn der 90er Jahre wurde in der Orthopadischen Universitatsklinik Mainz uberpruft, bei welchen Krankheitsbildern die niederenergetische extrakorporale Stoswellentherapie sinnvoll eingesetzt werden kann. Methode: In einer prospektiv-randomierten Studie wurde die Wirksamkeit der 3maligen Applikation von 1000 vs. 10 Impulsen niedriger Energieflusdichte bei chronischer Epicondylopathia humeri radialis uberpruft. Ergebnisse: Sehr gute oder gute Ergebnisse lagen nach einem Follow-up von 12 Monaten bei 26 von 50 Patienten der Behandlungsgruppe vor, aber lediglich bei 3 der Kontrollgruppe. Schlusfolgerungen: Zusammenfassend last sich sagen, das die Methode bei entsprechender …

Einige vermeidbare Behandlungsfehler bei der Therapie von Erkrankungen des Bewegungsapparates

Vermeintlich vermeidbare Fehler bei der Behandlung von Patienten besonders in operativen Fachgebieten sind der Grund fur die standig steigende Zahl der Haftpflichtprozesse und Antrage an die Schlichtungskommissionen der Arztekammern. Typische Fehlermoglichkeiten liegen zum einen in der Indikationsstellung zu operativen Eingriffen, ebenso mussen Patienteninformation und Aufklarung mit aller Sorgfalt und unter Berucksichtigung der Rechtslage erfolgen. Daruber hinaus konnen naturlich Fehler auch im Rahmen des operativen Vorgehens und der Nachbehandlung unterlaufen. Der vorliegende Uberblick soll unter Hinweis auf die empfohlenen Richtlinien einzelner Institutionen und unter Berucksichtigung de…

Metastatic instability at the proximal end of the femur

A retrospective study was performed of the surgical treatment of metastatic lesions of the proximal femur in 50 patients. In 25 consecutive cases a megaprosthesis was implanted; compound plate osteosynthesis was performed in another 25 consecutive patients. Indications for surgical treatment were pathological fractures or, for prophylactic treatment, lesions of the femoral cortex exceeding 2.5 cm in diameter or affecting half the diameter of the bone or more. In all patients capable of walking preoperatively mobility was regained. Immediate full weight-bearing stability was obtained in all patients. Group analysis showed that the functional rating of the hip joint was unchanged, i.e., good …

Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial.

Background:Recent articles have reported success with repeated low-energy shock wave application for treatment of chronic plantar fasciitis in runners.Hypothesis:Shock wave treatment for chronic plantar fasciitis is safe and effective.Study Design:Prospective, randomized, placebo-controlled trial.Methods:Forty-five running athletes with intractable plantar heel pain for more than 12 months were enrolled; half were assigned to a treatment group that received three applications of 2100 impulses of low-energy shock waves, and half received sham treatment. Follow-up examinations were performed at 6 months and at 1 year by a blinded observer.Results:After 6 months, self-assessment of pain on fir…

Decompression/Stabilization of the Metastatic Spine: Cotrel-Dubousset-Lnstrumentation in 50 Patients Jan

50 patients with metastatic disease of the spine underwent dorsal decompression and stabilization with the Cotrel-Dubousset-Instrumentation from 1987 to 1991. Indications for surgical treatment were neurologic deficit, spinal instability, and/or pain resistant to medical or radiation treatment. No external orthotics were used postoperatively. Pain was relieved dramatically in 45 patients. Among 25 patients suffering from neurologic deficit preoperatively, 13 improved, 15 remained unchanged, whereas 2 developed an incomplete, transient paraplegia. 15 (7) patients were alive after 1 (2) years. Postoperative complications were frequent, but there were only 2 failures of the stabilization devic…

Repetitive low-energy shock wave treatment for chronic lateral epicondylitis in tennis players.

Background There is conflicting evidence regarding extracorporeal shock wave treatment for chronic tennis elbow. Hypothesis Treatment with repetitive low-energy extracorporeal shock wave treatment is superior to repetitive placebo extracorporeal shock wave treatment. Methods Seventy-eight patients enrolled in a placebo-controlled trial. All patients were tennis players with recalcitrant MRIconfirmed tennis elbow of at least 12 months’ duration. Patients were randomly assigned to receive either active low-energy extracorporeal shock wave treatment given weekly for 3 weeks (treatment group 1) or an identical placebo extracorporeal shock wave treatment (sham group 2). Main outcome measure was …

Outcome after palliative posterior surgery for metastatic disease of the spine - evaluation of 106 consecutive patients after decompression and stabilisation with the Cotrel-Dubousset instrumentation

