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Lynen, N., De Vroey, T., Spiegel, I., Van Ongeval, F., Hendrickx, N.-J., and Stassijns, G. (2017). Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles' Tendinopathy: A Randomized Clinical Efficacy and Safety Study, Arch Phys Med Rehabil, 98(1), 64-71Mansur, N. S. B., Faloppa, F., Belloti, J. C., Ingham, S. J. M., Matsunaga, F. T., Santos, P. R. D. D., Santos, B. S. D., Carrazzone, O. L., Peixoto, G., Aoyama, B. T., and Tamaoki, M. J. S. (2017). Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol, BMJ Open, 7(1), e013332Marwan, Y., Dahrab, B., Esmaeel, A., Ibrahim, S. A., and Al-Failakawi, J. (2017). Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases, Eur J Orthop Surg Traumatol, (), Porso, M., Loreti, S., Nusca, S. M., Luziatelli, S., Caccia, D., Taborri, G., Trischitta, D., Taurino, M., Padua, L., Saraceni, V. M., Vulpiani, M. C., and Vetrano, M. (2017). Defocused Shock Wave Therapy for Chronic Soft Tissue Wounds in the Lower Limbs: A Pilot Study, Ultrasound Med Biol, 43(1), 362-369Saldaña-Gallo, J., Torres-Román, J. S., and Grandez-Urbina, J. A. (2017). Shock wave therapy for erectile dysfunction: The lack of evidence at the Latin America and Caribbean level, Actas Urol Esp, (), Sansone, V., Romeo, P., and Lavanga, V. (2017). Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study, Med Princ Pract, 26(1), 23-29Schöberl, M., Prantl, L., Loose, O., Zellner, J., Angele, P., Zeman, F., Spreitzer, M., Nerlich, M., and Krutsch, W. (2017). Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study, Knee Surg Sports Traumatol Arthrosc, (), Williams, H., Jones, S. A., Lyons, C., Wilson, C., and Ghandour, A. (2017). Refractory patella tendinopathy with failed conservative treatment-shock wave or arthroscopy?, J Orthop Surg (Hong Kong), 25(1), 2309499016684700Zhang, Q., Liu, L., Sun, W., Gao, F., Cheng, L., and Li, Z. (2017). Extracorporeal shockwave therapy in osteonecrosis of femoral head: A systematic review of now available clinical evidences, Medicine (Baltimore), 96(4), e5897Zou, Z.-J., Liu, Z.-H., Tang, L.-Y., and Lu, Y.-P. (2017). Is there a role for extracorporeal shock wave therapy for erectile dysfunction unresponsive to phosphodiesterase type 5 inhibitors?, World J Urol, 35(1), 167-171Angulo, J. C. (2016). Commentary to low-energy shock wave therapy ameliorates erectile dysfunction in a pelvic neurovascular injuries rat model, published in J Sex Med 2016;13:22-32 by Li H, Matheu P, Sun F, et al, Transl Androl Urol, 5(6), 956-957Assad, S., Ahmad, A., Kiani, I., Ghani, U., Wadhera, V., and Tom, T. N. (2016). Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis, Cureus, 8(12), e913Behr-Roussel, D. and Giuliano, F. (2016). Low-energy shock wave therapy ameliorates erectile dysfunction in a pelvic neurovascular injuries rat model, Transl Androl Urol, 5(6), 977-979Fleckenstein, J., Friton, M., Himmelreich, H., and Banzer, W. (2016). Effect of a single administration of focused extracorporeal shock wave in the relief of Delayed-Onset Muscle Soreness: results of a partially-blinded randomized controlled trial, Arch Phys Med Rehabil, (), Huang, T.-H., Sun, C.-K., Chen, Y.-L., Wang, C.-J., Yin, T.-C., Lee, M. S., and Yip, H.-K. (2016). Shock Wave Enhances Angiogenesis through VEGFR2 Activation and Recycling, Mol Med, 22(), Jin, Y., Xu, L., Zhao, Y., Wang, M., Jin, X., and Zhang, H. (2016). Endogenous Stem Cells Were Recruited by Defocused Low-Energy Shock Wave in Treating Diabetic Bladder Dysfunction, Stem Cell Rev, (), Ke, M.-J., Chen, L.-C., Chou, Y.-C., Li, T.-Y., Chu, H.-Y., Tsai, C.-K., and Wu, Y.-T. (2016). The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel

syndrome: a prospective, randomized, single-blind, placebo-controlled trial, Sci Rep, 6(), 38344Kraemer, R., Sorg, H., Forstmeier, V., Knobloch, K., Liodaki, E., Stang, F. H., Mailaender, P., and Kisch, T. (2016). Immediate Dose-Response Effect of High-Energy Versus Low-Energy Extracorporeal Shock Wave Therapy on Cutaneous Microcirculation, Ultrasound Med Biol, 42(12), 2975-2982Liu, L., Guo, R., Chen, L., Cao, Y., Yang, Y., and Zhao, B. (2016). A prediction model for two-dimensional pressure distribution from underwater shock wave focusing by an ellipsoidal reflector, J Acoust Soc Am, 140(6), 4506Lou, J., Wang, S., Liu, S., and Xing, G. (2016). Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials, Am J Phys Med Rehabil, (), Seol, P.-H., Ha, K. W., Kim, Y. H., Kwak, H.-J., Park, S.-W., and Ryu, B.-J. (2016). Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome, Ann Rehabil Med, 40(6), 1124-1128Tepeköylü, C., Primessnig, U., Pölzl, L., Graber, M., Lobenwein, D., Nägele, F., Kirchmair, E., Pechriggl, E., Grimm, M., and Holfeld, J. (2016). Shockwaves prevent from heart failure after acute myocardial ischaemia via RNA/protein complexes, J Cell Mol Med, (), Viganò, M., Sansone, V., d'Agostino, M. C., Romeo, P., Perucca Orfei, C., and de Girolamo, L. (2016). Mesenchymal stem cells as therapeutic target of biophysical stimulation for the treatment of musculoskeletal disorders, J Orthop Surg Res, 11(1), 163Wang, H.-J., Lee, W.-C., Tyagi, P., Huang, C.-C., and Chuang, Y.-C. (2016). Effects of low energy shock wave therapy on inflammatory moleculars, bladder pain, and bladder function in a rat cystitis model, Neurourol Urodyn, (), Xu, L., Zhao, Y., Wang, M., Song, W., Li, B., Liu, W., Jin, X., and Zhang, H. (2016). Defocused low-energy shock wave activates adipose tissue-derived stem cells in vitro via multiple signaling pathways, Cytotherapy, 18(12), 1503-1514Yahata, K., Kanno, H., Ozawa, H., Yamaya, S., Tateda, S., Ito, K., Shimokawa, H., and Itoi, E. (2016). Low-energy extracorporeal shock wave therapy for promotion of vascular endothelial growth factor expression and angiogenesis and improvement of locomotor and sensory functions after spinal cord injury, J Neurosurg Spine, 25(6), 745-755Zhang, X., Krier, J. D., Amador Carrascal, C., Greenleaf, J. F., Ebrahimi, B., Hedayat, A. F., Textor, S. C., Lerman, A., and Lerman, L. O. (2016). Low-Energy Shockwave Therapy Improves Ischemic Kidney Microcirculation, J Am Soc Nephrol, 27(12), 3715-3724Carlisi, E., Lisi, C., Dall'angelo, A., Monteleone, S., Nola, V., Tinelli, C., and Dalla Toffola, E. (2016). Focused extracorporeal shock wave therapy combined with supervised eccentric training for supraspinatus calcific tendinopathy, Eur J Phys Rehabil Med, (), Furia, J. P., Rompe, J.-D., Maffulli, N., Cacchio, A., and Schmitz, C. (2016). Radial Extracorporeal Shock Wave Therapy Is Effective and Safe in Chronic Distal Biceps Tendinopathy, Clin J Sport Med, (), Jeppesen, S. M., Yderstraede, K. B., Rasmussen, B. S. B., Hanna, M., and Lund, L. (2016). Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers: a prospective randomised trial, J Wound Care, 25(11), 641-649Lee, J.-H. (2016). Knee joint angle of intracerebral hemorrhage-induced rats after extracorporeal shock wave therapy, J Phys Ther Sci, 28(11), 3122-3124Mori, L., Marinelli, L., Pelosin, E., Gambaro, M., Trentini, R., Abbruzzese, G., and Trompetto, C. (2016). Radial shock wave therapy: effect on pain and motor performance in a paralympic athlete. A case report, Eur J Phys Rehabil Med, (), Reed-Maldonado, A. B. and Lue, T. F. (2016). Re: A Meta-analysis of Extracorporeal Shock Wave Therapy for Peyronie's Disease, Eur Urol, 70(5), 895-896Sun, W., Gao, F., Guo, W., Wang, B., Li, Z., Cheng, L., and Wang, W. (2016). Focused extracorporeal shock wave for osteonecrosis of the femoral head with leukemia after allo-HSCT: a case series, Bone Marrow Transplant, 51(11), 1507-1509Wang, C.-J., Huang, C.-C., Yip, H.-K., and Yang, Y.-J. (2016). Dosage effects of extracorporeal shockwave therapy in early hip necrosis, Int J Surg, 35(), 179-186

Alizadeh, Z., Halabchi, F., Mazaheri, R., Abolhasani, M., and Tabesh, M. (2016). Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat, Int J Endocrinol Metab, 14(4), e36727Cho, S. J., Yang, J. R., Yang, H. S., and Yang, H.-E. (2016). Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study, Ann Rehabil Med, 40(5), 862-870Gatewood, C. T., Tran, A. A., and Dragoo, J. L. (2016). The efficacy of post-operative devices following knee arthroscopic surgery: a systematic review, Knee Surg Sports Traumatol Arthrosc, (), Han, Y., Lee, J.-K., Lee, B.-Y., Kee, H.-S., Jung, K.-I., and Yoon, S.-R. (2016). Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head, Ann Rehabil Med, 40(5), 871-877Leeman, J. J., Shaw, K. K., Mison, M. B., Perry, J. A., Carr, A., and Shultz, R. (2016). Extracorporeal shockwave therapy and therapeutic exercise for supraspinatus and biceps tendinopathies in 29 dogs, Vet Rec, 179(15), 385Nwokeoha, S., Carlisle, R., and Cleveland, R. O. (2016). The Application of Clinical Lithotripter Shock Waves to RNA Nucleotide Delivery to Cells, Ultrasound Med Biol, 42(10), 2478-92Pfaff, J. A., Boelck, B., Bloch, W., and Nentwig, G.-H. (2016). Growth Factors in Bone Marrow Blood of the Mandible With Application of Extracorporeal Shock Wave Therapy, Implant Dent, 25(5), 606-12Qi, B., Yu, T., Wang, C., Wang, T., Yao, J., Zhang, X., Deng, P., Xia, Y., Junger, W. G., and Sun, D. (2016). Shock wave-induced ATP release from osteosarcoma U2OS cells promotes cellular uptake and cytotoxicity of methotrexate, J Exp Clin Cancer Res, 35(1), 161Sawan, S., Abd-Allah, F., Hegazy, M. M., Farrag, M. A., and El-Den, N. H. S. (2016). Effect of shock wave therapy on ankle planter flexors spasticity in stroke patients, NeuroRehabilitation, (), Zissler, A., Steinbacher, P., Zimmermann, R., Pittner, S., Stoiber, W., Bathke, A. C., and Sänger, A. M. (2016). Extracorporeal Shock Wave Therapy Accelerates Regeneration After Acute Skeletal Muscle Injury, Am J Sports Med, (), Eslamian, F., Shakouri, S. K., Jahanjoo, F., Hajialiloo, M., and Notghi, F. (2016). Extra Corporeal Shock Wave Therapy Versus Local Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis, a Single Blinded Randomized Clinical Trial, Pain Med, 17(9), 1722-31Everding, J., Freistühler, M., Stolberg-Stolberg, J., Raschke, M. J., and Garcia, P. (2016). [Extracorporal shock wave therapy for the treatment of pseudarthrosis : New experiences with an old technology], Unfallchirurg, (), Gao, L., Qian, S., Tang, Z., Li, J., and Yuan, J. (2016). A meta-analysis of extracorporeal shock wave therapy for Peyronie's disease, Int J Impot Res, 28(5), 161-6Hatanaka, K., Ito, K., Shindo, T., Kagaya, Y., Ogata, T., Eguchi, K., Kurosawa, R., and Shimokawa, H. (2016). Molecular mechanisms of the angiogenic effects of low-energy shock wave therapy: roles of mechanotransduction, Am J Physiol Cell Physiol, 311(3), C378-85Ji, Q., Wang, P., and He, C. (2016). Extracorporeal shockwave therapy as a novel and potential treatment for degenerative cartilage and bone disease: Osteoarthritis. A qualitative analysis of the literature, Prog Biophys Mol Biol, 121(3), 255-65Kim, E.-K. and Kwak, K.-I. (2016). Effect of extracorporeal shock wave therapy on the shoulder joint functional status of patients with calcific tendinitis, J Phys Ther Sci, 28(9), 2522-2524Krukowska, J., Wrona, J., Sienkiewicz, M., and Czernicki, J. (2016). A comparative analysis of analgesic efficacy of ultrasound and shock wave therapy in the treatment of patients with inflammation of the attachment of the plantar fascia in the course of calcaneal spurs, Arch Orthop Trauma Surg, 136(9), 1289-96Pajovic, B., Radojevic, N., Dimitrovski, A., and Vukovic, M. (2016). Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple

therapy itself in Category III B chronic pelvic pain syndrome (CPPS), Aging Male, 19(3), 202-207Qi, X., Zhao, Y., Zhang, J., Han, D., Chen, C., Huang, Y., Chen, X., Zhang, X., Wang, T., and Li, X. (2016). Increased Effects of Extracorporeal Shock Waves Combined with Gentamicin against Staphylococcus aureus Biofilms In Vitro and In Vivo, Ultrasound Med Biol, 42(9), 2245-52Santamato, A., Panza, F., Notarnicola, A., Cassatella, G., Fortunato, F., de Sanctis, J. L., Valeno, G., Kehoe, P. G., Seripa, D., Logroscino, G., Fiore, P., and Ranieri, M. (2016). Is Extracorporeal Shockwave Therapy Combined With Isokinetic Exercise More Effective Than Extracorporeal Shockwave Therapy Alone for Subacromial Impingement Syndrome? A Randomized Clinical Trial, J Orthop Sports Phys Ther, 46(9), 714-25Tepeköylü, C., Lobenwein, D., Urbschat, A., Graber, M., Pechriggl, E. J., Fritsch, H., Paulus, P., Grimm, M., and Holfeld, J. (2016). Shock wave treatment after hindlimb ischemia results in increased perfusion and M2 macrophage presence, J Tissue Eng Regen Med, (), Torjesen, I., journalist, and London (2016). The cricketer promoting shockwave therapy for erectile dysfunction, BMJ, 354(), i4808Zhai, L., Ma, X.-L., Jiang, C., Zhang, B., Liu, S.-T., and Xing, G.-Y. (2016). Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones, Indian J Orthop, 50(5), 543-550Angulo, J. C., Arance, I., de Las Heras, M. M., Meilán, E., Esquinas, C., and Andrés, E. M. (2016). Efficacy of low-intensity shock wave therapy for erectile dysfunction: A systematic review and meta-analysis, Actas Urol Esp, (), Arirachakaran, A., Boonard, M., Yamaphai, S., Prommahachai, A., Kesprayura, S., and Kongtharvonskul, J. (2016). Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs, Eur J Orthop Surg Traumatol, (), Cayton, T., Harwood, A., Smith, G. E., and Chetter, I. (2016). A Systematic Review of Extracorporeal Shockwave Therapy as a Novel Treatment for Intermittent Claudication, Ann Vasc Surg, 35(), 226-33Cho, Y. S., Joo, S. Y., Cui, H., Cho, S.-R., Yim, H., and Seo, C. H. (2016). Effect of extracorporeal shock wave therapy on scar pain in burn patients: A prospective, randomized, single-blind, placebo-controlled study, Medicine (Baltimore), 95(32), e4575Haghighat, S. and Mashayekhi Asl, M. (2016). Effects of Extracorporeal Shock Wave Therapy on Pain in Patients With Chronic Refractory Coccydynia: A Quasi-Experimental Study, Anesth Pain Med, 6(4), e37428Ibrahim, M. I., Donatelli, R. A., Hellman, M., Hussein, A. Z., Furia, J. P., and Schmitz, C. (2016). Long-term results of radial extracorporeal shock wave treatment for chronic plantar fasciopathy: A prospective, randomized, placebo-controlled trial with two years follow-up, J Orthop Res, (), Kim, Y.-S., Lee, H.-J., and Kong, C.-G. (2016). Response to "Incorrect methodology may favor ultrasound-guided needling over shock wave treatment in calcific tendinopathy of the shoulder", J Shoulder Elbow Surg, 25(8), e244-5Moya, D., Ramón, S., d'Agostino, M. C., Leal, C., Aranzabal, J. R., Eid, J., and Schaden, W. (2016). Incorrect methodology may favor ultrasound-guided needling over shock wave treatment in calcific tendinopathy of the shoulder, J Shoulder Elbow Surg, 25(8), e241-3Newman, P., Waddington, G., and Adams, R. (2016). Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial, J Sci Med Sport, (), Alkhayal, A. and Carrier, S. (2016). Con: does shockwave therapy have a place in the treatment of Peyronie's disease?, Transl Androl Urol, 5(3), 371-4Caron, J., Michel, P.-A., Dussaule, J.-C., Chatziantoniou, C., Ronco, P., and Boffa, J.-J. (2016). Extracorporeal shock wave therapy does not improve hypertensive nephropathy, Physiol Rep, 4(11), Chung, E. (2016). Pro: does shockwave therapy have a place in the treatment of Peyronie's disease?, Transl Androl Urol, 5(3), 366-70

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Marano, F., Rinella, L., Argenziano, M., Cavalli, R., Sassi, F., D'Amelio, P., Battaglia, A., Gontero, P., Bosco, O., Peluso, R., Fortunati, N., Frairia, R., and Catalano, M. G. (2016). Targeting Taxanes to Castration-Resistant Prostate Cancer Cells by Nanobubbles and Extracorporeal Shock Waves, PLoS One, 11(12), e0168553Notarnicola, A., Moretti, L., Maccagnano, G., Tafuri, S., and Moretti, B. (2016). Tendonitis of the rotator cuff treated with extracorporeal shock wave therapy: radiographic monitoring to identify prognostic factors for disintegration, J Biol Regul Homeost Agents, 30(4), 1195-1202Notarnicola, A., Vicenti, G., Maccagnano, G., Silvestris, F., Cafforio, P., and Moretti, B. (2016). Extracorporeal shock waves induce osteogenic differentiation of human bone-marrow stromal cells, J Biol Regul Homeost Agents, 30(4 Suppl 1), 139-144Patel, C. K. and Bennett, N. (2016). Advances in the treatment of erectile dysfunction: what's new and upcoming?, F1000Res, 5(), Pavone, V., Cannavò, L., Di Stefano, A., Testa, G., Costarella, L., and Sessa, G. (2016). Low-Energy Extracorporeal Shock-Wave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy: A Case Series, Biomed Res Int, 2016(), 7123769Shimpi, R. K. and Jain, R. J. (2016). Role of extracorporeal shock wave therapy in management of Peyronie's disease: A preliminary report, Urol Ann, 8(4), 409-417Taheri, P., Vahdatpour, B., and Andalib, S. (2016). Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius, Adv Biomed Res, 5(), 138Vahdatpour, B., Kiyani, A., and Dehghan, F. (2016). Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome, Adv Biomed Res, 5(), 120Wang, L., Jiang, Y., Jiang, Z., and Han, L. (2016). Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function, Neuropsychiatr Dis Treat, 12(), 2189-98Wu, Z., Yao, W., Chen, S., and Li, Y. (2016). Outcome of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy with and without Haglund's Deformity, Biomed Res Int, 2016(), 6315846

Articles with abstractAl Edwan, G. M., Muheilan, M. M., and Atta, O. N. M. (2017). Long term efficacy of extracorporeal shock wave therapy [ESWT] for treatment of refractory chronic abacterial prostatitis, Ann Med Surg (Lond), 14(), 12-17, OBJECTIVE: To evaluate the effect and safety of extracorporeal shockwave therapy (ESWT) on chronic pelvic pain syndrome (CPPS)/chronic abacterial prostatitis after failure of most other modalities of treatment, the maintenance of the treatment effect for up to one year post treatment and whether the patients are in need for further sessions.MATERIALS AND METHODS: In a follow-up survey of 41 patients, the study inclusion criteria were CPPS patients who failed at least previously 3 modalities of treatment other than ESWT, who were treated by ESWT once a week for one month with a protocol of 2500 pulses at 1 bar over 13 min, Nonaddiction to drugs and narcotics. The exclusion criteria included being under treatment by another method another diagnosis such as prostate cancer, therapy plan alteration, and noninclination to continue this treatment. Then the patients were followed up at 2 weeks, 6 months and 12 months after finishing the course of ESWT. The study was designed as an open-label uncontrolled therapeutic clinical trial which was conducted in Jordan university hospital through the period 2015-2016. Data were compared using paired samples t-test.RESULTS: Of our total 55 patients 8 of them did not complete the study protocol, 6 of them had missed follow up over the whole follow up period and 41 patients were evaluated. The patient's age group ranged between 18 and 78 years with a mean age of 42 and a median age of 43. The mean of National Institutes of Health -Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptom Score (IPSS), American Urological Association Quality of Life Due to Urinary Symptoms (AUA QOL_US) and International Index of Erectile Function (IIEF) were evaluated pre and post ESWT at 2 weeks, 6 months and 12 months and it showed statistically significant improvement in all parameters with maintenance of the effect without any significant side-effect of the treatment over the 12 months.CONCLUSIONS: The evidence in this study would support the safety and efficacy of ESWT in refractory cases of CPPS at least for one year post treatment.Hatzichristou, D. (2017). Low-Intensity Extracorporeal Shock Waves Therapy (LI-ESWT) for the treatment of erectile dysfunction: Where do we stand?, Eur Urol, 71(2), 234-236, Lu, Z., Lin, G., Reed-Maldonado, A., Wang, C., Lee, Y.-C., and Lue, T. F. (2017). Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis, Eur Urol, 71(2), 223-233, CONTEXT: As a novel therapeutic method for erectile dysfunction (ED), low-intensity extracorporeal shock wave treatment (LI-ESWT) has been applied recently in the clinical setting. We feel that a summary of the current literature and a systematic review to evaluate the therapeutic efficacy of LI-ESWT for ED would be helpful for physicians who are interested in using this modality to treat patients with ED.OBJECTIVE: A systematic review of the evidence regarding LI-ESWT for patients with ED was undertaken with a meta-analysis to identify the efficacy of the treatment modality.EVIDENCE ACQUISITION: A comprehensive search of the PubMed and Embase databases to November 2015 was performed. Studies reporting on patients with ED treated with LI-ESWT were included. The International Index of Erectile Function (IIEF) and the Erection Hardness Score (EHS) were the most commonly used tools to evaluate the therapeutic efficacy of LI-ESWT.EVIDENCE SYNTHESIS: There were 14 studies including 833 patients from 2005 to 2015. Seven studies were randomized controlled trials (RCTs); however, in these studies, the setup parameters of LI-ESWT and the protocols of treatment were variable. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference: 2.00; 95% confidence interval [CI], 0.99-3.00; p<0.0001) and EHS (risk difference: 0.16; 95% CI, 0.04-0.29; p=0.01). Therapeutic efficacy could last at least 3 mo. The patients with mild-moderate ED had better therapeutic efficacy after treatment than patients with more severe ED or comorbidities. Energy flux density, number of shock waves per treatment, and duration of LI-

