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SICOT e-Newsletter

Issue No. 70 - October 2014

Articles by SICOT Members

ESWT in Orthopaedic Surgery

Kandiah Raveendran
SICOT First Vice President - Ipoh, Malaysia

Extracorporeal Shock Wave Therapy (ESWT) was first used for the disintegration of renal and ureteric calculi. In 1988, the use of these acoustic waves was tried for the treatment of non-union in Germany. In the nineties, shockwave therapy was successfully used in the treatment of patients with tennis elbow and plantar fasciitis.

Today ESWT can be used to treat a wide variety of musculoskeletal conditions involving soft tissue and bone. The conditions most frequently treated with shockwave therapy are recalcitrant plantar fasciitis, rotator cuff tendinitis, tennis elbow, patellar tendinitis and Achilles tendinopathy. The success rate is about 80 percent.

The other big group is bony diseases including delayed and non-union and avascular necrosis of the femur. Currently, basic research and clinical studies are ongoing on the treatment of chronic skin ulcers, Peyronie's disease, erectile dysfunction, neurological disorders and ischaemic heart disease.

After many years of basic research on cellular mechanisms, we now have a better understanding of how ESWT promotes tissue healing. The mechanical pressure induces neovascularization and stimulates healing probably through 'stem' cells.

The ISMST (International Society for Medical Shockwave Treatment) has formulated recommendations for the use of shockwave therapy (

Many orthopaedic surgeons have not heard of shockwave or believe it to be akin to alternative medicine. It is not part of the curriculum. The FDA has approved the use of ESWT for the treatment of plantar fasciitis in 2000 and the treatment of tennis elbow in 2002. There are many peer-reviewed scientific papers on the basic sciences and clinical use of ESWT and there are regular certification courses.

SICOT, acknowledging the advent of this relatively new technology, has included shockwave sessions during the SICOT Triennial World Congress in Rio de Janeiro from 19 to 22 November 2014 so that orthopaedic surgeons and trainees from all over the world can avail themselves of this simple and effective therapy. The next ISMST Annual Congress will be held in Mendoza, Argentina, from 15 to 18 April 2015.