Extracorporeal Shock Wave Therapy in Acute Injury Care

                                                                             Master student

                                                                           Leshkovich S.A.

 

                                                                                               

                                                                            Department of

                                                                                       electronic engineering
                                                                             and technology                                           

                                                                              Group 7M1101 

 

                                                                                                Scientific Adviser                                     

                                                                                               Dostanko A.P.                                              

 

Minsk 2018

CONTENTS

Оглавление

ANNOTATION.. 3

INTRODUCTION.. 4

1 BBIOLOGICAL EFFECTS OF ESTW IN EARLY TISSUE REGENERATION.. 6

2 DIELECTRIC PROPERTIES OF SOME TISSUES. 8

3 ESWT PARAMETERS AND SAFETY IN ACUTE INJURY CARE. 9

3.1. ESWT parameters in acute injury care. 8

3.2. Safety of ESWT parameters in acute injury care. 10

CONCLUSION.. 11

GLOSSARY. 12

REFERENCES. 19

 

 

ANNOTATION

 

           It was reviewed the method of extracorporeal shock wave therapy(ESWT) in treatment of acute injury. It was described time of treatment after injury by ESWT. It was provided parameters ESWT in acute traumatism. It was described recommendations related to safety ESWT in acute traumatism.

 

A ННОТАЦИЯ

 

Проведен обзор метода экстракорпоральной ударно-волновой терапии (ЭУВТ) при лечении острых травм. Описано время лечения после травмы методом ЭУВТ. Даны параметры ЭУВТ при острой травматизации. Описаны рекомендации по безопасности ЭУВТ при острой травматизации.

INTRODUCTION

 

Focused high-energy shock waves applied from outside the body have been used as a means of medical treatment since 1980 when extracorporeal shock wave lithotripsy was introduced to enable the noninvasive disintegration of renal and gall stones. Since then, the scope of disorders to which the technique is applied has been extended to various medical fields.

When directed to biological tissues, shock waves generate physical interactions and effects by formation of cavitation bubbles and shear stress, which are considered to evoke distinct biological responses in tissues, cells, and at subcellular level. Energy flux density (EFD) and the number of applied impulses are thus key determinants of shock wave effects in medical use. Despite the considerable time span over which extracorporeal shock wave therapy (ESWT) has been used for medical purposes, the technique is not yet optimized for clinical practice. It has been shown that responses to shock waves are dose dependent and tissue specific. This means that clinicians and physical therapists have to handle optimal dosage while deployment of appropriate tissue-specific energy levels is required to induce a positive outcome. In addition to the optimization of energy modalities, it is particularly the timing of the therapy onset within the postinjury period which may be a further major factor of influence on the success of ESWT that has been given less attention so far.

The importance of optimal treatment timing in the postinjury phase is highlighted by considering basic biological principles of tissue repair processes. It is well established that tissue regeneration occurs in 3 distinct phases, which partially overlap in time: inflammation (in case of bleeding proceeding interdependently with haemostasis), proliferation, and remodeling. Perturbations in any of these repair phases can develop into a chronic condition and failed repair, representing a prolonged, dysregulated, and maladaptive process that eventually leads to tissue destruction. In orthopedics, for a large part, it is precisely those chronic conditions that are currently treated with ESWT, typically applied at least 3 months after injury, and often only after years of unsuccessful conservative treatment and/or to avoid invasive, and in some cases repeated surgical intervention. Under such circumstances, the main objective of ESWT is to bring the chronic condition back into a more responsive acute state, thus escaping the vicious inflammatory cycle and triggering the self-repair mechanisms of the body. This inevitably raises the question of whether ESWT could also bring a benefit in acute trauma healing by supporting the regular process of regeneration. If so, ESWT could provide a beneficial noninvasive means of therapy for treatment of severe soft tissue and bone injuries, as it is often exactly those complex conditions that are at high risk to become chronic due to persistent inflammation and poor tissue perfusion, what makes their management challenging to practitioners. If ESWT, applied in the acute postinjury phase, would be able to accelerate tissue repair while accounting for nonhazardous inflammatory control, as already shown in various animal models, it would help reduce the risk of complications and may even prevent development of chronicity.