ESWT treatment were closely related to clinical outcome, especially regarding IIEF improvement.CONCLUSIONS: The number of studies of LI-ESWT for ED have increased dramatically in recent years. Most of these studies presented encouraging results, regardless of variation in LI-ESWT setup parameters or treatment protocols. These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of ED patients. The publication of robust evidence from additional RCTs and longer-term follow-up would provide more confidence regarding use of LI-ESWT for ED patients.PATIENT SUMMARY: We reviewed 14 studies of men who received low-intensity extracorporeal shock wave treatment (LI-ESWT) for erectile dysfunction (ED). There was evidence that these men experienced improvements in their ED following LI-ESWT.Onger, M.-E., Bereket, C., Sener, I., Ozkan, N., Senel, E., and Polat, A.-V. (2017). Is it possible to change of the duration of consolidation period in the distraction osteogenesis with the repetition of extracorporeal shock waves?, Med Oral Patol Oral Cir Bucal, (), 0, BACKGROUND: In this study we examined the effects of two different repeated Extracorporeal Shock Waves (ESW) on the consolidation period of the distraction osteogenesis (DO) of the rabbit mandible using stereological, radiological and immunohistochemical methods.MATERIAL AND METHODS: DO was performed unilaterally in the mandible of 18 New Zealand rabbits (six months old, weighing between 2.5-3 kg). In the consolidation period, rabbits were divided into three groups randomly after the distraction period. The distraction zone of the mandible was received no treatment as controls (E0*2). Group 2 (E 500*2) received ESWT (twice 500 impulses at 14 kV and 0.19 mJ/mm2 energy) in the first and fourth days of the consolidation. Group 3 (E1000*2) treated with ESWT (twice 1000 impulses at 14 kV and 0.19 mJ/mm2 energy) in the first and fourth days of the consolidation period. After the sacrification, radiologically bone mineral density, new bone formation, new fibrous tissue and new vessel formation were analyzed by stereological.RESULTS: It was found a statistically significant difference between the study groups and control group in the bone mineral density measurements and the highest value was in the E1000*2 group. In the stereological analysis, new bone formation was highest in the E1000*2 group and there was a significant difference compared to the other groups (E0*2 and E500*2) (p=0.000). The lowest connective tissue volume was found in the E500*2 and there was a significant difference compared to the other groups (E0*2 and E1000*2) (p=0.000). The volume of the new vessel was highest in the E500*2 and lowest in the E0*2 group. It was found statistically significant difference between the values of the study and control groups.CONCLUSIONS: Interestingly, we found that repetition of the 1000 impulses ESWT accelerated the consolidation, 500 impulses ESWT extended consolidation period of the DO.Raissi, G. R., Ghazaei, F., Forogh, B., Madani, S. P., Daghaghzadeh, A., and Ahadi, T. (2017). The Effectiveness of Radial Extracorporeal Shock Waves for Treatment of Carpal Tunnel Syndrome: A Randomized Clinical Trial, Ultrasound Med Biol, 43(2), 453-460, This study examined the effectiveness of radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome (CTS). Forty patients with mild to moderate CTS were allocated to two groups: (i) shock wave + wrist splint and (ii) wrist splint. Patients used wrist splints followed by three sessions of low-energy shock wave therapy in the intervention group and wrist splints alone in the other group. The QuickDASH Questionnaire, visual analogue scale and nerve conduction studies were used to evaluate the patients before the study and at 3, 8 and 12 wk after the start of the treatment. At the end of the study, both groups saw the same clinical benefits. However, a significantly greater improvement in the median nerve distal sensory latency was noted in the shock wave group compared with the control group. We suggest that application of shock wave with alternative protocols may be effective in the treatment of CTS in future studies.Santoboni, F., Balducci, S., D'Errico, V., Haxhi, J., Vetrano, M., Piccinini, G., Ferretti, A., Pugliese, G., and Vulpiani, M. C. (2017). Extracorporeal Shockwave Therapy Improves Functional Outcomes of Adhesive Capsulitis of the Shoulder in Patients With Diabetes, Diabetes Care, 40(2), e12-e13,

Yang, T.-H., Huang, Y.-C., Lau, Y.-C., and Wang, L.-Y. (2017). Efficacy of Radial Extracorporeal Shock Wave Therapy on Lateral Epicondylosis, and Changes in the Common Extensor Tendon Stiffness with Pretherapy and Posttherapy in Real-Time Sonoelastography: A Randomized Controlled Study, Am J Phys Med Rehabil, 96(2), 93-100, OBJECTIVE: To investigate the effects of radial extracorporeal shock wave therapy (rESWT) and to determine the posttreatment common extensor tendon stiffness among patients with lateral epicondylosis.DESIGN: Thirty patients with lateral epicondylosis were randomly divided into experimental and control groups. Participants in the experimental group received rESWT plus physical therapy, and those in the control group received sham shock wave plus physical therapy for 3 weeks. Visual analog scale; grip strength dynamometer; Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; and ultrasonography in 2-dimensional image, and real-time sonoelastography were used in the assessments at baseline and after 6, 12, and 24 weeks (T3).RESULTS: The experimental group had more significant pain reduction at T3 than the control group. Compared with the control group, the experimental group had significantly higher maximal grip strength at 12 and 24 weeks, with significant increases. Compared to baseline, the experimental group had significantly lower Taiwan version DASH disability/symptom scores and work module scores at all posttreatment follow-up points. Five participants in the experimental group had partial tear within common extensor tendon at their involved elbow, and all the tears totally healed at T3. However, the inter-rater reliabilities for real-time sonoelastography were poor to fair.CONCLUSIONS: Patients with lateral epicondylosis had better and faster pain reduction, grip strength increase, and functional improvement after receiving rESWT in addition to physical therapy than those who received physical therapy only.Acar, N., Karaarslan, A. A., and Karakasli, A. (2017). The effectiveness of extracorporeal shock wave therapy in snapping scapula, J Orthop Surg (Hong Kong), 25(1), 2309499016684723, BACKGROUND: Bursitis of the snapping scapula is commonly a misdiagnosed problem. Extracorporeal shockwave therapy (ESWT) has been used successfully in the treatment of many chronic inflammatory conditions. The aim of this study was to assess and compare the effectiveness of ESWT in the treatment of scapulothoracic bursitis with the outcome of corticosteroid injection.METHODS: Using the randomized controlled trials 43 patients with scapulothoracic bursitis were divided into two groups. Group 1 ( n = 22) received three sessions of ESWT. Group 2 ( n = 21) received a single local injection of 80 mg of methylprednisolone. Visual analogue scale (VAS) scores were recorded at each follow-up, whereas the level of satisfaction was evaluated using the Roles and Maudsley criteria.RESULTS: In group 1, the average VAS scores after 1, 2, 3, and 6 months were 39, 30, 27, and 16, respectively, whereas, in group 2, the average VAS scores were 46, 44, 35, and 36, respectively. There was no statistical significance between the two groups in the first and second months. However, after 3 and 6 months, group 1 revealed lower average VAS scores compared to that of the second group with p-values (0.012 and 0.001), respectively. Roles and Maudsley criteria showed that first group patients were 46% excellent, 36% good, 14% acceptable, and 4% had poor results. However, second group patients were 24% excellent, 33% good, 19% acceptable, and 24% had poor results.CONCLUSION: We believe that ESWT is a beneficial and trustable method of treatment and can be strongly recommended in painful cases of scapulothoracic bursitis.Barratt, P. A., Brookes, N., and Newson, A. (2017). Conservative treatments for greater trochanteric pain syndrome: a systematic review, Br J Sports Med, 51(2), 97-104, BACKGROUND: Greater trochanteric pain syndrome (GTPS) can have a significant effect on quality of life.AIM: To evaluate the conservative treatments for GTPS.DESIGN: This systematic review assessed risk of bias using the Cochrane Risk of Bias Tool and Cochrane Risk of Bias Tool for non-randomised studies of interventions.

DATA SOURCES: On 13 January 2016, a comprehensive search was conducted, with no limit on year of publication for relevant studies in the MEDLINE, CINAHL, AMED and EMBASE databases.ELIGIBILITY CRITERIA FOR SELECTING STUDIES: English language randomised controlled trials, case-control or cohort studies reporting outcome data for conservative treatments for adults having a diagnosis of GTPS, or trochanteric bursitis, were included.RESULTS: 8 studies (n=696) were eligible for inclusion in the review; corticosteroid injections (CSI) (n=6), shockwave therapy (n=2), home training (n=1) and orthotics (n=1). Based on pain, CSI demonstrated superior outcomes for up to 3 months compared with home training, radial shockwave therapy (RSWT) and usual care, in 4 studies demonstrating either a low or moderate risk of bias. Fluoroscopy-guided injections failed to show additional benefit. RSWT and home training had limited evidence. No conclusions can be drawn regarding the use of orthotics due to the serious risk of bias and methodological flaws within that study.CONCLUSIONS: This review demonstrates a paucity of high-quality research for the conservative treatments of GTPS. The risk of bias was low in only one study, demonstrating no additional benefit with fluoroscopically guided injections. Risk of bias in all remaining studies was varied. Standardisation of diagnostic criteria and outcome measures is essential to enable more powerful analysis.Clavijo, R. I., Kohn, T. P., Kohn, J. R., and Ramasamy, R. (2017). Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis, J Sex Med, 14(1), 27-35, INTRODUCTION: Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been proposed as an effective non-invasive treatment option for erectile dysfunction (ED).AIM: To use systematic review and meta-analysis to assess the efficacy of Li-ESWT by comparing change in erectile function as assessed by the erectile function domain of the International Index of Erectile Function (IIEF-EF) in men undergoing Li-ESWT vs sham therapy for the treatment of ED.METHODS: Systematic search was conducted of MEDLINE, EMBASE, and ClinicalTrials.gov for randomized controlled trials that were published in peer-reviewed journals or presented in abstract form of Li-ESWT used for the treatment of ED from January 2010 through March 2016. Randomized controlled trials were eligible for inclusion if they were published in the peer-reviewed literature and assessed erectile function outcomes using the IIEF-EF score. Estimates were pooled using random-effects meta-analysis.MAIN OUTCOME MEASURES: Change in IIEF-EF score after treatment with Li-ESWT in patients treated with active treatment vs sham Li-ESWT probes.RESULTS: Data were extracted from seven trials involving 602 participants. The average age was 60.7 years and the average follow-up was 19.8 weeks. There was a statistically significant improvement in pooled change in IIEF-EF score from baseline to follow-up in men undergoing Li-ESWT vs those undergoing sham therapy (6.40 points; 95% CI = 1.78-11.02; I(2) = 98.7%; P < .0001 vs 1.65 points; 95% CI = 0.92-2.39; I(2) = 64.6%; P < .0001; between-group difference, P = .047). Significant between-group differences were found for total treatment shocks received by patients (P < .0001).CONCLUSION: In this meta-analysis of seven randomized controlled trials, treatment of ED with Li-ESWT resulted in a significant increase in IIEF-EF scores.Everhart, J. S., Cole, D., Sojka, J. H., Higgins, J. D., Magnussen, R. A., Schmitt, L. C., and Flanigan, D. C. (2017). Treatment Options for Patellar Tendinopathy: A Systematic Review, Arthroscopy, (), , PURPOSE: To compare the efficacy of common invasive and noninvasive patellar tendinopathy (PT) treatment strategies.METHODS: A systematic search was performed in PubMed, Google Scholar, CINAHL, UptoDate, Cochrane Reviews, and SPORTDiscus. Fifteen studies met the following inclusion criteria: (1) therapeutic outcome trial for PT, and (2) Victorian Institute of Sports Assessment was used to assess symptom severity at follow-up. Methodological quality and reporting bias were evaluated with a modified Coleman score and Begg's and Egger's tests of bias, respectively.RESULTS: A total of 15 studies were included. Reporting quality was high (mean Coleman score 86.0, standard deviation 9.7), and there was no systematic evidence of reporting bias.

Increased duration of symptoms resulted in poorer outcomes regardless of treatment (0.9% decrease in improvement per additional month of symptoms; P = .004). Eccentric training with or without core stabilization or stretching improved symptoms (61% improvement in the Victorian Institute of Sports Assessment score, 95% confidence interval [CI] 53% to 69%). Surgery in patients refractory to nonoperative treatment also improved symptoms (57%, 95% CI 52% to 62%) with similar outcomes among arthroscopic and open approaches. Results from shockwave (54%, 95% CI 22% to 87%) and platelet-rich plasma (PRP) studies (55%, 95% CI 5% to 105%) varied widely though PRP may accelerate early recovery. Finally, steroid injection provided no benefit (20%, 95% CI -20% to 60%).CONCLUSIONS: Initial treatment of PT can consist of eccentric squat-based therapy, shockwave, or PRP as monotherapy or an adjunct to accelerate recovery. Surgery or shockwave can be considered for patients who fail to improve after 6 months of conservative treatment. Corticosteroid therapy should not be used in the treatment of PT.LEVEL OF EVIDENCE: Level IV, systematic review of Level II-IV studies.Foglietta, F., Duchi, S., Canaparo, R., Varchi, G., Lucarelli, E., Dozza, B., and Serpe, L. (2017). Selective sensitiveness of mesenchymal stem cells to shock waves leads to anticancer effect in human cancer cell co-cultures, Life Sci, (), , AIM: Mesenchymal stem cells (MSC) possess the distinctive feature of homing in on and engrafting into the tumor stroma making their therapeutic applications in cancer treatment very promising. Research into new effectors and external stimuli, which can selectively trigger the release of cytotoxic species from MSC toward the cancer cells, significantly raises their potential.MAIN METHODS: Shock waves (SW) have recently gained recognition for their ability to induce specific biological effects, such as the local generation of cytotoxic reactive oxygen species (ROS) in a non-invasive and tunable manner. We thus investigate whether MSC are able to generate ROS and, in turn, affect cancer cell growth when in co-culture with human glioblastoma (U87) or osteosarcoma (U2OS) cells and exposed to SW.KEY FINDINGS: MSC were found to be the cell line that was most sensitive to SW treatment as shown by SW-induced ROS production and cytotoxicity. Notably, U87 and U2OS cancer cell growth was unaffected by SW exposure. However, significant decreases in cancer cell growth, 1.8 fold for U87 and 2.3 fold for U2OS, were observed 24h after the SW treatment of MSC co-cultures with cancer cells. The ROS production induced in MSC by SW exposure was then responsible for lipid peroxidation and cell death in U87 and U2OS cells co-cultured with MSC.SIGNIFICANCE: This experiment highlights the unique ability of MSC to generate ROS upon SW treatment and induce the cell death of co-cultured cancer cells. SW might therefore be proposed as an innovative tool for MSC-mediated cancer treatment.Fojecki, G. L., Tiessen, S., and Osther, P. J. S. (2017). Effect of Low-Energy Linear Shockwave Therapy on Erectile Dysfunction-A Double-Blinded, Sham-Controlled, Randomized Clinical Trial, J Sex Med, 14(1), 106-112, INTRODUCTION: Previous studies have shown that focal low-energy extracorporeal shockwave therapy (Li-ESWT) can have a positive effect in men with erectile dysfunction (ED). Linear Li-ESWT (LLi-ESWT) for ED has not been previously assessed in a randomized trial.AIM: To evaluate the treatment outcome of LLi-ESWT for ED.METHODS: Men with ED (n = 126) and a score lower than 25 points on the International Index of Erectile Function erectile function domain (IIEF-EF) were included. Subjects were allocated to receive LLi-ESWT once a week for 5 weeks or sham treatment once a week for 5 weeks. After a 4-week break, the two groups received active treatment once a week for 5 weeks. Subjects completed the IIEF, Erection Hardness Scale (EHS), Sexual Quality of Life-Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction at baseline, after 9 weeks, and after 18 weeks.MAIN OUTCOME MEASURES: The primary outcome measurement was an increase of at least five points on the IIEF-EF score. The secondary outcome measurement was an increased EHS score to at least 3 in men with a score no higher than 2 at baseline. Data were analyzed by linear and logistic regression.RESULTS: Mean IIEF-EF scores were 11.5 at baseline (95% CI = 9.8-13.2), 13.0 after five sessions (95% CI = 11.0-15.0), and 12.6 after 10 sessions (95% CI = 11.0-14.2) in the sham

group and correspondingly 10.9 (95% CI = 9.1-12.7), 13.1 (95% CI = 9.3-13.4), and 11.8 (95% CI = 10.1-13.4) in the ESWT group. Success rates based on IIEF-EF score were 38.3% in the sham group and 37.9% in the ESWT group (odds ratio = 0.95, 95% CI = 0.45-2.02, P = .902). Success rates based on EHS score were 6.7% in the sham group and 3.5% in the ESWT group (odds ratio = 0.44, 95% CI = 0.08-2.61, P = .369). A limitation of this study is that device settings (number of shockwaves and penetration depth) were estimated based on an existing trial on focused ESWT.CONCLUSION: No clinically relevant effect of LLi-ESWT on ED was found.Frizziero, A., Barazzuol, M., Vittadini, F., Bellon, G., Masiero, S., and Meneghini, A. (2017). Plantar Fascial Fibromatosis: Two Cases Treated With Low-Energy Focused Shock Waves, J Clin Rheumatol, 23(1), 63-65, Gaulke, R. and Krettek, C. (2017). [Tendinopathies of the foot and ankle : Evidence for the origin, diagnostics and therapy], Unfallchirurg, (), , Tendinopathies of the foot and ankle result in substantial impairment of the mobility of patients and have a high clinical significance. Knowledge of the origin of these diseases has been accumulated over decades from the multitude of intrinsic and extrinsic triggering factors based on biomechanical considerations with an evidence-based medicine (EBM) level 5. A high correlation between tendinopathy and hypervascularization of the Achilles tendon was found in a double-blind randomized prospective study using Doppler ultrasound (EBM level 1) but these results were not reproducible; therefore, the importance of these findings is unclear. Inspection and clinical examination supplemented by ultrasound and magnetic resonance imaging (MRI) are essential to achieve the correct diagnosis. The varying extent of load-dependent irritation of tendons and the surrounding tissues and the individual variation in experience of investigators mean that the results of clinical examinations are difficult to collate or not reproducible and cannot be investigated in studies. The expression of the varying results is difficult to assess even by the use of sonography and magnetic resonance imaging (MRI). Conservative treatment of tendinopathy is based on medical experience (EBM level 5). The effectiveness of physiotherapeutic eccentric loading and extracorporal shock wave treatment (ESWT) for Achilles tendinopathy was demonstrated in several case control studies and series (EBM level 3). Due to the high rate of healing with physiotherapy, surgery should only be performed following a minimum of 6-12 weeks of unsuccessful conservative treatment, because formation of scar tissue on the foot can result in permanent complaints (EBM level 4).Horstmann, H., Clausen, J. D., Krettek, C., and Weber-Spickschen, T. S. (2017). [Evidence-based therapy for tendinopathy of the knee joint : Which forms of therapy are scientifically proven?], Unfallchirurg, (), , Tendinopathy in the region of the knee joint is a common pathological disorder. People active in sports, in particular, have a high probability of suffering from tendinopathy. Despite its high clinical relevance, the level of evidence of therapy options for tendinopathy in the knee region differs greatly. This review gives an overview of current evidence levels for therapy options in tendinopathy of the quadriceps, patellar and pes anserinus insertion tendons as well as of the distal iliotibial tract tendon. The treatment with platelet-rich plasma showed a significantly better outcome when used correctly and treatment with shock waves, operative treatment and sclerotherapy have also shown positive effects. Treatment with corticosteroid injections and with oral non-steroidal anti-inflammatory drugs (NSAID) showed positive short-term effects (follow-up ±4 weeks). No reasonable data are available for the treatment of tendinopathy in the knee region by acupuncture, fascial therapy or cryotherapy. The use of kinesio taping showed no significant relief from complaints compared with standard conservative treatment. The use of multimodal therapy without evidence is, therefore, particularly common in elite athletes.Imamura, M., Alamino, S., Hsing, W. T., Alfieri, F. M., Schmitz, C., and Battistella, L. R. (2017). Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis, J Rehabil Med, 49(1), 54-62, OBJECTIVE: To assess the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for disabling pain due to primary knee osteoarthritis.DESIGN: Randomized, placebo-controlled trial (level of evidence, 1).