From 1987 to 1996, 106 consecutive patients with metastatic disease of the spine who underwent palliative decompression from a dorsal approach and subsequent stabilisation with Cotrel-Dubousset instrumentation (CDI) were followed prospectively, and independent of the surgeons. Parameters evaluated were neurological function, perioperative complications, survival and rehabilitation. Following the Frankel system for the assessment of neurological disorder, 33 patients had a major deficit (grade A, B or C), 23 a minor deficit (grade D) and 50 no deficit. If there was no neurological dysfunction, the only patients who underwent operation were those graded as class IV according to Harrington. Ou…

„Extracorporeal shock wave therapy for plantar fasciitis–a double blind randomised controlled trial” by C. A. Speed et al., J Orthop res 2003;21:937-40

“Extracorporeal shock wave therapy for lateral epicondylitis—a double blind randomized controlled trial” by C. A. Speed et al., J Orthop Res 2002;20:895–8

Effectiveness of low-energy extracorporal shock waves for chronic plantar fasciitis

Summary Over a period of 4 years we performed a prospective randomized trial on 100 patients in order to compare the effects of low-energy extracorporal shock-wave therapy (ESWT) in the treatment of painful heel (chronic plantar fasciitis). Patients in group I were treated three times at weekly intervals with 1000 impulses of 0.08 mJ/mm 2 given around the heel spur. Group II received treatment three times with 10 impulses of the same energy density at weekly intervals. Follow-up examinations were done at 12 and 52 weeks, respectively. The main outcomes assessed were reduction in severity of pressure pain, period of pain-free walking, and patient satisfaction. At 12 weeks, 16 of 50 patients …

Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis

Background: It remains unclear whether application of local anesthesia (LA) interferes with clinical e!cacy of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis. Aims: To evaluate the e"ect of local anesthesia on the clinical outcome after repetitive low-energy ESWT for chronic plantar fasciitis. Methods: Eighty-six patients with chronic plantar fasciitis were randomly assigned to receive either low-energy ESWT without LA, given weekly for three weeks (Group I, n = 45; 3 · 2000 pulses, total energy flux density per shock 0.09 mJ/mm 2 ) or identical ESWT with LA (Group II, n = 41). Primary outcome measure was: Reduction of pain from baseline to month 3 post-treatment in …

Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder.

A prospective quasirandomized study was performed to compare the effects of surgical extirpation (Group I, 29 patients) with the outcome after high-energy extracorporeal shock wave therapy (Group II, 50 patients; 3,000 impulses of an energy flux density of 0.6 mJ/mm2) in patients with a chronic calcifying tendinitis in the supraspinatus tendon. Symptoms and demographic data of the two groups were comparable. According to the University of California Los Angeles Rating System, the mean score in Group I was 30 points with 75% good or excellent results after 12 months, and 32 points with 90% good or excellent results after 24 months. Radiologically, there was no calcific deposit in 85% of the …

Plantar Fasciitis

Operative management of epidural tumors of the spine

Seventy-two patients with neoplastic involvement of the vertebral column were operated on between 1986 and 1991. In the course of 79 operations anterior decompression and stabilization alone were performed in 3 cases, while ventrodorsal spondylodesis was carried out in 10 individuals. The remainder of the patients underwent exclusively dorsal decompression and stabilization, mainly with the Cotrel-Dubousset instrumentation (CDI). No external spinal support was required following posterior fixation by CDI alone or in combination with ventral spondylodesis. Forty patients suffered from neurological deficits preoperatively, 20 of them being unable to walk, in most cases owing to severe vertebr…

Shoulder function after extracorporal shock wave therapy for calcific tendinitis.

We report a controlled, prospective study that explored the effect of extracorporal shock waves of low- versus high-energy density in patients with chronic shoulder pain and calcific tendinitis. We assigned at random 100 patients who had had calcific tendinitis for more than 12 months to 2 groups to receive shock wave therapy either of a low- or high-energy density. Group 1 received 1500 impulses of 0.06 mJ/mm2, whereas group 2 received 1500 impulses of 0.28 mJ/mm2. Unlike group 1, in which the shock wave application could be performed without local anesthesia, all patients in group 2 required brachial plexus anesthesia. The patients were reviewed at 6 and 24 weeks. Partial or complete disi…

Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip.

Total joint replacement in patients suffering from developmental dysplasia of the hip poses specific technical difficulties due to insufficient bone stock at the site of the original and secondary acetabulum and a narrow, cranially displaced proximal femur. Twelve hips with severe congenital dislocation (4 Crowe type II, 5 type III, 3 type IV) were treated with cementless, porous structured total hip replacement. The cup was implanted at the anatomic height, a femoral segment was resected below the minor trochanter to reduce the femoral component in all cases. One femoral component was exchanged for a longer stem after 2 months due to insufficient fit and fill. After a mean follow-up of 5.1…