SUBJECTS: A total of 105 women with disabling pain due to primary knee osteoarthritis lasting for a mean of 103 months (range 3-480 months).METHODS: Patients received either rESWT (3 sessions, each one week apart, 2,000 rESWT impulses per session, positive energy flux density 0.10-0.16 mJ/mm2) or placebo treatment. Primary outcome measure was pain on movement 3 months after the final treatment session. Secondary outcomes were pain, stiffness and limitations in physical function on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and the level of tolerance to pressure over muscles, tendons, ligaments and skin at both the treated and the untreated side at 1 week and 3 months follow-up examinations.RESULTS: Compared with placebo treatment, rESWT led to a statistically significant improvement only in mean WOMAC scores for pain and a few of the pressure measurements.CONCLUSION: rESWT, as performed in the present study, is not efficient for treating patients with disabling pain due to primary knee osteoarthritis. Published data indicate that substantially higher energy flux densities are necessary for treatment success in this condition.Lama, A., Santoro, A., Corrado, B., Pirozzi, C., Paciello, O., Pagano, T. B., Russo, S., Calignano, A., Mattace Raso, G., and Meli, R. (2017). Extracorporeal shock waves alone or combined with raloxifene promote bone formation and suppress resorption in ovariectomized rats, PLoS One, 12(2), e0171276, Osteoporosis is a metabolic skeletal disease characterized by an imbalance between osteoclast-mediated bone resorption and osteoblast-mediated bone formation. We examined the beneficial effect of shock waves (SW) alone or in combination with raloxifene (RAL) on bone loss in ovariectomized rats (OVX). Sixteen weeks after surgery, OVX were treated for five weeks with SW at the antero-lateral side of the right hind leg, one session weekly, at 3 Hz (EFD of 0.33 mJ/mm2), or with RAL (5 mg/kg/die, per os) or with SW+RAL. Sera, femurs, tibiae and vertebrae were sampled for following biochemical and histological analysis. SW, alone or combined with RAL, prevented femur weight reduction and the deterioration of trabecular microarchitecture both in femur and vertebrae. All treatments increased Speed of Sound (SoS) values, improving bone mineral density, altered by OVX. Serum parameters involved in bone remodeling (alkaline phosphatase, receptor activator of nuclear factor kappa-B ligand, osteoprotegerin) and osteoblast proliferation (PTH), altered by ovariectomy, were restored by SW and RAL alone or in combination. In tibiae, SW+RAL significantly reduced cathepsin k and TNF-α levels, indicating the inhibition of osteoclast activity, while all treatments significantly increased runt-related transcription factor 2 and bone morphogenetic-2 expression, suggesting an increase in osteoblastogenic activity. Finally, in bone marrow from tibiae, SW or RAL reduced PPARγ and adiponectin transcription, indicating a shift of mesenchymal cells toward osteoblastogenesis, without showing a synergistic effect. Our data indicate SW therapy, alone and in combination with raloxifene, as an innovative strategy to limit the hypoestrogenic bone loss, restoring the balance between bone formation and resorption.Lynen, N., De Vroey, T., Spiegel, I., Van Ongeval, F., Hendrickx, N.-J., and Stassijns, G. (2017). Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles' Tendinopathy: A Randomized Clinical Efficacy and Safety Study, Arch Phys Med Rehabil, 98(1), 64-71, OBJECTIVE: To compare the safety and efficacy of hyaluronan (HA) injections with standard extracorporeal shock wave therapy (ESWT) in the treatment of painful midportion Achilles' tendinopathy.DESIGN: Multinational, prospective, randomized controlled, blinded-observer trial.SETTING: Ambulatory care.PARTICIPANTS: Adults (N=62) with Achilles' midportion tendinopathy for ≥6 weeks and a pain score of at least 40mm (Huskisson visual analog scale [VAS], 100mm) were randomized, and 59 were analyzed in the intention-to-treat data set. There were no withdrawals because of adverse effects.INTERVENTIONS: Two peritendinous HA injections versus 3 ESWT applications at weekly intervals.MAIN OUTCOME MEASURES: Primary efficacy criterion was changed from the Victorian Institute of Sports Assessment-Achilles' questionnaire (VISA-A) score to the percent change

in pain (VAS) at 3 months posttreatment, compared with baseline values. Main secondary parameters were VISA-A, Clinical Global Impression (CGI), and clinical parameters.RESULTS: HA treatment provided a clinically relevant improvement in Achilles' midportion tendinopathy. A large superiority of the HA group, compared with ESWT application, was observed for percent change in pain (VAS), and this superiority was proven to be statistically significant (Mann-Whitney statistic [MW]=.7507 with P=.0030 lower than required α=.025 significance level 1-sided; Mann-Whitney U test) at 3 months posttreatment. Similar findings for HA were also observed at 4 weeks (MW=.6425, P=.0304) and 6 months (MW=.7172, P=.0018). Advantage of HA treatment was confirmed by VISA-A questionnaire, CGI, and clinical parameters. Ten adverse events, 4 in the HA group and 6 in the ESWT group, were reported, but none were classified as serious.CONCLUSIONS: Two peritendinous HA injections showed greater treatment success in Achilles' midportion tendinopathy compared with standard ESWT.Mansur, N. S. B., Faloppa, F., Belloti, J. C., Ingham, S. J. M., Matsunaga, F. T., Santos, P. R. D. D., Santos, B. S. D., Carrazzone, O. L., Peixoto, G., Aoyama, B. T., and Tamaoki, M. J. S. (2017). Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol, BMJ Open, 7(1), e013332, BACKGROUND: There is no consensus regarding the treatment of Achilles insertional tendinopathies. Eccentric training remains the main choice in the conservative treatment of this illness; however, the good results in the management of non-insertional Achilles tendinopathy were not replicated in the insertional condition. Low energy shock wave therapy has been described as an alternative to these patients, but has yet to be empirically tested.HYPOTHESIS: Shock wave therapy, adjunctive to the eccentric strengthening protocol, will improve measures of pain and function.DESIGN: Double blind, placebo-controlled, parallel groups, randomised clinical trial.MATERIALS AND METHODS: 93 patients with a diagnosis of chronic insertional tendinopathy, referred from primary or secondary healthcare services, will be assessed and enrolled in this study. They will be divided into two groups (randomised by sequentially numbered identical envelopes, which will be administered serially to participants), one containing the combination of low energy shock wave and eccentric exercises, as treatment and the other comprehending the exercises and the placebo treatment (an apparatus placed in the therapeutic head). The assessments will occur in 2, 4, 6, 12 and 24 weeks. Patients will be evaluated primarily by the Victorian Institute of Sport Assessment-Achilles questionnaire and secondarily by the visual analogue scale, Algometry, the American Orthopedic Foot and Ankle Society scale, the Foot and Ankle Outcome Score and the 12-item Short Form Health Survey. We will use comparison of two proportions via relative frequency analysis, the Pearson Correlation the χ(2) test and the analysis of variance for statistical analyses.DISCUSSION: This study intends to demonstrate if the association of the eccentric exercise programme with the shock wave therapy can produce good results regarding the treatment of the Achilles insertional tendinopathy. In an attempt to prevent the high costs and complications associated with the surgical intervention, we will try to prove this combination as a viable therapeutic option in the conservative management of this prevalent condition. The strengths of the study are the design and the novelty of the combination of methods. The main limitation is the short follow-up course.ETHICS AND DISSEMINATION: The study is registered in the Clinical Trials database (protocol number: 8094833648737701) and was approved by the University Ethics Committee (number: 1373481).TRIAL REGISTRATION NUMBER: 8094833648737701 (NCT02757664); Pre-results.Marwan, Y., Dahrab, B., Esmaeel, A., Ibrahim, S. A., and Al-Failakawi, J. (2017). Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases, Eur J Orthop Surg Traumatol, (), , BACKGROUND: Coccydynia can lead to significant functional disability and worsening of quality of life if not properly managed. In this study, we aim to assess the outcomes of extracorporeal shock wave therapy in patients with coccydynia.

METHODS: A prospective case series study was carried out from January to December 2015. Twenty-three patients, mean age of 38.3 ± 12.1 (range 18-64), were included. The majority were females (13; 56.5%), had pain for at least 6 weeks (17; 73.9%) and had trauma to the sacrococcygeal region (17; 73.9%). They had three sessions (one session per week for three consecutive weeks) of focused shock wave therapy directed to the maximal point of coccygeal tenderness. Numerical pain scale and Oswestry disability index were used to assess outcome.RESULTS: Six (26.1%) patients did not complete the follow-up because of no, or minimal, improvement of their pain. After 6 months of follow-up, the median numerical pain scale significantly decreased from 7.0 ± 4.0 to 2.0 ± 2.0 among the 17 patients with coccydynia (p < 0.001). The median Oswestry disability index improved from 24.0 ± 9.0 before therapy to 8.0 ± 9.0 at final follow-up (p < 0.001). Before treatment, 12 (70.6%) patients had moderate-to-severe disability. In contrast, no patients had severe disability and only one (5.9%) patient had moderate disability at final follow-up (p < 0.001).CONCLUSION: Extracorporeal shock wave therapy had favorable outcomes in treating coccydynia. The majority of patients had partial relief of their pain and disability following this therapy.Porso, M., Loreti, S., Nusca, S. M., Luziatelli, S., Caccia, D., Taborri, G., Trischitta, D., Taurino, M., Padua, L., Saraceni, V. M., Vulpiani, M. C., and Vetrano, M. (2017). Defocused Shock Wave Therapy for Chronic Soft Tissue Wounds in the Lower Limbs: A Pilot Study, Ultrasound Med Biol, 43(1), 362-369, Chronic soft tissue wounds of the lower limbs are debilitating, painful and often unresponsive to advanced dressing treatments. Extracorporeal shock wave therapy (ESWT) could represent an alternative treatment. Ten patients with chronic soft tissue wounds of the legs, unresponsive to advanced dressing treatments for more than 3 mo, underwent three defocused ESWT sessions at 72-h intervals. In every session, the sum of 300 standard pulses + 100 pulses per square centimeter was applied at 0.15 mJ/mm(2) and 4 Hz over the edge of the wound. The wound size in square centimeters, Bates-Jensen Wound Assessment Tool and visual analogue scale were used as outcome measures. A significant reduction in wound size and Bates-Jensen Wound Assessment Tool and visual analogue scale values from pre-treatment to 90 d was observed. Seven of ten ulcers healed completely and nine of ten patients reported complete pain relief. Defocused ESWT represents a non-invasive, feasible strategy for difficult-to-treat soft tissue wounds of the lower limbs.Saldaña-Gallo, J., Torres-Román, J. S., and Grandez-Urbina, J. A. (2017). Shock wave therapy for erectile dysfunction: The lack of evidence at the Latin America and Caribbean level, Actas Urol Esp, (), , Sansone, V., Romeo, P., and Lavanga, V. (2017). Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study, Med Princ Pract, 26(1), 23-29, OBJECTIVE: To test the hypothesis that shock wave therapy can produce a statistically significant improvement in symptoms and imaging features of the knee bone marrow edema syndrome (BMES) within 6 months of treatment.SUBJECTS AND METHODS: Eighty-six consecutive patients suffering from BMES of the medial compartment of the knee were prescribed a course of high-energy extracorporeal shock wave therapy (ESWT) and clinically followed up at 3 and 6 months and finally from 14 to approximately 18 months after treatment. Thirty-one patients were unable to undergo ESWT but returned for the 6-month and final follow-up; these were referred to as the conservative (control) group, while the other 55 patients constituted the ESWT group. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analog Scale (VAS) score of each patient were calculated at every follow-up. The BME area was assessed using magnetic resonance imaging before treatment and at the 6-month follow-up.RESULTS: Statistically significant improvements were observed in clinical scores and in the BME area for both the ESWT and the control group (p < 0.05). The improvements in the ESWT group were statistically better in all parameters compared with the control group: the ESWT group had a reduction in the BME area of 86% versus 41% in the control group, the VAS pain score improved by 88% in the ESWT group versus 42% in the control group, and

the WOMAC score improved by 65% in the ESWT group versus 22% in the control group. Clinical scores were significantly better for patients with medial tibial lesions in the ESWT group.CONCLUSION: In this study, ESWT reduced pain and the BME area in the knee, with significant clinical improvement noticed 3 months after treatment.Schöberl, M., Prantl, L., Loose, O., Zellner, J., Angele, P., Zeman, F., Spreitzer, M., Nerlich, M., and Krutsch, W. (2017). Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study, Knee Surg Sports Traumatol Arthrosc, (), , PURPOSE: The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardised non-surgical treatment for swift return-to-football.METHODS: In a prospective double-blinded controlled study, 143 amateur football players with groin pain as well as radiological signs and clinical symptoms of pubic overload were analysed for 1 year. Two randomised study groups participated in an intensive physical rehabilitation programme, either with or without shock wave therapy. The control group did not participate in any standardised rehabilitation programme but only stopped participating in sports activity. Follow-up examinations took place 1, 3 months and 1 year after the beginning of therapy. Endpoints were visual analogue scale (VAS), functional tests, the time of return-to-football, recurrent complaints and changes in the MR image.RESULTS: Forty-four football players with groin pain and aseptic osteitis pubis were randomised into two study groups; 26 received shock wave therapy, 18 did not. Clinical examination showed pubic overload as a multi-located disease. Players receiving shock wave therapy showed earlier pain relief in the VAS (p < 0.001) and returned to football significantly earlier (p = 0.048) than players without this therapy. Forty-two of 44 players of both study groups returned to football within 4 months after the beginning of therapy and had no recurrent groin pain within 1 year after trauma. Fifty-one players of the control group returned to football after 240 days (p < 0.001), of whom 26 (51%) experienced recurrent groin pain. Follow-up MRI scans did not show any effect of shock wave therapy.CONCLUSION: Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shock wave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma. Early and correct diagnosis is essential for successful intensive physiotherapy.LEVEL OF EVIDENCE: I.Williams, H., Jones, S. A., Lyons, C., Wilson, C., and Ghandour, A. (2017). Refractory patella tendinopathy with failed conservative treatment-shock wave or arthroscopy?, J Orthop Surg (Hong Kong), 25(1), 2309499016684700, AIM: To identify whether the location of refractory patella tendinopathy (PT) has an effect on treatment modality (radial extracorporeal shock wave therapy (rESWT) or arthroscopic debridement).METHODS: Between 2012 and 2014, 40 patients with PT underwent a magnetic resonance imaging (MRI) scan. This confirmed the diagnosis as either involving the tendon itself (group A, 20) or with retropatella fat pad extension (group B, 20). All patients underwent rESWT. If there was no improvement patients proceeded with surgery in the form of arthroscopic debridement (by senior authors CW and AG). Outcomes were assessed before and after treatment using the Victorian Institute of Sports Assessment-Patella (VISA-P) score.RESULTS: There were 18 males and 2 females in group A and 15 males and 5 females in group B. The mean age was 41.4 years in group A (23-59) and 34.7 in group B (19-52). Seventeen of 20 in group A reported good or excellent outcomes and did not require surgical intervention (remaining three improved after second course of ESWT). All patients in group B failed to improve with rESWT, resulting in arthroscopic debridement and reported good or excellent outcomes. After 6 months, group A mean VISA-P score increased from 50.2 to 65.0 ( p = 0.01) and group B from 39.6 to 78.4 ( p = <0.001).CONCLUSION: An MRI should be performed to determine the precise location of tendinosis in patients with refractory PT who fail standard conservative management. If the MRI scan shows intratendon changes only, ESWT should be performed and those with extension into the fat pad should proceed to arthroscopic debridement without rESWT.

Zhang, Q., Liu, L., Sun, W., Gao, F., Cheng, L., and Li, Z. (2017). Extracorporeal shockwave therapy in osteonecrosis of femoral head: A systematic review of now available clinical evidences, Medicine (Baltimore), 96(4), e5897, BACKGROUND: Osteonecrosis is an incapacitating disorder with high morbidity. Though extracorporeal shockwave therapy (ESWT) provides a noninvasive treatment option, controversial subjects still exist about its effectiveness, indications, and mechanism of action.METHODS: An electronic databases search was performed using PubMed, Embase, and the Cochrane library to collect clinical trials, case reports, and cases series on this topic and then useful data were extracted and appraised by experienced clinicians. We evaluated the quality of included evidences by using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence.RESULTS: A total of 17 articles including 2 case reports, 9 open label trials, 2 cohorts, and 6 randomized controlled trials were considered to be eligible for this systematic review. Visual analog scale (VAS), Harris hip scores, and the imaging results were the frequently-used outcome estimates of included studies.CONCLUSION: By systematically analyzing these evidences, we could conclude that ESWT could act as a safe and effective method to improve the motor function and relieve the pain of patients with osteonecrosis of femoral hip, especially those at early stage. Imaging revealed that bone marrow edema was significantly relieved, but the necrotic bone could not be reversed after ESWT. This technique could slow or even block the progression of ONFH and therefore reduce the demand for surgery. Collaboration with other conservative modalities would not improve the curative benefits of ESWT. Meanwhile, ONFH with various risk factors showed similar reaction to this noninvasive treatment method. However, these conclusions should be interpreted carefully for the low-quality of included publications and further studies are requisite to validate the effect of ESWT in ONFH.Zou, Z.-J., Liu, Z.-H., Tang, L.-Y., and Lu, Y.-P. (2017). Is there a role for extracorporeal shock wave therapy for erectile dysfunction unresponsive to phosphodiesterase type 5 inhibitors?, World J Urol, 35(1), 167-171, Angulo, J. C. (2016). Commentary to low-energy shock wave therapy ameliorates erectile dysfunction in a pelvic neurovascular injuries rat model, published in J Sex Med 2016;13:22-32 by Li H, Matheu P, Sun F, et al, Transl Androl Urol, 5(6), 956-957, Assad, S., Ahmad, A., Kiani, I., Ghani, U., Wadhera, V., and Tom, T. N. (2016). Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis, Cureus, 8(12), e913, We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.Behr-Roussel, D. and Giuliano, F. (2016). Low-energy shock wave therapy ameliorates erectile dysfunction in a pelvic neurovascular injuries rat model, Transl Androl Urol, 5(6), 977-979, Fleckenstein, J., Friton, M., Himmelreich, H., and Banzer, W. (2016). Effect of a single administration of focused extracorporeal shock wave in the relief of Delayed-Onset Muscle Soreness: results of a partially-blinded randomized controlled trial, Arch Phys Med Rehabil,

(), , OBJECTIVES: To examine the effects of a single administration of focused extracorporeal shockwave therapy (fESWT) on eccentric exercise-induced delayed-onset muscle soreness (DOMS). DOMS is a common symptom in people participating in exercise, sports, or recreational physical activities.DESIGN: Three-arm randomized controlled study conducted in 2009.SETTING: DOMS was induced by eccentric exercise of the non-dominant arm in voluntary participants at the Sports Campus of a German university.INTERVENTIONS: Participants were randomly allocated to verum (energy flux density 0.06 to 0.09 mJ/mm(2); pulse ratio per point 200), or sham fESWT (no energy) at 7 equidistant points along the biceps muscle, or no intervention.MAIN OUTCOME MEASURE: The primary outcome was the difference in pain intensity. Secondary outcomes included maximum isometric voluntary force (MIVF), pressure pain threshold (PPT) and impairment in daily life.RESULTS: DOMS was induced in 46 participants (23 female) with a mean age of 29.0 years (standard deviation [SD] = 3.0) and a mean BMI of 23.8 kg/m(2) (SD = 2.8). Despite descriptive clinically meaningful differences, mixed-effects analysis (group x time) of changes to baseline did not reveal significant differences in the reduction of pain intensity between groups (F2.498, df2, p = 0.094). The MIVF was not significantly different between groups (F1.917, df2, p = 0.159). The PTT was not significantly decreased over time (F0.158, df2, p = 0.854), as was the daily life impairment (F1.444, df2, p = 0.248), and there were no differences between groups in the post-hoc analysis.CONCLUSIONS: A single treatment with fESWT causes clinically relevant effects in the relief of pain, increase in force, and improvement of pain-associated impairments of daily living. Still, results need to be cautiously interpreted due to the pilot character of this study. Focused ESWT might present an option in the mid-term recovery from DOMS (72 hours). This being an approach enhancing the return to play in athletes.Huang, T.-H., Sun, C.-K., Chen, Y.-L., Wang, C.-J., Yin, T.-C., Lee, M. S., and Yip, H.-K. (2016). Shock Wave Enhances Angiogenesis through VEGFR2 Activation and Recycling, Mol Med, 22(), , Although low-energy shock wave (SW) is adopted to treat ischemic diseases because of its pro-angiogenic properties, the underlying mechanism remains unclear. This study aimed at testing whether SW-induced angiogenesis may be through endothelial vascular endothelial growth factor receptor 2 (VEGFR2) signaling and trafficking. Phosphorylation of VEGFR2-Akt-eNOS axis and production of nitric oxide (NO) were determined in human umbilical vein endothelial cells (HUVECs) treated with SW. Carotid artery in ob/ob mice was treated with SW before evaluation with sprouting assay. Critical limb ischemia was induced in ob/ob mice to evaluate blood flow recovery after SW treatment. Tube formation and migration assays were also performed with/without SW treatment in the presence/absence of SU5416 (VEGFR2 kinase inhibitor) and siRNA-driven silencing of VEGFR2. Chloroquine was used for disrupting endosome, and Rab11a controlling slow endocytic recycling was silenced with siRNA in vitro. Following SW treatment, augmented ligand-independent phosphorylation in VEGFR2-Akt-eNOS axis and endogenous NO production, increased cellular migration and tube formation, elevated sprouting of carotid artery and blood flow in ischemic limb in ob/ob mice were noted. Moreover, SU5416 and VEGFR2 silencing both inhibited SW-induced angiogenesis. SW-induced angiogenesis, which was accompanied by increased VEGFR2 protein expression without transcriptional change, was suppressed by chloroquine and Rab11a silencing. We concluded that SW enhanced angiogenesis via ligand-independent activation of VEGFR2 and further prolonged through endosome-to-plasma membrane recycling in endothelial cells.Jin, Y., Xu, L., Zhao, Y., Wang, M., Jin, X., and Zhang, H. (2016). Endogenous Stem Cells Were Recruited by Defocused Low-Energy Shock Wave in Treating Diabetic Bladder Dysfunction, Stem Cell Rev, (), , Defocused low-energy shock wave (DLSW) has been shown effects on activating mesenchymal stromal cells (MSCs) in vitro. In this study, recruitment of endogenous stem cells was firstly examined as an important pathway during the healing process of diabetic bladder dysfunction (DBD) treated by DLSW in vivo. Neonatal rats received intraperitoneal injection of 5-ethynyl-2-deoxyuridine (EdU) and then DBD rat model was created by injecting streptozotocin. Four weeks later, DLSW treatment was

performed. Afterward, their tissues were examined by histology. Meanwhile, adipose tissue-derived stem cells (ADSCs) were treated by DLSW in vitro. Results showed DLSW ameliorated voiding function of diabetic rats by recruiting EdU(+)Stro-1(+)CD34(-) endogenous stem cells to release abundant nerve growth factor (NGF) and vascular endothelial growth factor (VEGF). Some EdU(+) cells overlapped with staining of smooth muscle actin. After DLSW treatment, ADSCs showed higher migration ability, higher expression level of stromal cell-derived factor-1 and secreted more NGF and VEGF. In conclusion, DLSW could ameliorate DBD by recruiting endogenous stem cells. Beneficial effects were mediated by secreting NGF and VEGF, resulting into improved innervation and vascularization in bladder.Ke, M.-J., Chen, L.-C., Chou, Y.-C., Li, T.-Y., Chu, H.-Y., Tsai, C.-K., and Wu, Y.-T. (2016). The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial, Sci Rep, 6(), 38344, Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.Kraemer, R., Sorg, H., Forstmeier, V., Knobloch, K., Liodaki, E., Stang, F. H., Mailaender, P., and Kisch, T. (2016). Immediate Dose-Response Effect of High-Energy Versus Low-Energy Extracorporeal Shock Wave Therapy on Cutaneous Microcirculation, Ultrasound Med Biol, 42(12), 2975-2982, Elucidation of the precise mechanisms and therapeutic options of extracorporeal shock wave therapy (ESWT) is only at the beginning. Although immediate real-time effects of ESWT on cutaneous hemodynamics have recently been described, the dose response to different ESWT energies in cutaneous microcirculation has never been examined. Thirty-nine Sprague-Dawley rats were randomly assigned to three groups that received either focused high-energy shock waves (group A: total of 1000 impulses, 10 J) to the lower leg of the hind limb, focused low-energy shock waves (group B: total of 300 impulses, 1 J) or placebo shock wave treatment (group C: 0 impulses, 0 J) using a multimodality shock wave delivery system (Duolith SD-1 T-Top, Storz Medical, Tägerwilen, Switzerland). Immediate microcirculatory effects were assessed with the O2C (oxygen to see) system (LEA Medizintechnik, Giessen, Germany) before and for 20 min after application of ESWT. Cutaneous tissue oxygen saturation increased significantly higher after high-energy ESWT than after low-energy and placebo ESWT (A: 29.4% vs. B: 17.3% vs. C: 3.3%; p = 0.003). Capillary blood velocity was significantly higher after high-energy ESWT and lower after low-energy ESWT versus placebo ESWT (group A: 17.8% vs. group B: -22.1% vs. group C: -5.0%, p = 0.045). Post-capillary venous filling pressure was significantly enhanced in the high-energy ESWT group in contrast to the low-energy ESWT and placebo groups (group A: 25% vs. group B: 2% vs. group C: -4%, p = 0.001). Both high-energy and low-energy ESWT affect cutaneous hemodynamics in a standard rat model. High-energy ESWT significantly increases parameters of cutaneous microcirculation immediately after application, resulting in higher tissue oxygen saturation, venous filling pressure and blood velocity, which suggests higher tissue perfusion with enhanced oxygen saturation, in contrast to low-energy as well as placebo ESWT. Low-energy ESWT also increased tissue oxygen saturation, albeit to a lower extent, and decreases both blood velocity and venous filling

pressure. Low-energy ESWT reduced tissue perfusion, but improved oxygen saturation immediately after the application.Liu, L., Guo, R., Chen, L., Cao, Y., Yang, Y., and Zhao, B. (2016). A prediction model for two-dimensional pressure distribution from underwater shock wave focusing by an ellipsoidal reflector, J Acoust Soc Am, 140(6), 4506, Underwater shock wave focusing by ellipsoidal reflector is an important method for medical treatment, detection, and acoustic warfare. However, its pressure field is difficult to predict due to complicated physics. In this study, the pressure by focusing is modeled based on theories of shock wave propagation, nonlinear reflection, and nonlinear focusing, and the calculation domain is determined by approximate equations of wave fronts and lines. The pressure field during the whole process is described by combining direct and focusing pressures in the time and space domains. On this basis, the focusing behavior is simulated, and obtained pressure profiles are compared with experimental results, and the influence of reflector length on focusing performance is also discussed. The results indicate that although there are some rough assumptions, this model can simulate the underwater focusing in some detail and does a good job of predicting the pressure distribution, especially for the positive peak pressure, with an error below 10%; as the reflector length increases, the dynamic focus tends to move linearly forward to the other geometric focus, and the pressure gain increases continuously but the growth rate decreases.Lou, J., Wang, S., Liu, S., and Xing, G. (2016). Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials, Am J Phys Med Rehabil, (), , OBJECTIVE: The objective of this meta-analysis was to investigate the efficacy of extracorporeal shock wave therapy in the treatment of recalcitrant plantar fasciitis without local anesthesia.METHODS: The Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched from inception to September 2015 for randomized controlled trials comparing ESWT without local anesthesia versus placebo for treatment of plantar fasciitis in adults. The primary outcome was the 12-week post-intervention success rate of reducing the visual analog scale score by 60% from baseline at the first step in the morning, reducing the VAS score by 60% from baseline during daily activities, reducing the Roles and Maudsley score, reducing overall heel pain, and reducing pain after applying a force meter.RESULTS: Nine studies were included in the meta-analysis. Compared with placebo, ESWT significantly improved the success rate of reducing overall heel pain, reducing the VAS score by 60% at the first step in the morning and during daily activities, improving the Roles and Maudsley score to excellent or good, and reducing heel pain after application of a pressure meter.CONCLUSIONS: ESWT seems to be particularly effective in relieving pain associated with RPF. ESWT should be considered when traditional treatments have failed.TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) understand the recovery rates for nonsurgical treatment of plantar fasciitis, (2) understand the role of extracorporeal shockwave therapy (ESWT) in the treatment of recalcitrant plantar fasciitis, and (3) understand the indications to incorporate ESWT in the treatment plan of recalcitrant plantar fasciitis.LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.Seol, P.-H., Ha, K. W., Kim, Y. H., Kwak, H.-J., Park, S.-W., and Ryu, B.-J. (2016). Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome, Ann Rehabil Med, 40(6), 1124-1128, The fabella is a small sesamoid bone generally located in the tendon of the lateral head of the gastrocnemius behind the lateral condyle of the femur. Fabella syndrome is the occurrence of posterolateral knee pain associated with the fabella. It is a rare cause of knee pain that is often misdiagnosed. Fabella syndrome can be managed with

conservative or surgical treatment. We applied radial extracorporeal shock wave therapy as a new treatment strategy for fabella syndrome and achieved a successful outcome.Tepeköylü, C., Primessnig, U., Pölzl, L., Graber, M., Lobenwein, D., Nägele, F., Kirchmair, E., Pechriggl, E., Grimm, M., and Holfeld, J. (2016). Shockwaves prevent from heart failure after acute myocardial ischaemia via RNA/protein complexes, J Cell Mol Med, (), , Shock wave treatment (SWT) was shown to induce regeneration of ischaemic myocardium via Toll-like receptor 3 (TLR3). The antimicrobial peptide LL37 gets released by mechanical stress and is known to form complexes with nucleic acids thus activating Toll-like receptors. We suggested that SWT in the acute setting prevents from the development of heart failure via RNA/protein release. Myocardial infarction in mice was induced followed by subsequent SWT. Heart function was assessed 4 weeks later via transthoracic echocardiography and pressure-volume measurements. Human umbilical vein endothelial cells (HUVECs) were treated with SWT in the presence of RNase and proteinase and analysed for proliferation, tube formation and LL37 expression. RNA release and uptake after SWT was evaluated. We found significantly improved cardiac function after SWT. SWT resulted in significantly higher numbers of capillaries and arterioles and less left ventricular fibrosis. Supernatants of treated cells activated TLR3 reporter cells. Analysis of the supernatant revealed increased RNA levels. The effect could not be abolished by pre-treatment of the supernatant with RNase, but only by a sequential digestion with proteinase and RNase hinting strongly towards the involvement of RNA/protein complexes. Indeed, LL37 expression as well as cellular RNA uptake were significantly increased after SWT. We show for the first time that SWT prevents from left ventricular remodelling and cardiac dysfunction via RNA/protein complex release and subsequent induction of angiogenesis. It might therefore develop a potent regenerative treatment alternative for ischaemic heart disease.Viganò, M., Sansone, V., d'Agostino, M. C., Romeo, P., Perucca Orfei, C., and de Girolamo, L. (2016). Mesenchymal stem cells as therapeutic target of biophysical stimulation for the treatment of musculoskeletal disorders, J Orthop Surg Res, 11(1), 163, BACKGROUND: Musculoskeletal disorders are regarded as a major cause of worldwide morbidity and disability, and they result in huge costs for national health care systems. Traditional therapies frequently turned out to be poorly effective in treating bone, cartilage, and tendon disorders or joint degeneration. As a consequence, the development of novel biological therapies that can treat more effectively these conditions should be the highest priority in regenerative medicine. Mesenchymal stem cells (MSCs) represent one of the most promising tools in musculoskeletal tissue regenerative medicine, thanks to their proliferation and differentiation potential and their immunomodulatory and trophic ability. Indeed, MSC-based approaches have been proposed for the treatment of almost all orthopedic conditions, starting from different cell sources, alone or in combination with scaffolds and growth factors, and in one-step or two-step procedures. While all these approaches would require cell harvesting and transplantation, the possibility to stimulate the endogenous MSCs to enhance their tissue homeostasis activity represents a less-invasive and cost-effective therapeutic strategy. Nowadays, the role of tissue-specific resident stem cells as possible therapeutic target in degenerative pathologies is underinvestigated. Biophysical stimulations, and in particular extracorporeal shock waves treatment and pulsed electromagnetic fields, are able to induce proliferation and support differentiation of MSCs from different origins and affect their paracrine production of growth factors and cytokines.SHORT CONCLUSIONS: The present review reports the attempts to exploit the resident stem cell potential in musculoskeletal pathologies, highlighting the role of MSCs as therapeutic target of currently applied biophysical treatments.Wang, H.-J., Lee, W.-C., Tyagi, P., Huang, C.-C., and Chuang, Y.-C. (2016). Effects of low energy shock wave therapy on inflammatory moleculars, bladder pain, and bladder function in a rat cystitis model, Neurourol Urodyn, (), , AIMS: Low energy shock wave (LESW) is known to facilitate tissue regeneration with analgesic and anti-inflammatory effects. We examined the effects of LESW on the expression of inflammatory molecules, pain behavior, and bladder function in a rat cystitis model.METHODS: Control and experimental animals were injected with saline or cyclophosphamide (CYP; 75 mg/kg intraperitoneally) on day 1 and 4. After lower midline

incision, the bladders were exposed to LESW (300 pulses, 0.12 mJ/mm(2) ) or sham operation on day 2. In study 1 (N = 12, 4 for each group), the nociceptive effects of CYP were evaluated for 30 min by behavioral assessment on day 4 one hour after CYP injection. In study 2 (N = 21, 7 for each group), continuous cystometry (CMG) was performed on day 8. The bladder was harvested after behavioral assessment or CMG for histology and Western blotting.RESULTS: CYP-induced upregulation of COX2 and IL6 expression, caused pain behavior (eye closing and hypolocomotion), and bladder inflammation was noted on days 4 and 8 along with bladder hyperactivity. LESW treatment reduced pain behavior and downregulated the NGF expression (33.3%, P < 0.05) on day 4 and IL6 (40.9%, P < 0.05). LESW treatment suppressed bladder overactivity (intercontraction interval 77.8% increase, P < 0.05) by decreasing inflammation and COX2 (38.6%, P < 0.05) expression and NGF expression (25.2%, P = 0.0812).CONCLUSIONS: CYP-induced bladder pain, inflammation, and overactivity involves activation of IL6, NGF, and COX2 expression. These changes are suppressed by LESW, indicating it as a potential candidate for relieving bladder inflammatory conditions and overactivity.Xu, L., Zhao, Y., Wang, M., Song, W., Li, B., Liu, W., Jin, X., and Zhang, H. (2016). Defocused low-energy shock wave activates adipose tissue-derived stem cells in vitro via multiple signaling pathways, Cytotherapy, 18(12), 1503-1514, BACKGROUND AIMS: We found defocused low-energy shock wave (DLSW) could be applied in regenerative medicine by activating mesenchymal stromal cells. However, the possible signaling pathways that participated in this process remain unknown. In the present study, DLSW was applied in cultured rat adipose tissue-derived stem cells (ADSCs) to explore its effect on ADSCs and the activated signaling pathways.METHODS: After treating with DLSW, the cellular morphology and cytoskeleton of ADSCs were observed. The secretions of ADSCs were detected. The expressions of ADSC surface antigens were analyzed using flow cytometry. The expressions of proliferating cell nuclear antigen and Ki67 were analyzed using western blot. The expression of CXCR2 and the migrations of ADSCs in vitro and in vivo were detected. The phosphorylation of selected signaling pathways with or without inhibitors was also detected.RESULTS: DLSW did not change the morphology and phenotype of ADSCs, and could promote the secretion, proliferation and migration of ADSCs. The phosphorylation levels were significantly higher in mitogen-activated protein kinases (MAPK) pathway, phosphoinositide 3-kinase (PI-3K)/AKT pathway and nuclear factor-kappa B (NF-κB) signaling pathway but not in Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway. Furthermore, ADSCs were not activated by DLSW after adding the inhibitors of these pathways simultaneously.CONCLUSIONS: Our results demonstrated for the first time that DLSW could activate ADSCs through MAPK, PI-3K/AKT and NF-κB signaling pathways. Combination of DLSW and agonists targeting these pathways might improve the efficacy of ADSCs in regenerative medicine in the future.Yahata, K., Kanno, H., Ozawa, H., Yamaya, S., Tateda, S., Ito, K., Shimokawa, H., and Itoi, E. (2016). Low-energy extracorporeal shock wave therapy for promotion of vascular endothelial growth factor expression and angiogenesis and improvement of locomotor and sensory functions after spinal cord injury, J Neurosurg Spine, 25(6), 745-755, OBJECTIVE Extracorporeal shock wave therapy (ESWT) is widely used to treat various human diseases. Low-energy ESWT increases expression of vascular endothelial growth factor (VEGF) in cultured endothelial cells. The VEGF stimulates not only endothelial cells to promote angiogenesis but also neural cells to induce neuroprotective effects. A previous study by these authors demonstrated that low-energy ESWT promoted expression of VEGF in damaged neural tissue and improved locomotor function after spinal cord injury (SCI). However, the neuroprotective mechanisms in the injured spinal cord produced by low-energy ESWT are still unknown. In the present study, the authors investigated the cell specificity of VEGF expression in injured spinal cords and angiogenesis induced by low-energy ESWT. They also examined the neuroprotective effects of low-energy ESWT on cell death, axonal

damage, and white matter sparing as well as the therapeutic effect for improvement of sensory function following SCI. METHODS Adult female Sprague-Dawley rats were divided into the SCI group (SCI only) and SCI-SW group (low-energy ESWT applied after SCI). Thoracic SCI was produced using a New York University Impactor. Low-energy ESWT was applied to the injured spinal cord 3 times a week for 3 weeks after SCI. Locomotor function was evaluated using the Basso, Beattie, and Bresnahan open-field locomotor score for 42 days after SCI. Mechanical and thermal allodynia in the hindpaw were evaluated for 42 days. Double staining for VEGF and various cell-type markers (NeuN, GFAP, and Olig2) was performed at Day 7; TUNEL staining was also performed at Day 7. Immunohistochemical staining for CD31, α-SMA, and 5-HT was performed on spinal cord sections taken 42 days after SCI. Luxol fast blue staining was performed at Day 42. RESULTS Low-energy ESWT significantly improved not only locomotion but also mechanical and thermal allodynia following SCI. In the double staining, expression of VEGF was observed in NeuN-, GFAP-, and Olig2-labeled cells. Low-energy ESWT significantly promoted CD31 and α-SMA expressions in the injured spinal cords. In addition, low-energy ESWT significantly reduced the TUNEL-positive cells in the injured spinal cords. Furthermore, the immunodensity of 5-HT-positive axons was significantly higher in the animals treated by low-energy ESWT. The areas of spared white matter were obviously larger in the SCI-SW group than in the SCI group, as indicated by Luxol fast blue staining. CONCLUSIONS The results of this study suggested that low-energy ESWT promotes VEGF expression in various neural cells and enhances angiogenesis in damaged neural tissue after SCI. Furthermore, the neuroprotective effect of VEGF induced by low-energy ESWT can suppress cell death and axonal damage and consequently improve locomotor and sensory functions after SCI. Thus, low-energy ESWT can be a novel therapeutic strategy for treatment of SCI.Zhang, X., Krier, J. D., Amador Carrascal, C., Greenleaf, J. F., Ebrahimi, B., Hedayat, A. F., Textor, S. C., Lerman, A., and Lerman, L. O. (2016). Low-Energy Shockwave Therapy Improves Ischemic Kidney Microcirculation, J Am Soc Nephrol, 27(12), 3715-3724, Microvascular rarefaction distal to renal artery stenosis is linked to renal dysfunction and poor outcomes. Low-energy shockwave therapy stimulates angiogenesis, but the effect on the kidney microvasculature is unknown. We hypothesized that low-energy shockwave therapy would restore the microcirculation and alleviate renal dysfunction in renovascular disease. Normal pigs and pigs subjected to 3 weeks of renal artery stenosis were treated with six sessions of low-energy shockwave (biweekly for 3 consecutive weeks) or left untreated. We assessed BP, urinary protein, stenotic renal blood flow, GFR, microvascular structure, and oxygenation in vivo 4 weeks after completion of treatment, and then, we assessed expression of angiogenic factors and mechanotransducers (focal adhesion kinase and β1-integrin) ex vivo A 3-week low-energy shockwave regimen attenuated renovascular hypertension, normalized stenotic kidney microvascular density and oxygenation, stabilized function, and alleviated fibrosis in pigs subjected to renal artery stenosis. These effects associated with elevated renal expression of angiogenic factors and mechanotransducers, particularly in proximal tubular cells. In additional pigs with prolonged (6 weeks) renal artery stenosis, shockwave therapy also decreased BP and improved GFR, microvascular density, and oxygenation in the stenotic kidney. This shockwave regimen did not cause detectable kidney injury in normal pigs. In conclusion, low-energy shockwave therapy improves stenotic kidney function, likely in part by mechanotransduction-mediated expression of angiogenic factors in proximal tubular cells, and it may ameliorate renovascular hypertension. Low-energy shockwave therapy may serve as a novel noninvasive intervention in the management of renovascular disease.Carlisi, E., Lisi, C., Dall'angelo, A., Monteleone, S., Nola, V., Tinelli, C., and Dalla Toffola, E. (2016). Focused extracorporeal shock wave therapy combined with supervised eccentric training for supraspinatus calcific tendinopathy, Eur J Phys Rehabil Med, (), , BACKGROUND: Extracorporeal shock wave therapy is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Eccentric exercise has been introduced as an effective treatment choice for Achilles tendinopathy, but poor evidence exists about its role in the treatment of rotator cuff tendinopathy.

AIM: To investigate if adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome of extracorporeal shock wave therapy.DESIGN: Pre-post intervention pilot study with matched control-group.SETTING: Outpatient, University Hospital.POPULATION: Twenty-two subjects affected by painful supraspinatus calcific tendinopathy.METHODS: The study-group was assigned to receive focal extracorporeal shockwave therapy (f-ESWT) plus a supervised eccentric training (SET) of the shoulder abductor muscles. The matched control-group received f-ESWT only. The post-treatment assessment (follow-up t1) was performed nine weeks after the enrollment (t0). We assessed shoulder pain and function by the means of a numeric rating scale (p-NRS) and a DASH scale. As secondary outcome, we measured the isometric strength of the abductor muscles of the affected shoulder using a handheld dynamometer.RESULTS: At t1, we recorded a significant decrease in pain (p<0.001) and an improvement in upper limb function (p<0.001) in both groups. However, we observed no statistical differences in favour of the study-group, in terms of p-NRS and DASH total score. A mild increase (13% from the baseline) of the maximum isometric abduction strength was noticed in the study- group at t1.CONCLUSIONS: Our findings did not support the hypothesis that adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome (pain and function) of shock wave therapy.CLINICAL REHABILITATION IMPACT: Our study confirmed that f-ESWT is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Adding a supervised eccentric training, focused on the abductor muscles, was useful to improve maximum isometric abduction strength, but appeared to give no advantage in the short-term outcome of shock wave therapy.Furia, J. P., Rompe, J.-D., Maffulli, N., Cacchio, A., and Schmitz, C. (2016). Radial Extracorporeal Shock Wave Therapy Is Effective and Safe in Chronic Distal Biceps Tendinopathy, Clin J Sport Med, (), , OBJECTIVE: To assess the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for chronic distal biceps tendinopathy (cDBT).DESIGN: Case-control study (level of evidence, 3).SETTING: SUN Orthopaedics and Sports Medicine.PATIENTS: Patients with a diagnosis of cDBT were recruited between January 2010 and February 2015.INTERVENTIONS: Patients received a single session of rESWT (2000 shock waves with energy flux density of 0.18 mJ/mm) or other forms of nonoperative therapy.MAIN OUTCOME MEASURES: Patients completed the visual analog scale (VAS), the modified QuickDASH (MQD) score, and the Roles and Maudsley (RM) score over a 12-month period.RESULTS: Forty-eight patients completed the final review at 12 months and were included in the study. Subjects ranged in age from 30 to 64 years. Mean pretreatment VAS scores for the rESWT and control groups were 8.3 and 8.5, respectively. Three and 12 months after inclusion in the study, the mean VAS scores for the rESWT and control groups were 3.4 and 5.6 (P < 0.001) and 2.7 and 4.7 (P < 0.001), respectively. Twelve-month follow-up MQD-Sports and MQD-Work scores for the rESWT and control groups were 3.7 and 1.7 (P < 0.001) and 3.8 and 1.8 (P < 0.001), respectively. Differences in mean RM scores were statistically significant between groups at 3 months after the treatment. There were no significant complications.CONCLUSIONS: Overall, rESWT is an effective and safe treatment for cDBT.CLINICAL RELEVANCE: Radial ESWT as a novel, effective, and safe treatment for cDBT.Jeppesen, S. M., Yderstraede, K. B., Rasmussen, B. S. B., Hanna, M., and Lund, L. (2016). Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers: a prospective randomised trial, J Wound Care, 25(11), 641-649, OBJECTIVE: To investigate the efficacy of extracorporeal shockwave therapy (ESWT) on healing chronic diabetic foot ulcers (DFU).METHOD: Patients with chronic DFUs were randomised (1:1) to receive a series of six ESWT treatments over 3 weeks in combination with standard care or standard care alone.

ESWT was performed on DFUs using 250 shocks/cm(2) and 500 shocks on arterial beds supplying the ulcer location.RESULTS: We recruited 23 patients, 11 in the intervention group and 12 in the control. Transcutaneous oxygen tension was significantly increased in patients treated with ESWT compared with those receiving standard care alone at 3 weeks (p=0.044). Ulcer area reduction was 34.5% in the intervention group versus 5.6% in the control group at 7 weeks (p=0.387). Within-group analysis revealed a significant reduction of ulcer area in the intervention group (p<0.01), while healing was not demonstrated in the control group (p>0.05) (data tested for trend).CONCLUSION: This randomised study indicates a potential beneficial effect of ESWT on ulcer healing as well as tissue oxygenation. Owing to weaknesses of the study and the fact that ulcer healing was not significantly improved in the intervention group compared with the control group, a larger randomised trial with blinded design is suggested.Lee, J.-H. (2016). Knee joint angle of intracerebral hemorrhage-induced rats after extracorporeal shock wave therapy, J Phys Ther Sci, 28(11), 3122-3124, [Purpose] The purpose of this study was to investigate the impact on rat knee joints of extracorporeal shock wave therapy after experimentally induced intracerebral hemorrhage. [Subjects and Methods] Sprague-Dawley (SD) rats were divided into an experimental group that received extracorporeal shock wave therapy after central nervous system injury (n=10) and a control group that did not receive any therapeutic intervention after central nervous system injury (n=10). The Dartfish program was used to evaluate the SD rats' locomotion. [Results] There was a significant difference between the control group and the experimental group in the change of knee joint angle during midstance after the intervention. [Conclusion] In conclusion, at extracorporeal shock wave therapy for central nervous system injury was confirmed to be effective at reducing knee joint angle, confirming it is a good physical therapy intervention, based on its efficacy.Mori, L., Marinelli, L., Pelosin, E., Gambaro, M., Trentini, R., Abbruzzese, G., and Trompetto, C. (2016). Radial shock wave therapy: effect on pain and motor performance in a paralympic athlete. A case report, Eur J Phys Rehabil Med, (), , BACKGROUND: Recent studies demonstrated the usefulness of Radial Shock Waves Therapy (RSWT) in treating hypertonia in patients affected by cerebral palsy (CP), stroke, and dystonia. RSWT have never been used to treat spasticity in disabled athletes.CASE REPORT: An athlete affected by tetraparesis due to CP underwent three RSWT sessions in a week. We assessed muscular tone using the Modified Ashworth scale (MAS), pain and fatigue experienced during athletic performance with Visual Analogic Scale (VAS) and Borg scale Category-Ratio anchored at number 10 (Borg CR10). We also performed an electrophysiological study recording the stretch reflex on the quadriceps femori muscle and assessing the soleus H-reflex to calculate post-activation depression (PAD). After 3 RSWT sessions, we found a reduction in all clinical parameters. Although MAS was unchanged, stretch reflex was significantly reduced and PAD increased, suggesting a role in contrasting non-reflex components of hypertonia.CLINICAL REHABILITATION IMPACT: The use of RSWT may improve the disabled athletes' performance.Reed-Maldonado, A. B. and Lue, T. F. (2016). Re: A Meta-analysis of Extracorporeal Shock Wave Therapy for Peyronie's Disease, Eur Urol, 70(5), 895-896, Sun, W., Gao, F., Guo, W., Wang, B., Li, Z., Cheng, L., and Wang, W. (2016). Focused extracorporeal shock wave for osteonecrosis of the femoral head with leukemia after allo-HSCT: a case series, Bone Marrow Transplant, 51(11), 1507-1509, Wang, C.-J., Huang, C.-C., Yip, H.-K., and Yang, Y.-J. (2016). Dosage effects of extracorporeal shockwave therapy in early hip necrosis, Int J Surg, 35(), 179-186, BACKGROUND: This study investigated the effects of different dosages of extracorporeal shockwave therapy (ESWT) in early osteonecrosis of the femoral head (ONFH).MATERIALS AND METHODS: Thirty-three patients (42 hips) were randomly divided into three groups. Group A (10 patients with 16 hips) received 2000 impulses of ESWT at 24 Kv to the affected hip. Group B (11 patients with 14 hips) and Group C (12 patients with 12 hips) received 4000 and 6000 impulses of ESWT respectively. The evaluations included clinical

assessment, radiographs, dynamic contrast-enhanced MRI for microcirculation (K(trans)) and plasma volume (Vp), and blood tests for biomarker analysis (NO3, VEGF, BMP-2, osteocalcin, TNF-α, IL-6, substance P, CGRP, DKK-1 and IGF).RESULTS: Significant differences of pain and Harris hip scores were noticed between Group A and C in 6 months after ESWT (all P < 0.05). The pain score decreased, but not Harris hip score improved over the observation time period from 6 to 24 months. Total hip arthroplasty was performed in 3 patients (4 hips) in Group A, but none in Groups B and C. Group C showed significant changes in serum biomarkers for angiogenesis, osteogenesis, anti-inflammation, pain threshold and tissue regeneration between one week and one month after treatment (all P < 0.05). However, no significant changes in the infarction volume in image studies were noted in all groups (all P > 0.05). The post-treatment K(trans) and Vp in the peri-necrotic areas of Group B and C were significantly greater than pre-treatment data (both P < 0.05).CONCLUSIONS: High dosage ESWT is more effective in early stage ONFH. The systemic beneficial effects of ESWT may ultimately enhance angiogenesis with improvement of microcirculation of the peri-necrotic areas, that in turn, can improve subchondral bone remodeling and prevent femoral head collapse.Alizadeh, Z., Halabchi, F., Mazaheri, R., Abolhasani, M., and Tabesh, M. (2016). Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat, Int J Endocrinol Metab, 14(4), e36727, CONTEXT: Today, different kinds of non-invasive body contouring modalities, including cryolipolysis, radiofrequency (RF), low-level laser therapy (LLLT), and high-intensity focused ultrasound (HIFU) are available for reducing the volume of subcutaneous adipose tissue or cellulite. Each procedure has distinct mechanisms for stimulating apoptosis or necrosis adipose tissue. In addition to the mentioned techniques, some investigations are underway for analyzing the efficacy of other techniques such as whole body vibration (WBV) and extracorporeal shockwave therapy (ESWT). In the present review the mechanisms, effects and side effects of the mentioned methods have been discussed. The effect of these devices on cellulite or subcutaneous fat reduction has been assessed.EVIDENCE ACQUISITION: We searched pubmed, google scholar and the cochrane databases for systemic reviews, review articles, meta-analysis and randomized clinical trials up to February 2015. The keywords were subcutaneous fat, cellulite, obesity, noninvasive body contouring, cryolipolysis, RF, LLLT, HIFU, ESWT and WBV with full names and abbreviations.RESULTS: We included seven reviews and 66 original articles in the present narrative review. Most of them were applied on normal weight or overweight participants (body mass index < 30 kg/m(2)) in both genders with broad range of ages (18 to 50 years on average). In the original articles, the numbers of included methods were: 10 HIFU, 13 RF, 22 cryolipolysis, 11 LLLT, 5 ESWT and 4 WBV therapies. Six of the articles evaluated combination therapies and seven compared the effects of different devices.CONCLUSIONS: Some of the noninvasive body contouring devices in animal and human studies such as cryolipolysis, RF, LLLT and HIFU showed statistical significant effects on body contouring, removing unwanted fat and cellulite in some body areas. However, the clinical effects are mild to moderate, for example 2 - 4 cm circumference reduction as a sign of subcutaneous fat reduction during total treatment sessions. Overall, there is no definitive noninvasive treatment method for cellulite. Additionally, due to the methodological differences in the existing evidence, comparing the techniques is difficult.Cho, S. J., Yang, J. R., Yang, H. S., and Yang, H.-E. (2016). Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study, Ann Rehabil Med, 40(5), 862-870, OBJECTIVE: To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA).METHODS: A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for

3 weeks, totaling to an energy dose of 0.05 mJ/mm(2) on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height).RESULTS: The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT.CONCLUSION: It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.Gatewood, C. T., Tran, A. A., and Dragoo, J. L. (2016). The efficacy of post-operative devices following knee arthroscopic surgery: a systematic review, Knee Surg Sports Traumatol Arthrosc, (), , PURPOSE: There is a wide array of device modalities available for post-operative treatment following arthroscopic knee surgery; however, it remains unclear which types and duration of modality are the most effective. This systematic review aimed to investigate the efficacy of device modalities used following arthroscopic knee surgery.METHODS: A systematic search of the literature was performed on: PubMed; Scopus; MEDLINE; EMBASE; PEDro; SportDiscus; and CINAHL databases (1995-2015) for clinical trials using device modalities following arthroscopic knee surgery: cryotherapy, continuous passive motion (CPM), neuromuscular electrical stimulation (NMES), surface electromyographic (sEMG) biofeedback and shockwave therapy (ESWT). Only level 1 and 2 studies were included and the methodological quality of studies was evaluated using Physiotherapy Evidence Database (PEDro) scores. Outcome measures included: muscle strength, range of motion, swelling, blood loss, pain relief, narcotic use, knee function evaluation and scores, patient satisfaction and length of hospital stay.RESULTS: Twenty-five studies were included in this systematic review, nineteen of which found a significant difference in outcomes. For alleviating pain and decreasing narcotic consumption following arthroscopic knee surgery, cryocompression devices are more effective than traditional icing alone, though not more than compression alone. CPM does not affect post-operative outcomes. sEMG biofeedback and NMES improve quadriceps strength and overall knee functional outcomes following knee surgery. There is limited evidence regarding the effects of ESWT.CONCLUSION: Cryotherapy, NMES and sEMG are recommended for inclusion into rehabilitation protocols following arthroscopic knee surgery to assist with pain relief, recovery of muscle strength and knee function, which are all essential to accelerate recovery. CPM is not warranted in post-operative protocols following arthroscopic knee surgery because of its limited effectiveness in returning knee range of motion, and additional studies are required to investigate the effects of ESWT.LEVEL OF EVIDENCE: II.Han, Y., Lee, J.-K., Lee, B.-Y., Kee, H.-S., Jung, K.-I., and Yoon, S.-R. (2016). Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head, Ann Rehabil Med, 40(5), 871-877, OBJECTIVE: To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head.METHODS: Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm(2)) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm(2)). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine

the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months.RESULTS: In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05).CONCLUSION: Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.Leeman, J. J., Shaw, K. K., Mison, M. B., Perry, J. A., Carr, A., and Shultz, R. (2016). Extracorporeal shockwave therapy and therapeutic exercise for supraspinatus and biceps tendinopathies in 29 dogs, Vet Rec, 179(15), 385, Supraspinatus tendinopathy (ST) and biceps tendinopathy (BT) are common causes of forelimb lameness in large-breed dogs and have historically been treated with conservative management or surgery. Extracorporeal shockwave therapy (ESWT) and therapeutic exercise (TE) are thought to be treatment options for these conditions. The objectives of this study were to report the clinical presentations of dogs treated with ESWT for shoulder tendinopathies, to determine the association between shoulder lesion severity identified on ultrasonography or MRI and outcome, and to compare the outcomes of dogs treated with ESWT with and without TE. Medical records of 29 dogs diagnosed with shoulder tendinopathies and treated with ESWT were reviewed, and 24 dogs were diagnosed with either unilateral BT or BT and ST. None were found to have unilateral ST. Five dogs were diagnosed with bilateral disease. Eighty-five per cent of dogs had good or excellent outcomes determined by owner assessment 11-220 weeks after therapy. Outcomes were found to be better as tendon lesion severity increased (P=0.0497), regardless if ESWT was performed with or without TE (P=0.92). ESWT should be considered a safe primary therapeutic option for canine shoulder tendinopathies. Larger controlled prospective studies are needed to adequately assess these findings.Nwokeoha, S., Carlisle, R., and Cleveland, R. O. (2016). The Application of Clinical Lithotripter Shock Waves to RNA Nucleotide Delivery to Cells, Ultrasound Med Biol, 42(10), 2478-92, The delivery of genes into cells through the transfer of ribonucleic acids (RNAs) has been found to cause a change in the level of target protein expression. RNA-based transfection is conceptually more efficient than commonly delivered plasmid DNA because it does not require division or damage of the nuclear envelope, thereby increasing the chances of the cell remaining viable. Shock waves (SWs) have been found to induce cellular uptake by transiently altering the permeability of the plasma membrane, thereby overcoming a critical step in gene therapy. However, accompanying SW bio-effects include dose-dependent irreversible cell injury and cytotoxicity. Here, the effect of SWs generated by a clinical lithotripter on the viability and permeabilisation of three different cell lines in vitro was investigated. Comparison of RNA stability before and after SW exposure revealed no statistically significant difference. Optimal SW exposure parameters were identified to minimise cell death and maximise permeabilisation, and applied to enhanced green fluorescent protein (eGFP) messenger RNA (mRNA) or anti-eGFP small interfering RNA delivery. As a result, eGFP mRNA expression levels increased up to 52-fold in CT26 cells, whereas a 2-fold decrease in GFP expression was achieved after anti-eGFP small interfering RNA delivery to MCF-7/GFP cells. These results indicate that SW parameters can be employed to achieve effective nucleotide delivery, laying the foundation for non-invasive and high-tolerability RNA-based gene therapy.Pfaff, J. A., Boelck, B., Bloch, W., and Nentwig, G.-H. (2016). Growth Factors in Bone Marrow Blood of the Mandible With Application of Extracorporeal Shock Wave Therapy, Implant Dent, 25(5), 606-12, INTRODUCTION: Enhancement of bone regeneration is crucial to dental implantology. Growth factors play a significant role during osteogenesis and angiogenesis. Extracorporeal shock wave therapy (ESWT) enhances bone healing; however, no studies have yet been performed in oral implantology.MATERIALS AND METHODS: Twenty patients who underwent bilateral mandibular wisdom tooth removal were included. ESWT was applied to 1 side of the jaw. Blood samples were collected from the peripheral vein (PB), mandibular bone marrow without and with ESWT (BM-/+SW). Quantity and quality of the growth factors bone morphogenetic protein (BMP)-2, BMP-4, insulin-like growth factor 1 (IGF-1), vascular endothelial growth factor (VEGF), and

transforming growth factor-beta (TGF-β) were investigated via ELISA and cell proliferation assay.RESULTS: ELISA revealed superior amounts of IGF-1 and VEGF in BM-/+SW compared to PB (P < 0.05). TGF-β demonstrated no variance. Levels of BMP-2 and BMP-4 were too low for adequate detection in the ELISA. No difference was noticed upon ESWT. The cell proliferation assay did not identify any changes comparing PB versus BM-SW versus BM + SW.CONCLUSION: IGF-1 and VEGF are present at higher levels in mandibular bone marrow than in peripheral blood (PB). This study did not identify any benefits of extracorporeal shock wave therapy to increase the investigated growth factors.Qi, B., Yu, T., Wang, C., Wang, T., Yao, J., Zhang, X., Deng, P., Xia, Y., Junger, W. G., and Sun, D. (2016). Shock wave-induced ATP release from osteosarcoma U2OS cells promotes cellular uptake and cytotoxicity of methotrexate, J Exp Clin Cancer Res, 35(1), 161, BACKGROUND: Osteosarcoma is the most prevalent primary malignant bone tumor, but treatment is difficult and prognosis remains poor. Recently, large-dose chemotherapy has been shown to improve outcome but this approach can cause many side effects. Minimizing the dose of chemotherapeutic drugs and optimizing their curative effects is a current goal in the management of osteosarcoma patients.METHODS: In our study, trypan blue dye exclusion assay was performed to investigate the optimal conditions for the sensitization of osteosarcoma U2OS cells. Cellular uptake of the fluorophores Lucifer Yellow CH dilithium salt and Calcein was measured by qualitative and quantitative methods. Human MTX ELISA Kit and MTT assay were used to assess the outcome for osteosarcoma U2OS cells in the present of shock wave and methotrexate. To explore the mechanism, P2X7 receptor in U2OS cells was detected by immunofluorescence and the extracellular ATP levels was detected by ATP assay kit. All data were analyzed using SPSS17.0 statistical software. Comparisons were made with t test between two groups.RESULTS: Treatment of human osteosarcoma U2OS cells with up to 450 shock wave pulses at 7 kV or up to 200 shock wave pulses at 14 kV had little effect on cell viability. However, this shock wave treatment significantly promoted the uptake of Calcein and Lucifer Yellow CH by osteosarcoma U2OS cells. Importantly, shock wave treatment also significantly enhanced the uptake of the chemotherapy drug methotrexate and increased the rate of methotrexate-induced apoptosis. We found that shock wave treatment increased the extracellular concentration of ATP and that KN62, an inhibitor of P2X7 receptor reduced the capacity methotrexate-induced apoptosis.CONCLUSIONS: Our results suggest that shock wave treatment promotes methotrexate-induced apoptosis by altering cell membrane permeability in a P2X7 receptor-dependent manner. Shock wave treatment may thus represent a possible adjuvant therapy for osteosarcoma.Sawan, S., Abd-Allah, F., Hegazy, M. M., Farrag, M. A., and El-Den, N. H. S. (2016). Effect of shock wave therapy on ankle planter flexors spasticity in stroke patients, NeuroRehabilitation, (), , BACKGROUND: Large number of patients with first-ever stroke developed spasticity. Spasticity can reduce the range of motion, hinder voluntary movements, provoke pain, and result in impairment of functional activities of daily living.OBJECTIVE: Demonstrate the effect of shock wave therapy on ankle planter flexors spasticity in stroke patients.METHODS: We included forty ischemic stroke patients divided into 2 groups; group I were subjected to the selected physical therapy program and shock wave therapy whereas group II received the selected physical therapy program as well as placebo shock wave for six weeks. Both groups were subjected to pre- and post-treatment assessment by H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking.RESULTS: Baseline characteristics showed no significant difference between the two groups regarding the grades of spasticity. Whereas After treatment, there were a highly significant difference between both groups regarding the grades of spasticity according to the 3 parameters, H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking test (P values; <0.001, 0.006, and 0.009 respectively).

CONCLUSIONS: Shock wave therapy is effective in controlling spasticity, increase dorsiflexion active range of motion of ankle and improving ten- meters walking test in stroke patients.Zissler, A., Steinbacher, P., Zimmermann, R., Pittner, S., Stoiber, W., Bathke, A. C., and Sänger, A. M. (2016). Extracorporeal Shock Wave Therapy Accelerates Regeneration After Acute Skeletal Muscle Injury, Am J Sports Med, (), , BACKGROUND: Muscle injuries are among the most common sports-related lesions in athletes; however, optimal treatment remains obscure. Extracorporeal shock wave therapy (ESWT) may be a promising approach in this context, because it has gained increasing importance in tissue regeneration in various medical fields.HYPOTHESIS: ESWT stimulates and accelerates regenerative processes of acute muscle injuries.STUDY DESIGN: Controlled laboratory study.METHODS: Adult Sprague-Dawley rats were divided into 4 experimental groups (2 ESWT+ groups and 2 ESWT- groups) as well as an uninjured control group (n ≥ 6 in each group). An acute cardiotoxin-induced injury was set into the quadriceps femoris muscle of rats in the experimental groups. A single ESWT session was administered to injured muscles of the ESWT+ groups 1 day after injury, whereas ESWT- groups received no further treatment. At 4 and 7 days after injury, 1 each of the ESWT+ and ESWT- groups was euthanized. Regenerating lesions were excised and analyzed by histomorphometry and immunohistochemistry to assess fiber size, myonuclear content, and recruitment of satellite cells.RESULTS: The size and myonuclear content of regenerating fibers in ESWT+ muscle was significantly increased compared with ESWT- muscle fibers at both 4 and 7 days after injury. Similarly, at both time points, ESWT+ muscles exhibited significantly higher contents of pax7-positive satellite cells, mitotically active H3P(+) cells, and, of cells expressing the myogenic regulatory factors, myoD and myogenin, indicating enhanced proliferation and differentiation rates of satellite cells after ESWT. Mitotic activity at 4 days after injury was doubled in ESWT+ compared with ESWT- muscles.CONCLUSION: ESWT stimulates regeneration of skeletal muscle tissue and accelerates repair processes.CLINICAL RELEVANCE: We provide evidence for accelerated regeneration of damaged skeletal muscle after ESWT. Although further studies are necessary, our findings support the view that ESWT is an effective method to improve muscle healing, with special relevance to sports injuries.Eslamian, F., Shakouri, S. K., Jahanjoo, F., Hajialiloo, M., and Notghi, F. (2016). Extra Corporeal Shock Wave Therapy Versus Local Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis, a Single Blinded Randomized Clinical Trial, Pain Med, 17(9), 1722-31, OBJECTIVES: Plantar fasciitis is a self-limiting condition, but can be painful and disabling. Among the different treatments which exist, corticosteroid injections are effective and popular. Extracorporeal shock wave therapy (ESWT) is another treatment modality used for resistant conditions. In this study, the authors evaluated the efficacy of radial ESWT versus corticosteroid injections in the treatment of chronic plantar fasciitis.DESIGN: Randomized clinical trial.SETTING: Physical medicine and rehabilitation research center in a university hospital.SUBJECTS: Forty patients with plantar fasciitis who did not respond to conservative treatment.METHODS: Patients were allocated to radial ESWT with 2000 shock waves/session of 0.2 mJ/mm(2) (n = 20) or local methylprednisolone injections (n = 20). Pain in the morning and during the day based on a visual analog scale (VAS), functional abilities using the foot function index (FFI), and satisfaction were evaluated before treatment and at 4 and 8 weeks after treatment.RESULTS: Patients (average age: 42.1± 8.20) received five sessions of ESWT or single steroid injection. Changes in the VAS in morning and during the day and the FFI throughout the study period were significant in both groups (P < 0.001). ESWT group had a higher reduction in VAS in morning and better function in FFI, but these changes were insignificant

statistically [FFI decreased to 19.65 ± 21.26 points (67.4% improvement) in ESWT vs 31.50 ± 20.53 points (47.7%) in injection group at week 8, P = 0.072)]. Good or excellent results in the opinions of patients were achieved in 55% of ESWT and 30% of corticosteroid injection groups (P = 0.11).CONCLUSION: Both interventions caused improvement in pain and functional ability 2 months after treatment. Although inter-group differences were not significant, the FFI was improved more with ESWT and patients were more satisfied with ESWT, thus shockwave therapy seems a safe alternative for management of chronic plantar fasciitis.Everding, J., Freistühler, M., Stolberg-Stolberg, J., Raschke, M. J., and Garcia, P. (2016). [Extracorporal shock wave therapy for the treatment of pseudarthrosis : New experiences with an old technology], Unfallchirurg, (), , BACKGROUND: Between 5 and 10 % of all fractures show disturbed healing or nonunion formation. Extracorporeal shock wave therapy (ESWT) has been described as a non-surgical treatment option. Even though the outcome has shown promising results, the procedure is not commonly used in clinical practice. The purpose of this study was to analyze the union rate of pseudarthrosis and the cost savings after ESWT.METHODS: In this study 42 nonunions were treated with shock waves (LithSpaceOrtho, JenaMedtech). The follow up examinations were performed over a period of six months. Outcome measurement included radiological fracture union and pain (VAS). The study group contained 39 pseudarthrosis in the six-week follow-up (93 %), 41 after three months (98 %) and 41 after six months (98 %).RESULTS: After six weeks, 13 % of patients showed fracture union. After three months 61 % and after six months 73 % of the fractures were completely healed. The fracture healing was significantly lower in older nonunions. All patients presented significantly lower pain levels six weeks after ESWT. Shock wave treatment of all 42 pseudarthrosis made up less than one quarter of the overall operative costs.CONCLUSION: We established the ESWT as an important treatment option for fracture nonunion in our clinic. Considering the selection of patients in this study with a high mean time from injury to ESWT and multiple prior operations, the fracture healing rate of 73 % after ESWT is comparable with operative healing rates of nonunions. Further prospective, randomized and controlled studies are needed to show the effectiveness of ESWT in the treatment of nonunions on a higher level of evidence and to identify pseudarthrosis that particularly responds to the EWST.Gao, L., Qian, S., Tang, Z., Li, J., and Yuan, J. (2016). A meta-analysis of extracorporeal shock wave therapy for Peyronie's disease, Int J Impot Res, 28(5), 161-6, The efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie's disease (PD) has been controversial for a very long time. We aimed to evaluate the efficiency of ESWT for PD and provide possible evidence on the basis of a meta-analysis of existing comparative studies. All controlled studies, including randomized controlled trials (RCTs), cohort studies and case-control studies, that focused on the efficiency of ESWT for PD, were prospectively identified through comprehensive searches of PubMed, the Cochrane Library and Embase databases. We conducted a meta-analysis of these studies. Six studies including 443 patients were selected for the meta-analysis. Pooling data of these studies showed that ESWT could significantly increase the percentage of men with lessening of penile plaques (odds ratio (OR) 2.07, 95% confidence interval (CI) 1.11-3.85, P=0.02), relief of pain (OR 4.46, 95% CI 2.29-8.68, P<0.0001) and complete remission of pain (OR 5.86, 95% CI 2.66-12.92, P<0.0001). However, insignificant differences were found in improvement of penile curvature (OR 1.88, 95% CI 0.97-3.65, P=0.06) and sexual function (OR 2.22, 95% CI 0.69-7.11, P=0.18) between ESWT and placebo groups. Further, similar results were shown for sensitivity and publication bias analysis when only RCTs were included. However, sporadic complications caused by ESWT were reported, but no patient needed additional treatment aside from conservative observation. ESWT may be an effective and safe treatment for lessening of penile plaques and relieving pain for men with PD, but not for improving of penile curvature and sexual function.Hatanaka, K., Ito, K., Shindo, T., Kagaya, Y., Ogata, T., Eguchi, K., Kurosawa, R., and Shimokawa, H. (2016). Molecular mechanisms of the angiogenic effects of low-energy

shock wave therapy: roles of mechanotransduction, Am J Physiol Cell Physiol, 311(3), C378-85, We have previously demonstrated that low-energy extracorporeal cardiac shock wave (SW) therapy improves myocardial ischemia through enhanced myocardial angiogenesis in a porcine model of chronic myocardial ischemia and in patients with refractory angina pectoris. However, the detailed molecular mechanisms for the SW-induced angiogenesis remain unclear. In this study, we thus examined the effects of SW irradiation on intracellular signaling pathways in vitro. Cultured human umbilical vein endothelial cells (HUVECs) were treated with 800 shots of low-energy SW (1 Hz at an energy level of 0.03 mJ/mm(2)). The SW therapy significantly upregulated mRNA expression and protein levels of vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS). The SW therapy also enhanced phosphorylation of extracellular signal-regulated kinase 1/2 (Erk1/2) and Akt. Furthermore, the SW therapy enhanced phosphorylation of caveolin-1 and the expression of HUTS-4 that represents β1-integrin activity. These results suggest that caveolin-1 and β1-integrin are involved in the SW-induced activation of angiogenic signaling pathways. To further examine the signaling pathways involved in the SW-induced angiogenesis, HUVECs were transfected with siRNA of either β1-integrin or caveolin-1. Knockdown of either caveolin-1 or β1-integrin suppressed the SW-induced phosphorylation of Erk1/2 and Akt and upregulation of VEGF and eNOS. Knockdown of either caveolin-1 or β1-integrin also suppressed SW-induced enhancement of HUVEC migration in scratch assay. These results suggest that activation of mechanosensors on cell membranes, such as caveolin-1 and β1-integrin, and subsequent phosphorylation of Erk and Akt may play pivotal roles in the SW-induced angiogenesis.Ji, Q., Wang, P., and He, C. (2016). Extracorporeal shockwave therapy as a novel and potential treatment for degenerative cartilage and bone disease: Osteoarthritis. A qualitative analysis of the literature, Prog Biophys Mol Biol, 121(3), 255-65, Osteoarthritis (OA) is characterized with pathological changes on articular cartilage and subchondral bone, with clinical symptoms of pain and motor dysfunction in affected joints. A growing number of investigations demonstrated the therapeutic effects of extracorporeal shockwave therapy (ESWT) on joints with OA. While the partial mechanisms of action are based on cellular mechanotransduction through cytoskeleton into nuclei to regulate gene expression and cause biophysical influences, the efficacy and exact mechanisms are still under exploration. At present, a summary of the evidence regarding effectiveness of ESWT on OA is not available. The purpose of this review is thus to offer an overview of ESWT in the management of OA in the aspects of cartilage, subchondral bone, pain sensation and motor function, in hopes of eliciting further multi-disciplinary scientific investigations into this promising application as an adjunct to other modalities or surgery. The optimal frequencies, impulses, energy intensity and protocols of ESWT in the management of OA continue to be elucidated. Further studies are required to reveal its exact mechanisms and biophysical effects on cells, animals and humans prior to the clinical application.Kim, E.-K. and Kwak, K.-I. (2016). Effect of extracorporeal shock wave therapy on the shoulder joint functional status of patients with calcific tendinitis, J Phys Ther Sci, 28(9), 2522-2524, [Purpose] This study aimed to analyze the effect of extracorporeal shock wave therapy on the shoulder function of patients with calcific tendinitis through a 12-week follow-up. [Subjects and Methods] A total of 34 patients with calcific tendinitis participated in this study. In the extracorporeal shock wave therapy group, 18 patients received 6-week extracorporeal shock wave therapy and 12-week follow-up. The Constant-Murley scale was used to evaluate shoulder joint function. [Results] Analysis of variance showed a significant difference between the measurement periods. The independent t-test showed significant differences between the groups at 2, 6, and 12 weeks. [Conclusion] Extracorporeal shock wave therapy can be an effective treatment method for calcific tendinitis that affects patients' shoulder function.Krukowska, J., Wrona, J., Sienkiewicz, M., and Czernicki, J. (2016). A comparative analysis of analgesic efficacy of ultrasound and shock wave therapy in the treatment of patients with inflammation of the attachment of the plantar fascia in the course of calcaneal spurs, Arch Orthop Trauma Surg, 136(9), 1289-96, INTRODUCTION: Troublesome heel spur is a nuisance condition that affects people of all ages. Treatment of patients with heel spur is a

difficult and lengthy process requiring patience from both the patient and the therapist. Sometimes, the only and ultimate method of treatment is surgery, although spurs tend to recur. The aim of the study is a comparative analysis of the analgesic efficacy of ultrasound and shock wave therapy in patients with heel spur. The cause of pain in the course of calcaneal spur is inflammation of the attachment of the plantar fascia, which plays an important role in the process of walking and is seriously strained during different types of movement. Treatment of patients is a difficult and lengthy process.MATERIALS AND METHODS: The study was conducted on a group of 47 patients of both sexes, aged 38-60 years (mean 51.3) with a plantar calcaneal spur confirmed by X-ray images. Patients were randomly assigned into two groups using a simple randomization: Group 1-ultrasound therapy group (a series of ten treatments) and Group 2-the radial shock wave group (series of four treatments). In all patients, pain intensity was assessed three times: before therapy, after the first and second weeks of treatment. A version of Laitinen's pain assessment questionnaire and the Huskisson visual analogue scale (VAS) were used. Of the group of studied respondents, 47 patients of both sexes and aged 38-60 years (mean age 51.3) with a heel spur (confirmed on X-rays), who had pain for at least a month, were randomly included in the study. The patients were classified into: Group 1-US therapeutic group (a series of ten treatments) and Group 2-with RSWT (a series of five treatments). Pain intensity was assessed three times: before the treatment, after the first and second week of the treatment with the application of the VAS and the Leitinen Pain Questionnaire.RESULTS: However, a decrease in pain sensation was reported in all test intervals, and its largest decrease occurred in both groups within 1 week of beginning treatment. More dynamic change in this period was recorded in Group 1.CONCLUSION: The conclusion is that while ultrasound and shock wave therapy show significant analgesic efficacy in patients with heel spur, fewer shock wave therapy sessions are needed than ultrasound sessions for effective relief, suggesting that the shock wave therapy has greater analgesic efficacy. A similar analgesic effect was achieved with the administration of a smaller number of shock wave treatments and a full series of ultrasound treatments.Pajovic, B., Radojevic, N., Dimitrovski, A., and Vukovic, M. (2016). Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS), Aging Male, 19(3), 202-207, The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.Qi, X., Zhao, Y., Zhang, J., Han, D., Chen, C., Huang, Y., Chen, X., Zhang, X., Wang, T., and Li, X. (2016). Increased Effects of Extracorporeal Shock Waves Combined with Gentamicin against Staphylococcus aureus Biofilms In Vitro and In Vivo, Ultrasound Med Biol, 42(9), 2245-52, An implant-associated bacterial infection is one of the most common and costly complications of orthopedic surgery. Once biofilms develop, it is extremely difficult to cure infections with antimicrobial agents. High-energy extracorporeal shock wave (ESW) treatment has been used for orthopedic-related diseases and has been found to be an effective bactericidal agent that is tolerable both in vitro and in vivo. The broad-spectrum antibiotic gentamicin exhibits bactericidal activity against Staphylococcus aureus, and bacterial resistance to gentamicin is lower. We tested the effectiveness of gentamicin in

combination with ESW treatment against S. aureus biofilms in vivo and in vitro. The spread plate method, crystal violet staining, confocal laser scanning microscopy, scanning electron microscopy and microbiologic evaluation were used to compare the effects of combined treatment with those of either treatment alone. The results revealed statistically significant differences between the group treated with ESWs combined with gentamicin and all other groups. Our findings indicate that use of the combination of ESWs with gentamicin is more effective against S. aureus biofilms in vitro and in vivo.Santamato, A., Panza, F., Notarnicola, A., Cassatella, G., Fortunato, F., de Sanctis, J. L., Valeno, G., Kehoe, P. G., Seripa, D., Logroscino, G., Fiore, P., and Ranieri, M. (2016). Is Extracorporeal Shockwave Therapy Combined With Isokinetic Exercise More Effective Than Extracorporeal Shockwave Therapy Alone for Subacromial Impingement Syndrome? A Randomized Clinical Trial, J Orthop Sports Phys Ther, 46(9), 714-25, UNLABELLED: Study Design Single-blind randomized trial. Background Extracorporeal shockwave therapy (ESWT) has been shown to produce good results in the treatment of subacromial impingement syndrome (SAIS). The efficacy of a combined administration of ESWT and isokinetic exercise (IE) has not yet been studied. Objectives To evaluate the efficacy of focused ESWT combined with IE for the rotator cuff versus focused ESWT alone in the treatment of SAIS. The secondary objective was to assess the isokinetic torque recovery (external rotation at 210°/s, 180°/s, and 120°/s). Methods Thirty participants with SAIS were randomly assigned to a focused-ESWT group or focused ESWT-plus-IE group. Subjects of both groups received 3 treatment sessions of focused ESWT over a period of 10 days. Participants in the second group also received IE for 10 therapy sessions. Outcome measures were the Constant-Murley score (CMS), the visual analog scale (VAS), and isokinetic parameters (peak torque and total work calculated from 5 repetitions) measured with the isokinetic test. Subjects were assessed at baseline, 10 days after the last treatment session with focused ESWT, and after 2 months of follow-up. Results At 2 months posttreatment, participants in the focused ESWT-plus-IE group showed significantly less pain (focused-ESWT VAS, 3.4 ± 0.8 versus focused ESWT-plus-IE VAS, 1.5 ± 0.5; P<.001) and greater improvement in functionality (focused-ESWT CMS, 75.9 ± 6.7 versus focused ESWT-plus-IE CMS, 92.1 ± 6.3; P<.001) and muscle endurance than the subjects in the focused-ESWT group. Conclusion In subjects with SAIS, combined administration of focused ESWT and IE for the rotator cuff resulted in greater reduction of pain, as well as superior functional recovery and muscle endurance in the short to medium term, compared with ESWT alone. Level of evidence Therapy, 2b.TRIAL REGISTRATION: unregistered 2011 trial. J Orthop Sports Phys Ther 2016;46(9):714-725. Epub 5 Aug 2016. doi:10.2519/jospt.2016.4629.Tepeköylü, C., Lobenwein, D., Urbschat, A., Graber, M., Pechriggl, E. J., Fritsch, H., Paulus, P., Grimm, M., and Holfeld, J. (2016). Shock wave treatment after hindlimb ischemia results in increased perfusion and M2 macrophage presence, J Tissue Eng Regen Med, (), , BACKGROUND: Shock wave therapy (SWT) has been shown to induce angiogenesis in ischemic muscle. However, the mechanism of action remains unknown. Macrophages are crucial for angiogenic responses after ischemic injury. The M2 macrophage subset enables tissue repair and induces angiogenesis. We hypothesized that the angiogenic effects of SWT are at least partly caused by enhanced macrophage recruitment.METHODS: C57BL/6 mice were subjected to hind limb ischemia with subsequent SWT or sham treatment. Muscles were analyzed via immunofluorescence staining, RT-PCR and western blot. Gene expression and proteins involved in macrophage recruitment was analyzed. Tissue sections were stained for macrophages including subsets, capillaries and arterioles. Laser Doppler perfusion imaging was performed to assess functional outcome.RESULTS: Treated muscles showed increased expression of the pivotal macrophage recruiting factor monocyte chemotactic protein 1 (MCP-1). Higher levels of macrophage marker CD14 were found. Increased numbers of macrophages after SWT could be confirmed in immunofluorescence stainings. The expression of the M2 polarization promoting chemokine IL-13 was significantly elevated in the treatment group. We found elevated mRNA expression of the M2 scavenger receptor CD163 after SWT. Immunofluorescence stainings confirmed increased numbers of M2 macrophages after treatment. SWT resulted in higher

number of capillaries and arterioles. Assessment of functional outcome revealed significantly improved limb perfusion in treated animals.CONCLUSION: SWT causes increased macrophage recruitment and enhanced polarization towards reparative M2 macrophages in ischemic muscle resulting in angiogenesis and improved limb perfusion. SWT represents a promising new treatment option for the treatment of ischemic heart disease.Torjesen, I., journalist, and London (2016). The cricketer promoting shockwave therapy for erectile dysfunction, BMJ, 354(), i4808, Zhai, L., Ma, X.-L., Jiang, C., Zhang, B., Liu, S.-T., and Xing, G.-Y. (2016). Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones, Indian J Orthop, 50(5), 543-550, BACKGROUND: Currently, the available treatments for long bone nonunion (LBN) are removing of focus of infection, bone marrow transplantation as well as Ilizarov methods etc. Due to a high percentage of failures, the treatments are complex and debated. To develop an effective method for the treatment of LBN, we explored the use of human autologous bone mesenchymal stems cells (hBMSCs) along with extracorporeal shock wave therapy (ESWT).MATERIALS AND METHODS: Sixty three patients of LBN were subjected to ESWT treatment and were divided into hBMSCs transplantation group (Group A, 32 cases) and simple ESWT treatment group (Group B, 31 cases).RESULTS: The patients were evaluated for 12 months after treatment. In Group A, 14 patients were healed and 13 showed an improvement, with fracture healing rate 84.4%. In Group B, eight patients were healed and 13 showed an improvement, with fracture healing rate 67.7%. The healing rates of the two groups exhibited a significant difference (P < 0.05). There was no significant difference for the callus formation after 3 months treatment (P > 0.05). However, the callus formation in Group A was significantly higher than that in the Group B after treatment for 6, 9, and 12 months (P < 0.05).CONCLUSION: Autologous bone mesenchymal stems cell transplantation with ESWT can effectively promote the healing of long bone nonunions.Angulo, J. C., Arance, I., de Las Heras, M. M., Meilán, E., Esquinas, C., and Andrés, E. M. (2016). Efficacy of low-intensity shock wave therapy for erectile dysfunction: A systematic review and meta-analysis, Actas Urol Esp, (), , CONTEXT: The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction.OBJECTIVE: To assess the efficacy of LISW therapy for treating erectile dysfunction as described in the literature.ACQUISITION OF EVIDENCE: Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English and Spanish, using the databases of PubMed, EMBASE and Web of Science. We excluded studies on Peyronie's disease. We employed the DerSimonian-Laird method for defining heterogeneity, calculating the grouped standard deviation of the mean (SDM). The primary objective of this review is to assess efficacy based on the change in the International Index of Erectile Function (IIEF-EF) over baseline at 1 month from the start of treatment, both for the treatment arm and the placebo arm. The secondary objective is focused on analysing IIEF-EF at 3-6 months from the start of the therapy.SUMMARY OF THE EVIDENCE: The pooled data of 636 patients from 12 studies showed that treatment with LISW resulted in a significant increase in IIEF-EF at 1 month with respect to baseline (SDM, -2.92; P=.000), to a greater degree than placebo (SDM, -.99; P=.000). The IIEF-EF at 3-6 months for the treated patients was significantly greater than baseline (SDM, -2.78; P=.000). Only one study compared the efficacy of placebo at 3-6 months versus baseline (SDM, -9.14). The comparison between LISW and placebo favours active treatment (SDM, 2.53; P=.000) at 1 month. There are insufficient data in the literature to assess the response over placebo at 3-6 months.CONCLUSIONS: According to the literature, treatment with LISW for erectile dysfunction is effective, both in the short and medium term. LISW has been described as more effective than placebo in the short term. The long-term efficacy data are insufficient. More studies are needed to explain the role of this therapy according to specific causes of erectile dysfunction.

Arirachakaran, A., Boonard, M., Yamaphai, S., Prommahachai, A., Kesprayura, S., and Kongtharvonskul, J. (2016). Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs, Eur J Orthop Surg Traumatol, (), , Treatment of calcific tendinitis using extracorporeal shock wave therapy (ESWT), ultrasound-guided percutaneous lavage (UGPL or barbotage), subacromial corticosteroid injection (SAI) and combined treatment is still controversial. This systematic review and meta-regression aimed to compare clinical outcomes between treatments. Relevant RCTs were identified using PubMed and Scopus search engines to date of September 23, 2015. Seven of 920 studies identified were eligible. Compared to the other treatments, the results of this study indicate that ESWT significantly improved CMS and VAS when compared to placebo. Barbotage plus ESWT significantly improved CMS, VAS and decreased size of calcium deposit when compared to ESWT, while barbotage plus SAI significantly improved CMS and decreased size of calcium deposit when compared to SAI. There have no different adverse effects of all treatment groups. Multiple active treatment comparisons indicated that barbotage plus SAI significantly improved VAS and size of calcium deposit when compared to other groups, while barbotage plus SAI improved CMS when compared to other groups. But there was no significant difference. The network meta-analysis suggested that combined US-guided needling and subacromial corticosteroid injection significantly decreased shoulder pain VAS, improved CMS score and decreased the size of calcium deposits, while also lowering risks of adverse event when compared to barbotage plus ESWT, ESWT and subacromial corticosteroid injection; therefore, the evidence points to UGPL as being the treatment of choice for nonsurgical options of treatment in calcific tendinitis of the shoulder.LEVEL OF EVIDENCE I: Cayton, T., Harwood, A., Smith, G. E., and Chetter, I. (2016). A Systematic Review of Extracorporeal Shockwave Therapy as a Novel Treatment for Intermittent Claudication, Ann Vasc Surg, 35(), 226-33, BACKGROUND: Extracorporeal shockwave therapy (ESWT) is emerging as a potential new treatment option for a variety of clinical scenarios including promotion of wound healing and symptom control in end-stage ischemic heart disease. A number of small trials have investigated ESWT in the management of peripheral arterial disease (PAD). A systematic review of the literature was performed investigating the efficacy and potential mechanism of action of ESWT for PAD.METHODS: A systematic review was conducted using MEDLINE and PubMed databases in keeping with the standard reporting guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis group to identify any publications relating to the use of ESWT in PAD.RESULTS: Systematic literature review identified 5 studies in 4 articles investigating ESWT in the treatment of symptomatic PAD. Although participant numbers within the identified studies were small, significant improvements in pain-free walking distance and maximum walking distance were demonstrated. The mechanism of action is thought to be due to mechanotransduction and subsequent angiogenesis.CONCLUSIONS: ESWT shows promise as a potentially efficacious novel treatment for symptomatic PAD. However, studies to date are small and record heterogeneous outcomes. Appropriately powered, randomized, sham-controlled data including objective clinical outcomes to comprehensively assess the efficacy of this novel treatment modality is still required before determining if ESWT should be brought into routine clinical practice.Cho, Y. S., Joo, S. Y., Cui, H., Cho, S.-R., Yim, H., and Seo, C. H. (2016). Effect of extracorporeal shock wave therapy on scar pain in burn patients: A prospective, randomized, single-blind, placebo-controlled study, Medicine (Baltimore), 95(32), e4575, BACKGROUND: Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients.METHODS: A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized

into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm (0.05-0.15 mJ/mm) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores.RESULTS: The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128).CONCLUSION: ESWT significantly reduced scar pain in burn patients after wound recovery.Haghighat, S. and Mashayekhi Asl, M. (2016). Effects of Extracorporeal Shock Wave Therapy on Pain in Patients With Chronic Refractory Coccydynia: A Quasi-Experimental Study, Anesth Pain Med, 6(4), e37428, BACKGROUND: Several nonsurgical and surgical treatment modalities are available for patients with chronic coccydynia, with controversial results. Extracorporeal shock wave therapy (ECSWT) is effective in the treatment of many musculoskeletal disorders; however, it has not been tested for chronic coccydynia.OBJECTIVES: We performed the current study to determine the effects of ECSWT on pain in patients with chronic coccydynia.PATIENTS AND METHODS: This quasi-interventional clinical study included 10 patients with chronic coccydynia without acute fracture. All the patients received ECSWT with a radial probe delivering 3,000 shock waves of 2 bar per session at 21 Hz frequency directed to the coccyx. Each patient received four sessions of ECSWT at one-week intervals. The pain severity was recorded according to the visual analog scale (VAS) at one, two, three, and four weeks after initiation of therapy. The VAS score was also evaluated at one and six months after ending the therapy.RESULTS: Most of the participants were women (90.0%), and the participants' mean age was 39.1 ± 9.1 (ranging from 28 to 52) years. The VAS score did not decrease significantly seven months after therapy when compared to baseline (3.3 ± 3.6 vs. 7.3 ± 2.1; P = 0.011). However, the VAS score at two months (2.6 ± 2.9 vs. 7.3 ± 2.1; P = 0.007) and at four weeks (3.2 ± 2.8 vs. 7.3 ± 2.1; P = 0.007) significantly decreased when compared to baseline. The decrease in VAS scores was not persistent after cessation of the therapy.CONCLUSIONS: ECSWT is an effective modality in relieving the pain intensity in patients with refractory chronic coccydynia for the early period after intervention.Ibrahim, M. I., Donatelli, R. A., Hellman, M., Hussein, A. Z., Furia, J. P., and Schmitz, C. (2016). Long-term results of radial extracorporeal shock wave treatment for chronic plantar fasciopathy: A prospective, randomized, placebo-controlled trial with two years follow-up, J Orthop Res, (), , Numerous randomized controlled trials (RCTs) demonstrated efficacy and safety of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciopathy (cPF). However, only two such RCTs investigated a follow-up period of more than 1 year, both applying focused ESWT. Corresponding data for radial ESWT (rESWT) have not yet been reported. We therefore tested the hypothesis that rESWT is effective and safe for the management of cPF with long-term follow-up of 2 years. To this end n = 50 patients with cPF were randomly allocated to either two sessions of rESWT (one session per week; 2,000 shock waves with energy flux density of 0.16 mJ/mm(2) per session) (n = 25) or to placebo treatment (n = 25). Evaluation was by change in Visual Analog Scale (VAS) score and Roles and Maudsley (RM) score. Mean pretreatment VAS scores for the rESWT and placebo groups were 8.5 and 8.9, respectively. 1, 3, 6, 12, and 24 months after treatment, the mean VAS scores for the rESWT and placebo groups were 0.6, 1.1, 0.5, 2.3, and 1.4 and 7.6, 7.7, 7.4, 6.9, and 5.6 (p < 0.001), respectively. Differences in mean RM scores were statistically significant between groups at 1, 3, 6, 12, and 24 months post treatment, but not at baseline. There were no significant complications. These data indicate that rESWT is effective and

safe for the management of cPF with long-term follow-up of 2 years. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.Kim, Y.-S., Lee, H.-J., and Kong, C.-G. (2016). Response to "Incorrect methodology may favor ultrasound-guided needling over shock wave treatment in calcific tendinopathy of the shoulder", J Shoulder Elbow Surg, 25(8), e244-5, Moya, D., Ramón, S., d'Agostino, M. C., Leal, C., Aranzabal, J. R., Eid, J., and Schaden, W. (2016). Incorrect methodology may favor ultrasound-guided needling over shock wave treatment in calcific tendinopathy of the shoulder, J Shoulder Elbow Surg, 25(8), e241-3, Newman, P., Waddington, G., and Adams, R. (2016). Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial, J Sci Med Sport, (), , OBJECTIVES: Up to 35% of runners develop medial tibial stress syndrome (MTSS) which often results in lengthy disruption to training and sometimes affects daily activities. There is currently no high quality evidence to support any particular intervention for MTSS. This study aims to investigate the effect of shockwave therapy for MTSS.DESIGN: A randomized, sham-controlled, pilot trial in a university-based health clinic including 28 active adults with MTSS.METHODS: Intervention included standard dose shockwave therapy for the experimental group versus sham dose for the control group, delivered during Week 1-3, 5 and 9. Main outcome measures were pain measured during bone and muscle pressure as well as during running using a numerical rating scale (0-10) and running was measured as pain-limited distance (m), at Week 1 (baseline) and Week 10 (post-intervention). Self-perception of change was measured using the Global Rating of Change Scale (-7 to +7) at Week 10 (post-intervention).RESULTS: Pain (palpation) was reduced in the experimental group by 1.1 out of 10.0 (95% CI -2.3 to 0.0) less than the control group. There were no other statistically significant differences between the groups.CONCLUSIONS: Standard dose shockwave therapy is not more effective than sham dose at improving pain or running distance in MTSS. However, the sham dose may have had a clinical effect. Further investigation including a no intervention control is warranted to evaluate the effect of shockwave therapy in the management of MTSS.Alkhayal, A. and Carrier, S. (2016). Con: does shockwave therapy have a place in the treatment of Peyronie's disease?, Transl Androl Urol, 5(3), 371-4, Caron, J., Michel, P.-A., Dussaule, J.-C., Chatziantoniou, C., Ronco, P., and Boffa, J.-J. (2016). Extracorporeal shock wave therapy does not improve hypertensive nephropathy, Physiol Rep, 4(11), , Low-energy extracorporeal shock wave therapy (SWT) has been shown to improve myocardial dysfunction, hind limb ischemia, erectile function, and to facilitate cell therapy and healing process. These therapeutic effects were mainly due to promoting angiogenesis. Since chronic kidney diseases are characterized by renal fibrosis and capillaries rarefaction, they may benefit from a proangiogenic treatment. The objective of our study was to determine whether SWT could ameliorate renal repair and favor angiogenesis in L-NAME-induced hypertensive nephropathy in rats. SWT was started when proteinuria exceeded 1 g/mmol of creatinine and 1 week after L-NAME removal. SWT consisted of implying 0.09 mJ/mm(2) (400 shots), 3 times per week. After 4 weeks of SWT, blood pressure, renal function and urinary protein excretion did not differ between treated (LN + SWT) and untreated rats (LN). Histological lesions including glomerulosclerosis and arteriolosclerosis scores, tubular dilatation and interstitial fibrosis were similar in both groups. In addition, peritubular capillaries and eNOS, VEGF, VEGF-R, SDF-1 gene expressions did not increase in SWT-treated compared to untreated animals. No procedural complications or adverse effects were observed in control (C + SWT) and hypertensive rats (LN + SWT). These results suggest that extracorporeal kidney shock wave therapy does not induce angiogenesis and does not improve renal function and structure, at least in the model of hypertensive nephropathy although the treatment is well tolerated.Chung, E. (2016). Pro: does shockwave therapy have a place in the treatment of Peyronie's disease?, Transl Androl Urol, 5(3), 366-70, Ismail, E. A. and El-Sakka, A. I. (2016). Innovative trends and perspectives for erectile dysfunction treatment: A systematic review, Arab J Urol, 14(2), 84-93, OBJECTIVE: To

review contemporary knowledge concerning the innovative trends and perspectives in the treatment of erectile dysfunction (ED).METHODS: Medline was reviewed for English-language journal articles between January 2000 and March 2016, using the terms 'erectile dysfunction treatments', 'new trends' and 'perspectives'. In all, 114 original articles and 16 review articles were found to be relevant. Of the 76 cited papers that met the inclusion criteria, 51 papers had level of evidence of 1a-2b, whilst 25 had level of evidence of 3-4. Criteria included all pertinent review articles, randomised controlled trials with tight methodological design, cohort studies, and retrospective analyses. We also manually reviewed references from selected articles.RESULTS: Several interesting studies have addressed novel phosphodiesterase type 5 inhibitors (PDE5Is), orodispersible tablets, their recent chronic use, and combination with other agents. A few controlled studies have addressed herbal medicine as a sole or additional treatment for ED. Experimental studies and exciting review papers have addressed stem cells as novel players in the field of ED treatment. Other recent articles have revised the current status of low-intensity extracorporeal shockwave therapy in the field of ED. A few articles without long-term data have addressed new technologies that included: external penile support devices, penile vibrators, tissue engineering, nanotechnology, and endovascular tools for ED treatment.CONCLUSIONS: The current treatment of ED is still far from ideal. We expect to see new drugs and technologies that may revolutionise ED treatment, especially in complex cases.Kim, S. H., Ha, K. W., Kim, Y. H., Seol, P.-H., Kwak, H.-J., Park, S.-W., and Ryu, B.-J. (2016). Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome, Ann Rehabil Med, 40(3), 509-19, OBJECTIVE: To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome.METHODS: In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed.RESULTS: VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were -1.69±1.90 and -0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were -1.60±1.74 and -0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were -1.61±1.73 and -0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05).CONCLUSION: rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.Matsubara, T., Ito, K., and Shimokawa, H. (2016). [Cardiac shock wave therapy], Nihon Rinsho, 74 Suppl 4 Pt 1(), 618-23, Park, J. W., Hwang, J. H., Choi, Y. S., and Kim, S. J. (2016). Correction: Comparison of Therapeutic Effect of Extracorporeal Shock Wave in Calcific Versus Noncalcific Lateral Epicondylopathy, Ann Rehabil Med, 40(3), 557, [This corrects the article on p. 294 in vol. 40, PMID: 27152280.].Thijs, K. M., Zwerver, J., Backx, F. J. G., Steeneken, V., Rayer, S., Groenenboom, P., and Moen, M. H. (2016). Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Clin J Sport Med, (), , OBJECTIVE: To evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in participants with patellar tendinopathy (PT) after 24 weeks.

DESIGN: Randomized controlled trial.SETTING: Sports medicine departments of a university hospital and a general hospital in the Netherlands.PARTICIPANTS: Fifty-two physically active male and female participants with a clinical diagnosis of PT (mean age: 28.6 years; range, 18-45) were randomly allocated to the ESWT (n = 22) or sham shockwave (n = 30).INTERVENTIONS: Extracorporeal shockwave therapy and sham shockwave were applied in 3 sessions at 1-week intervals with a piezoelectric device. All participants were instructed to perform eccentric exercises (3 sets of 15 repetitions twice a day) for 3 months on a decline board at home.MAIN OUTCOME MEASURES: The Victorian Institute of Sport Assessment-Patella (VISA-P) scores (primary), pain scores during functional knee loading tests, and Likert score (secondary) were registered at baseline and at 6, 12, and 24 weeks after the start with the ESWT or sham-shockwave treatment.RESULTS: No significant differences for the primary and secondary outcome measures were found between the groups. In the ESWT/eccentric group, the VISA-P increased from 54.5 ± 15.4 to 70.9 ± 17.8, whereas the VISA-P in the sham-shockwave/eccentric group increased from 58.9 ± 14.6 to 78.2 ± 15.8 (between-group change in VISA-P at 24 weeks -4.8; 95% confidence interval, -12.7 to 3.0, P = 0.150).CONCLUSIONS: This study showed no additional effect of 3 sessions ESWT in participants with PT treated with eccentric exercises. The results should be interpreted with caution because of small sample size and considerable loss to follow-up, particularly in the ESWT group.Yang, T.-H., Wang, L.-Y., Huang, Y.-C., and Lau, Y.-C. (2016). Efficacy of Radial Extracorporeal Shockwave Therapy on Lateral Epicondylosis and Common Extensor Tendon Stiffness: 3157 Board #222 June 3, 2: 00 PM - 3: 30 PM, Med Sci Sports Exerc, 48(5 Suppl 1), 899, Magomedov, A. M., Gertsen, G. I., Fey, S., Kuzub, T. A., and Krinitskaya, O. F. (2016). [IMPACT OF RADIAL SHOCK-WAVE THERAPY OF A LOW FREQUENCY ON METABOLIC PROCESSES IN THE BONE TISSUE IN TRAUMATIC TIBIAL DEFECTS IN EXPERIMENT], Klin Khir, (4), 64-6, Results of investigations on impact of radial shock-wave therapy of low frequency on metabolism of the main protein of the bone tissue (collagen) as well as on the enzymes activity, taking part in a catabolic phase of the protein metabolism, were studied. Changes in content of glycosaminoglycans under impact of the therapy in experimental animals were studied.Blumhardt, S., Frey, D. P., Toniolo, M., Alkadhi, H., Held, U., and Distler, O. (2016). Safety and efficacy of extracorporeal shock wave therapy (ESWT) in calcinosis cutis associated with systemic sclerosis, Clin Exp Rheumatol, 34 Suppl 100(5), 177-180, OBJECTIVES: Calcinosis cutis is a frequent, difficult to treat manifestation of systemic sclerosis (SSc) associated with high morbidity. The aim of this prospective, controlled, monocentric study was to assess safety and efficacy of extracorporeal shock wave therapy (ESWT) for calcinosis cutis of the finger in SSc patients.METHODS: A 12-week proof of concept study in which 4 SSc patients with calcinosis cutis were treated at one painful finger with high-energy, focused ESWT, in 3 sessions with one-week interval between each session. A second, untreated finger, served as control. The outcome parameters were: change in pain, change in size of calcification measured by ultrasound (US) and computed tomography (CT) and of the force by pressing the finger against a Dolorimeter.RESULTS: Pain was reduced (by 91% and 60%) in the treated finger in two out of four patients. There was no change in the control fingers. The size of the calcinosis in the treated finger was reduced in three (US) and four patients (CT). Inter-assessor agreement was acceptable for US volume measures (ICC=0.863).CONCLUSIONS: We could show promising evidence for safety and efficacy of ESWT for chronic, treatment resistant calcinosis cutis in SSc patients, thus justifying the initiation of larger multicentre controlled trials.

Buza, 3rd, J. A. and Einhorn, T. (2016). Bone healing in 2016, Clin Cases Miner Bone Metab, 13(2), 101-105, Delayed fracture healing and nonunion occurs in up to 5-10% of all fractures, and can present a challenging clinical scenario for the treating physician. Methods for the enhancement of skeletal repair may benefit patients that are at risk of, or have experienced, delayed healing or nonunion. These methods can be categorized into either physical stimulation therapies or biological therapies. Physical stimulation therapies include electrical stimulation, low-intensity pulsed ultrasonography, or extracorporeal shock wave therapy. Biological therapies can be further classified into local or systemic therapy based on the method of delivery. Local methods include autologous bone marrow, autologous bone graft, fibroblast growth factor-2, platelet-rich plasma, platelet-derived growth factor, and bone morphogenetic proteins. Systemic therapies include parathyroid hormone and bisphosphonates. This article reviews the current applications and supporting evidence for the use of these therapies in the enhancement of fracture healing.Cheng, Y., Zhang, J., and Cai, Y. (2016). Utility of Ultrasonography in Assessing the Effectiveness of Extracorporeal Shock Wave Therapy in Insertional Achilles Tendinopathy, Biomed Res Int, 2016(), 2580969, Introduction. The aim of this study was to investigate the utility of ultrasonography (US) for predicting and assessing the effectiveness of extracorporeal shock wave therapy (ESWT) in insertional Achilles tendinopathy (IAT). Methods. A total of 42 patients with an established diagnosis of chronic IAT were examined by US before ESWT and at 4 weeks and 12 weeks after ESWT. The thickness and cross-sectional area (CSA) of the Achilles tendon, size of calcific plaques, tendon structure score, and neovascularization score were measured at each time point. Results. After therapy, Victorian Institute of Sport Assessment-Achilles (VISA-A) scores increased significantly, and the size of calcific plaques decreased (P < 0.05). Neovascularization scores increased at the 4th week and then decreased at the 12th week (P < 0.05). The thickness, CSA, and structure of the Achilles tendon did not change. Variables observed by US at baseline were not associated with changes in VISA-A scores at follow-up. However, the changes in calcific plaque size and neovascularization scores were related to the improvement of VISA-A scores between pre- and posttherapy (P < 0.01). Conclusion. Ultrasonography can reveal some changes in the insertion of the Achilles tendon after ESWT, but the outcome of ESWT in IAT cannot be predicted by the variables observed by US.D Agostino, M. C., Frairia, R., Romeo, P., Amelio, E., Berta, L., Bosco, V., Gigliotti, S., Guerra, C., Messina, S., Messuri, L., Moretti, B., Notarnicola, A., Maccagnano, G., Russo, S., Saggini, R., Vulpiani, M. C., and Buselli, P. (2016). Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice, J Biol Regul Homeost Agents, 30(2), 323-32, Extracorporeal Shock Wave Therapy (ESWT), after its first medical application in the urological field for lithotripsy, nowadays represents a valid therapeutical tool also for many musculoskeletal diseases, as well as for regenerative medicine applications. This is possible thanks to its mechanisms of action, which in the non-urological field are not related to mechanical disruption (as for renal stones), but rather to the capacity, by mechanotransduction, to induce neoangiogenesis, osteogenesis and to improve local tissue trophism, regeneration and remodeling, through stem cell stimulation. On the basis of these biological assumptions, it becomes clear that ESWT can represent a valid therapeutic tool also for all those pathological conditions that derive from musculoskeletal trauma, and are characterized by tissue loss and/or delayed healing and regeneration (mainly bone and skin, but not only). As a safe, repeatable and non�invasive therapy, in many cases it can represent a first �line therapeutic option, as an alternative to surgery (for example, in bone and skin healing disorders), or in combination with some other treatment options. It is hoped that with its use in daily practice also the muscle�skeletal field will grow, not only for standard indications, but also in post �traumatic sequelae, in order to improve recovery and shorten healing time, with undoubted advantages for the patients and lower health service expenses.Dymarek, R., Taradaj, J., and Rosińczuk, J. (2016). Extracorporeal Shock Wave Stimulation as Alternative Treatment Modality for Wrist and Fingers Spasticity in Poststroke Patients: A Prospective, Open-Label, Preliminary Clinical Trial, Evid Based Complement Alternat Med, 2016(), 4648101, Objective. To evaluate the effectiveness of radial shock waves (rESW) for

wrist and fingers flexors spasticity in stroke patients. Methods. Twenty patients with upper limb muscle spasticity were enrolled in the study and treated with a single session of rESW. The spasticity level of the radio carpal (RC) and finger (FF) joints was assessed using Modified Ashworth Scale (MAS). The resting bioelectrical activity of the flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU) was examined using surface electromyography (sEMG). Trophic conditions were measured using infrared thermal (IRT) imaging. All measurements were conducted at baseline (t 0), immediately after rESW (t 1), and 1 (t 2) and 24 (t 3) hours following rESW. Results. Significant reduction in MAS was observed for the RC joint in t 1, as well as for the FF joints in t 1, t 2, and t 3. A significant decrease in sEMG was shown for the FCR muscle in t 1 and t 2, as well as for the FCU muscle in t 1 and t 3. Also, a significant increase in IRT value was observed in t 3 only. Conclusions. A single session of rESW could be an effective alternative treatment for reduction of limb spasticity and could lead to improvement of trophic conditions of the spastic muscles.Frairia, R., Berta, L., and Catalano, M. G. (2016). Extracorporeal shock waves: perspectives in malignant tumor treatment, J Biol Regul Homeost Agents, 30(3), 641-648, Progress in basic research led to the design of new generations of anticancer drugs with some notable achievements. Over the years, more and more powerful drugs have been developed with the purpose of increasing the rate of response to therapy. As molecular power of chemotherapeutic agents increased, unfortunately also toxicity and undesired side-effects increased. The search for new therapeutic strategies to be used in the management of cancer is one of the more promising strategies to reduce chemotherapy toxicity. Extracorporeal Shock Waves (ESW), widely used for the treatment of urolithiasis, have been reported to cause modifications of cell growth both in vitro and in vivo. They exert an agonist cytotoxic effect with several chemotherapeutic agents, such as cisplatin, doxorubicin, bleomycin, paclitaxel. Moreover, as it has been reported that their main mechanism of action is an increase in cell membrane permeability, ESW are also used to deliver oligonucleotides and other small particles to cells. Recently, it was found that certain dye compounds, in particular porphyrins, can achieve a cytopathogenic effect when the disease site is subjected to ultrasound irradiation. This technique is referred to as sonodynamic therapy. Based on the new knowledge regarding the interaction between ultrasound with bulk liquid, several studies have shown a synergic effect of ESW and porphyrins in vitro, thus opening a new perspective in sonodynamic therapy, able to overcome some drawbacks encountered during conventional anticancer drug treatment. Finally, current advances in bioengineering encouraged the application of nano-scale technologies to medicine. Nanobubbles, composed of an external shell and a gas core, can deliver chemotropic drugs and porfirins, to target tumour tissues in response to physical triggers, and ESW features make them an ideal alternative to ultrasound in combination with drug-loaded nanobubbles in delivery strategies.Huang, H.-M., Li, X.-L., Tu, S.-Q., Chen, X.-F., Lu, C.-C., and Jiang, L.-H. (2016). Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein-2 and Osteoprotegerin in Osteoporotic Fracture in Rats, Chin Med J (Engl), 129(21), 2567-2575, BACKGROUND: Roughly focused extracorporeal shock waves therapy (ESWT) is characterized by a wide focal area, a large therapy zone, easy positioning, and less pain during treatment. The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin (OPG) and bone morphogenetic protein-2 (BMP-2) in osteoporotic fractures in rats.METHODS: Seventy-two female Sprague-Dawley (SD) rats, 3 months old, were divided into sham-operated group (n = 6) and an ovariectomized (OVX) group (n = 66). Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation. The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm2, 60 doses/min, and 2000 pact quantities. The contralateral right tibia was left untreated and served as a control. Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry, real-time polymerase chain reaction (PCR), and Western blotting analysis.RESULTS: Bone mineral density (BMD) at the proximal tibia, femur, and L5 spine was significantly reduced after ovariectomy. BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group. Meanwhile, bilateral oophorectomy resulted in a

lower trabecular bone volume fraction (BV/TV) in the proximal tibia of the sham-OVX animals. Three months after bilateral oophorectomy, BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs (P < 0.001). These data showed that the SD rats became a suitable model of osteoporosis, 3 months after they were OVX. Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group. Compared with the contralateral controls, decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT, followed by a later increase at 7 days, was indicated by real-time PCR and Western blotting analysis. The OPG messenger RNA (mRNA) expression levels peaked at 6 weeks after the shock wave treatment, paired with a much earlier (at 4 weeks) increase of BMP-2, and declined close to normal at 8 weeks.CONCLUSIONS: Roughly focused ESWT may promote the expression of OPG and BMP-2 in the osteoporotic fracture area in rats. BMP-2 and OPG may act synergistically and may lead to a significant enhancement of bone formation and remodeling.Król, P., Franek, A., Dolibog, P., Błaszczak, E., Durmała, J., Ficek, K., Król, T., Wnuk, B., and Dolibog, P. (2016). An attempt at objective and subjective evaluation of the therapeutic efficacy of focused and radial shockwave applied to symptomatic heel spur, Acta Bioeng Biomech, 18(3), 143-148, PURPOSE: The experiment was designed to evaluate and compare the efficacy of focused shockwave and radial shockwave in symptomatic heel spur treatment. Postural balance tests were used to ensure the objectivity of evaluations.METHODS: Forty three patients with symptomatic heel spur were divided into two comparative groups that received respectively focused shockwave therapy (the FSWT group; 2000 impulses, 4 Hz, 0.4 mJ/mm2) and radial shockwave therapy (the RSWT group; 2000 impulses, 8 Hz, 5 bars + 2000 impulses, 8 Hz, 2.5 bars). Each patient received 5 treatments at weekly intervals. Before therapy started and 1, 3, 6 and 12 weeks after it ended, the intensity of pain experienced by the patients was assessed and static balance tests were performed on a force platform.RESULTS: Successive measurements showed that the intensity of all kinds of pain under consideration was decreasing gradually and statistically significantly in both groups. The percentage reduction in pain intensity was similar between the groups. The standard deviation of the COP in the anterior-posterior and medial-lateral directions, 95% confidence ellipse area and COP velocity kept varying throughout the experiment, but in none of the groups changes were statistically significant.CONCLUSIONS: Focused shockwave therapy and radial shockwave therapy improve the well-being of patients with symptomatic heel spur significantly and comparably. Posturography cannot deliver unambiguous data for tracking changes that the two therapies induce in these patients.Malliaropoulos, N., Jury, R., Pyne, D., Padhiar, N., Turner, J., Korakakis, V., Meke, M., and Lohrer, H. (2016). Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit), Open Access J Sports Med, 7(), 143-151, INTRODUCTION: Stenosing tenosynovitis that is characterized by the inability to flex the digit smoothly, usually leads to prolonged rehabilitation or surgery.STUDY DESIGN: This case series is a retrospective cohort study.PURPOSE: The aim of this case series was to evaluate the effectiveness of radial extracorporeal shockwave therapy (rESWT) for the treatment of stenosing tenosynovitis of the digital flexor tendon (trigger digit).METHODS: A retrospective analysis of 44 patients (49 fingers) treated with an individually adapted rESWT protocol was conducted. Trigger digit pain and function were evaluated at baseline and 1-, 3-, and 12-months posttreatment. Recurrence and pretreatment symptom duration were analyzed.RESULTS: Significant reductions in pain scores and functional improvement were found between baseline and all follow-up assessments (P<0.001). Pretreatment symptom duration was significantly correlated with the number of rESWT sessions required (r=0.776, P<0.001) and 1-year posttreatment pain score (r=0.335, P=0.019).

CONCLUSION: This study provides initial evidence that rESWT is an effective treatment for trigger digit, but randomised controlled trials are required to provide further evidence of this effect.Malliaropoulos, N., Crate, G., Meke, M., Korakakis, V., Nauck, T., Lohrer, H., and Padhiar, N. (2016). Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study, Biomed Res Int, 2016(), 9415827, Background and Aims. The exploration of an individualised protocol of radial extracorporeal shock wave therapy (rESWT) for plantar fasciopathy, assessing success rates and the recurrence rate over a 1-year period after treatment, is not yet identified in literature. Methods and Results. Between 2006 and 2013, 68 patients (78 heels) were assessed for plantar fasciopathy. An individualised rESWT treatment protocol was applied and retrospectively analysed. Heels were analysed for mean number of shock wave impulses, mean pressure, and mean frequency applied. Significant mean pain reductions were assessed through Visual Analogue Scale (VAS) after 1-month, 3-month, and 1-year follow-up. Success rates were estimated as the percentage of patients having more than 60% VAS pain decrease at each follow-up. 1-year recurrence rate was estimated. The mean VAS score before treatment at 6.9 reduced to 3.6, 1 month after the last session, and to 2.2 and 0.9, after 3 months and 1 year, respectively. Success rates were estimated at 19% (1 month), 70% (3 months), and 98% (1 year). The 1-year recurrence rate was 8%. Moderate positive Spearman's rho correlation (r = 0.462, p < 0.001) was found between pretreatment pain duration and the total number of rESWT sessions applied. Conclusions. Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for plantar fasciitis.Marano, F., Rinella, L., Argenziano, M., Cavalli, R., Sassi, F., D'Amelio, P., Battaglia, A., Gontero, P., Bosco, O., Peluso, R., Fortunati, N., Frairia, R., and Catalano, M. G. (2016). Targeting Taxanes to Castration-Resistant Prostate Cancer Cells by Nanobubbles and Extracorporeal Shock Waves, PLoS One, 11(12), e0168553, To target taxanes to castration-resistant prostate cancer cells, glycol-chitosan nanobubbles loaded with paclitaxel and docetaxel were constructed. The loaded nanobubbles were then combined with Extracorporeal Shock Waves, acoustic waves widely used in urology and orthopedics, with no side effects. Nanobubbles, with an average diameter of 353.3 ± 15.5 nm, entered two different castration-resistant prostate cancer cells (PC3 and DU145) as demonstrated by flow cytometry and immunofluorescence. The shock waves applied increased the amount of intracellular nanobubbles. Loading nanobubbles with paclitaxel and docetaxel and combining them with shock waves generated the highest cytotoxic effects, resulting in a paclitaxel GI50 reduction of about 55% and in a docetaxel GI50 reduction of about 45% respectively. Combined treatment also affected cell migration. Paclitaxel-loaded nanobubbles and shock waves reduced cell migration by more than 85% with respect to paclitaxel alone; whereas docetaxel-loaded nanobubbles and shock waves reduced cell migration by more than 82% with respect to docetaxel alone. The present data suggest that nanobubbles can act as a stable taxane reservoir in castration-resistant prostate cancer cells and shock waves can further increase drug release from nanobubbles leading to higher cytotoxic and anti-migration effect.Notarnicola, A., Moretti, L., Maccagnano, G., Tafuri, S., and Moretti, B. (2016). Tendonitis of the rotator cuff treated with extracorporeal shock wave therapy: radiographic monitoring to identify prognostic factors for disintegration, J Biol Regul Homeost Agents, 30(4), 1195-1202, Extracorporeal shock wave therapy (ESWT) is widely used for calcific tendonitis of the shoulder. The initial rationale for this therapy was to break the calcification, but this effect does not always occur. To date, we do not know how calcifications evolve or why they may be less responsive to the action of the shock waves. One hundred and seventy-four shoulders with calcific tendinitis were prospectively evaluated before and after ESWT, using the radiographic classifications according to Gartner and Heyer, to Bosworth and to Molè. Three months after ESWT therapy, we observed the disappearance of calcification in 36.8% of the shoulders, a reduction in size in 21.8% and no change in 41.4%. The calcifications that disappeared were large according to Bosworth (p=0.004). The probability of disappearance of calcification increased with increasing age (p=0.011), for medium calcifications according to Bosworth (p=0.001), and calcifications of type A according to Molè (p=0.043). The results

of our study suggest that the radiographic aspects of calcific tendonitis of the rotator cuff could influence the disruptive effects after ESWT. With this knowledge we could define the timing of treatment and therapeutic choice for each patient.Notarnicola, A., Vicenti, G., Maccagnano, G., Silvestris, F., Cafforio, P., and Moretti, B. (2016). Extracorporeal shock waves induce osteogenic differentiation of human bone-marrow stromal cells, J Biol Regul Homeost Agents, 30(4 Suppl 1), 139-144, The effects of treatment with shock waves (SW) on osteoblastic cells have already been described. Furthermore, the effects of treatment with SW are also determined by the contextual stimulation of other cell lines, in particular of mesenchymal cells. This is the first experimental study of stimulation of a human mesenchymal stem cell line, taken from bone marrow, using SW (electromagnetic device), with two energy levels. The results showed a significant increase in expression of the main osteoblastic differentiation genes: BMP2, alkaline phosphatase, osteocalcin, COL1A1, RUNX2. The monitoring within 96 hours demonstrated a progressive increase of cell adhesion and an intense cell proliferation at 48 h. The differentiation response and proliferation of stem cells after treatment with SW shows that this therapy is an effective method of regenerative medicine.Patel, C. K. and Bennett, N. (2016). Advances in the treatment of erectile dysfunction: what's new and upcoming?, F1000Res, 5(), , Erectile dysfunction adversely affects up to 20% of all men and is the most commonly treated sexual disorder. The public health implications of this condition are significant and represent a challenge for our healthcare system. The physiological pathways responsible for erections have been extensively studied, and much advancement has been made since the introduction of phosphodiesterase 5 inhibitors. Newer agents, such as dopaminergic and melanocortin receptor agonists, which target central erectogenic pathways, are under investigation. Newer formulations and delivery methods of existing medications such as alprostadil will also be introduced in the near future. Furthermore, low-intensity shockwave lithotripsy and stem cell regenerative techniques are innovative approaches to the treatment of erectile dysfunction.Pavone, V., Cannavò, L., Di Stefano, A., Testa, G., Costarella, L., and Sessa, G. (2016). Low-Energy Extracorporeal Shock-Wave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy: A Case Series, Biomed Res Int, 2016(), 7123769, Introduction. We report the results of a series of 40 patients with chronic insertional Achilles tendinopathy treated with low-energy ESWT after the failure of a 3-month program of eccentric exercises alone. Methods and Materials. 40 patients, 28 (70%) males and 12 (30%) females, were treated between January and December 2014. All patients were previously treated with only eccentric exercises for a 3-month period. The treatment protocol included 4 sessions of ESWT with a 2-week interval, from 800 shots in each one (4 Hz, 14 KeV), together with eccentric exercises. Visual Analogue Scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot score were recorded. Results. At the 12-month follow-up, 26 (65.0%) patients did not complain about pain (VAS < 2), 11 (27.5%) patients got back to normal activities despite residual pain (VAS 2-4), and 3 (7.5%) of the patients still complained about pain (VAS > 4). There was no significative improvement in both scores after eccentric exercises alone. Mean VAS improvement was 5.8 ± 1.3 SD points (P < 0.001). Mean AOFAS Hindfoot score improvement was 19.8 ± 5.0 SD points (P < 0.001). Conclusions. ESWT is recommended, in combination with an eccentric exercise program, in patients with chronic Achilles tendinopathy being both insertional and not.Shimpi, R. K. and Jain, R. J. (2016). Role of extracorporeal shock wave therapy in management of Peyronie's disease: A preliminary report, Urol Ann, 8(4), 409-417, INTRODUCTION: Peyronie's Disease (PD) is a disease causing psycho social trauma to the patient. Multiple treatment options are available with variable results. Extra Corporeal Shock Wave Therapy (ESWT) is a new insight into the non invasive modality of management. It focuses on the mechanism of inducing angiogenesis in the penile cavernous tissue.MATERIALS AND METHODS: The aim of the study is to determine the role of ESWT in the management of PD. The objectives include demonstrating the improvement in mean International Index of Erectile Function Score (IIEFS), improvement in pain score by Visual Analogue Scale (VAS), change in cavernosal artery flow on colour penile Doppler, reduction in plaque size, and improvement in penile curvature degree after the therapy. 30 patients,

between 25-65 years, who were non responders to conservative line of management, were treated with ESWT. The results were evaluated at baseline and 18-24 weeks after the therapy.RESULTS: ESWT significantly improves the cavernosal artery velocity, thereby supporting the theory of angiogenesis. ESWT improves all the domains of IIEF including Erectile Function, Sexual Desire, Sexual Satisfaction, Orgasm and Overall Satisfaction. There is a significant improvement in the pain and penile curvature, and reduction in the plaque size. No adverse effects have been recorded.CONCLUSION: ESWT offers a safe, minimally invasive, OPD based option to the management of the patients of PD in the stable phase of the disease. Patients who do not respond to the conservative line of management can be really benefited by ESWT.Taheri, P., Vahdatpour, B., and Andalib, S. (2016). Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius, Adv Biomed Res, 5(), 138, BACKGROUND: The aim of this study is to compare the effects of laser therapy and shock wave therapy for symptoms treatment among patients with MPS in the upper trapezius muscle.MATERIALS AND METHODS: In a clinical trial study, 46 patients were selected based on the clinical criteria and physiathrist diagnosis. Subjects were randomized into two groups as follows: Twenty individuals were assigned to exercise-medication-laser therapy group, and 26 to exercise-medication-shock wave therapy group. The pain was assessed based on visual analog scale (VAS), neck disability index (NDI), and SPADI in three stages: Before treatment, subsequently after treatment, and a month after treatment.RESULTS: One man and 19 women, age group of 45.3 ± 7.7 years, were assigned into laser therapy group. Two men and 24 women, average age group of 42.3 ± 10.4 were assigned into shock wave therapy group. A significant difference was found among our study groups before treatment and after starting treatment for VAS, NDI, and SPDI indices, that is, two methods of treatments were effective (P < 0.001). However, among these two treatment methods, laser therapy provided higher effect on VAS and NDI as compared to the radial shock wave method (P < 0.05) in 2 weeks from starting the treatment (consequent to treatment).CONCLUSION: According to this study results, we can conclude that shock wave and laser therapy results on similar effect in long-term for relieve of pain and eliminating symptoms in patients with myofascial but laser provides a faster optimal results.Vahdatpour, B., Kiyani, A., and Dehghan, F. (2016). Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome, Adv Biomed Res, 5(), 120, BACKGROUND: The carpal tunnel syndrome (CTS) is the most common neuropathy. The aim of this study was to evaluate the effect of a new and noninvasive treatment including extracorporeal shock wave therapy (ESWT) in the treatment of CTS.MATERIALS AND METHODS: This study is a clinical trial conducted on 60 patients with moderate CTS in selected health centers of Isfahan Medical University from November 2014 to April 2015. Patients with CTS were randomly divided into two groups. Conservative treatment including wrist splint at night for 3 months, consumption of nonsteroidal anti-inflammatory drugs for 2 weeks, and oral consumption of Vitamin B1 for a month was recommended for both groups. The first group was treated with ESWT, one session per week for 4 weeks. Focus probe with 0.05, 0.07, 0.1, and 0.15 energy and shock numbers 800, 900, 1000, and 1100 were used from the first session to the fourth, respectively. The evaluated parameters were assessed before treatment and after 3 and 6 months. Data were analyzed using SPSS version 19, Student's t-test, and Chi-square test.RESULTS: All parameters were significantly decreased in the ESWT group after 3 months. These results remained almost constant after 6 months compared with 3 months after treatment. However, only two parameters considerably improved after 3 months of treatment in the control group. The entire indexes in the control group implicated the regression of results in long-term period.CONCLUSION: It is recommended to use ESWT as a conservative treatment in patients with CTS.

Wang, L., Jiang, Y., Jiang, Z., and Han, L. (2016). Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function, Neuropsychiatr Dis Treat, 12(), 2189-98, BACKGROUND: Latest studies show that low-energy extracorporeal shock wave therapy (ESWT) can upregulate levels of vascular endothelial growth factor (VEGF). VEGF can ease nervous tissue harm after spinal cord injury (SCI). This study aims to explore whether low-energy ESWT can promote expression of VEGF, protect nervous tissue after SCI, and improve motor function.METHODS: Ninety adult female rats were divided into the following groups: Group A (simple laminectomy), Group B (laminectomy and low-energy ESWT), Group C (spinal cord injury), and Group D (spinal cord injury and low-energy ESWT). Impinger was used to cause thoracic spinal cord injury. Low-energy ESWT was applied as treatment after injury three times a week, for 3 weeks. After SCI, the Basso, Beattie, and Bresnahan (BBB) scale was used to evaluate motor function over a period of 42 days at different time points. Hematoxylin and eosin (HE) staining was used to evaluate nerve tissue injury. Neuronal nuclear antigen (NeuN) staining was also used to evaluate loss of neurons. Polymerase chain reaction was used to detect messenger RNA (mRNA) expression of VEGF and its receptor fms-like tyrosine kinase 1 (Flt-1). Immunostaining was used to evaluate VEGF protein expression level in myeloid tissue.RESULTS: BBB scores of Groups A and B showed no significant result related to dyskinesia. HE and NeuN staining indicated that only using low-energy ESWT could not cause damage of nervous tissue in Group B. Recovery of motor function at 7, 35, and 42 days after SCI in Group D was better than that in Group C (P<0.05). Compared with Group C, number of NeuN-positive cells at 42 days after SCI increased significantly (P<0.05). The mRNA levels of VEGF and Flt-1 and VEGF expression at 7 days after SCI in Group D were significantly higher than those in Group C (P<0.05).CONCLUSION: Low-energy ESWT promotes expression of VEGF, decreases secondary damage of nerve tissue, and improves recovery of motor function. It can be regarded as one mode of clinical routine adjunctive therapy for spinal injury.Wu, Z., Yao, W., Chen, S., and Li, Y. (2016). Outcome of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy with and without Haglund's Deformity, Biomed Res Int, 2016(), 6315846, Purpose. To compare the results of extracorporeal shock wave therapy (ESWT) for insertional Achilles tendinopathy (IAT) with or without Haglund's deformity. Methods. Between September 2014 and May 2015, all patients who underwent ESWT were retrospectively enrolled in this study. A total of 67 patients were available for follow-up and assigned into nondeformtiy group (n = 37) and deformtiy group (n = 30). Clinical outcomes were evaluated by VISA-A Score and 6-point Likert scale. Results. The VISA-A score increased in both groups, from 49.57 ± 9.98 at baseline to 83.86 ± 8.59 at 14.5 ± 7.2 months after treatment in nondeformity group (P < 0.001) and from 48.70 ± 9.38 at baseline to 67.78 ± 11.35 at 15.3 ± 6.7 months after treatment in deformity group (P < 0.001). However, there was a greater improvement in VISA-A Score for the nondeformity group compared with deformity group (P = 0.005). For the 6-point Likert scale, there were decreases from 3.92 ± 0.80 at baseline to 1.57 ± 0.73 at the follow-up time point in nondeformity group (P < 0.001) and from 4.0 ± 0.76 at baseline to 2.37 ± 1.03 at the follow-up time point in deformity group (P < 0.001). There was no significant difference in improvement of the 6-point Likert scale between both groups (P = 0.062). Conclusions. ESWT resulted in greater clinical outcomes in patients without Haglund's deformity compared with patients with Haglund's deformity.