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ESWT History

Shockwaves were first


identified during World
War II. Submarine
crews exposed to
detonation of Hydrogen
bombs incurred
shockwave induced
injury to lungs.

1940

On February 7th 1980 the first


successful, non-invasiv
kidneystone treatment with
shockwaves. Extracorporal
Shockwave Therapy (Lithotripsy)
becomes Urologists treatment of
choice for Urolithiasis. To date > 30
Mio. lithotripsy procedures have
been performed.

1966
By accident,
Dornier Systems
develop the basic
physical
understanding for the
interaction of
shockwaves with
tissue, materials.

1980

1989

Continued
Application of
ESWT in
Orthopedics
including frozen
shoulder, tennis
elbow, heel spur,
bursitis, jumpers
knee and
achillodynia

1992

Observation of increased
bone density following
lithotripsy treatment leads to
investigation of possible
orthopedic applications.
1989 the first treatments of
non-healing fractures
(pseudarthrosis).

ESWT treatment of
mycardial Infarction
during open heart
surgery

December 2007

2004

2007

Application of ESWT
in Dermatology
including non-healing
wounds, diabetic foot
ulcers, decubital ulcers
and burns.

ESWT Introduction
Acoustic waves are pressure and density fluctuations and
thus are also termed pressure waves ;
Shockwaves are pressure waves with a specific and
characteristic pressure profile :
very short rise times (in the nanosecond range)
high amplitudes ( up to 100 MPa )
short pulse duration ( < 1 microsecond )

Electrohydraulic shockwaves are generated by an


electrical discharge in water.
(other means of shockwave generation include
piezoelectric and electromagnetic principles)

The reflector geometry enables generation of either


highly focused shock waves (Urolithiasis or
Pseudarthrosis) or soft focused shock waves (for most
soft tissue applications)

Biologic Effects of ESWT


Change of cell membrane permeability
Release of neurotransmitters
Antibacterial effects
Release of NO (nitrogen oxyde)
Release of growth factors (VEGF, eNOS, BMP-2, PCNA)
Induction of vessel growth
Stem cell migration and differentiation

Regeneration of vessels,
skin, bone and nerve tissue.
In addition to orthopedic
applications since 1992,
ESWT is nowadays used in
Dermatology.

ESWT Clinical Results


Chronic Infectious Skin Ulcer
Female patient
Age 94
Chronic skin lesion with
staph. aureus infection
Chronic leukemia
Chronic obstructive
pulmonary disease
( COPD )
Cortisone therapy

3 treatments with
Soft Focus ESWT
without anesthesia

Pre-treatment

After 2 weeks

After 4 weeks

After 7 weeks

ESWT Clinical Results


Chronic Ulcer
Male patient
Age 57
>1 year conservative
unsuccessful treatment

3 treatments with soft


focus ESWT without
anesthesia

Pre-treatment

After 2 weeks

After 4 weeks

After 6 weeks

ESWT Clinical Results


Chronic Ulcer
Male patient
Age 47
Trauma caused by
boating accident
Primary treatment with
ESWT

3 treatments with soft


focus ESWT without
anesthesia

Pre treatment

After 2 weeks

After 5 weeks

After 11 weeks

ESWT Clinical Results


Decubital Ulcer
Male patient
Age 20
Paraplegic due to bullet
wound incurred 2 years
earlier
Decubital ulcer since 5
months

5 treatments with soft


focus ESWT without
anesthesia

Pre treatment

After 1 week

After 3 weeks

After 5 weeks

ESWT Clinical Results


Chronic infected ulcer

After 6 weeks

Pre treatment

Decubital ulcer

After 6 months

Pre-treatment

Burn wounds

After 6 months

Pre-treatment

Non-healing wound post fracture

After 6 months

Pre-treatment

Pseudarthrosis
Male patient
Age 59
Talus fracture

Pre-treatment
After 3 months
After 5 months
After 1 year

Pseudarthrosis
Female Patient
Age 36
Sub-total
amputation
Replantation
K-Wire
Spongio-plasty
Plating
Ext. Fixator
After 4 years
ESWT application

After 6 months
Pre treatment

After 3
months

Pseudarthrosis
After 6 months

Pre treatment

Pseudarthrosis
Female patient
Age 59
Injury due to a fall
Diabetic

Pre treatment

After 3
months

After 6
months

Pseudarthrosis
Male Patient
Age 46
Motorcycle accident
Tibia fracture
External fixator
After 8 weeks removal of
fixator and cast
After 9 months ESWT
application

After 2
months

After 4
months

Pseudarthrosis
Male Patient
Age 46
Motorcycle accident
Tibia fracture
External fixator
After 8 weeks removal
and cast
After 9 months ESWT
application

CT pre treatment

CT 4 months post ESWT

Study Results
Orthopedics
Achilles tendon
Bursitis
Fasciitis plantaris
Tendinosis calcarea
Non-union (Pseudarthroses)
PPS (Patella tip syndrom)
Epicondylopathia humeri radialis
Epicondylopathia humeri ulnaris
Over a period of 2 years, 409 patients were treated for a
variety of sports related injuries at the sports medicine
clinic in Hellersen.

74% patients
reported positive to very
positive therapeutic results

Study Results
Dermatology

Clinical studies conducted by


Dr. Wolfgang Schaden, Vienna and Dr. Richard Thiele, Berlin
Total 200 patients

74,5% of the wounds


healed completely within
2-12 weeks.

ESWT Indications

Orthopedics

Achilles tendon
Bursitis
Fasciitis Plantaris
Tendinosis calcarea
Pseudarthrosis
PPS
Epicondylopathia humeri radialis
Epicondylopathia humeri ulnaris

Dermatology

Non-healing wounds
Post-traumatic lesions
Ulcers
Decubitus
Burns

ESWT forecast
Da Vinci projects

Dermatology
Orthopedics
Odontology
Neurology
Cardiology

ESWT forecast
Dermatology
Combat Wound Initiative 2007
Dermatology
Orthopedics
Odontology
Neurology
Cardiology

Walter Reed Army Medical Center


Extensive survey on ESWT
3-yearsstudy with wounded soldiers from Afghanistan and Iraque
Cooperation with the Army Research Center
Aim : Improve wound healing quality
Comparison Standard of Care vs. Standard of Care + ESWT
Budget: 10 Mio. USD
Data: 40.000 data elements per patient

ESWT forecast
Dermatology
Cellulite
Dermatology

Currently numerous studies running regarding


the effectivness of the ESWT in cellulite care

Orthopedics
Odontology
Neurology
Cardiology

Adipocellular / Lipolysis
First, very positive results out of running studies
in Korea and Italy

Burns
First, very positive results out of a running study
at the Verbrennungszentrum in Berlin

ESWT forecast
Orthopedics

Dermatology
Orthopedics
Odontology
Neurology
Cardiology

Arthrosis
In a study in Berlin a patients knee was
treated with ESWT
The knee was re-arthroscoped after 1 year.
The cartilage was almost totally recovered.

ESWT forecast
Dentistry

Dermatology
Orthopedics

Bacterial Parodontitis

Odontology
Neurology
Cardiology

At the University of Kentucky rats were


infected during 12 weeks with the bacteria
Porphyromonas gingivalis.
After 12 weeks the animals were sacrificed,
skeletonized, measured on bone reduction
and compared with the control group. The
bones of the ESWT-treated animals were
almost totally reproduced.

ESWT forecast
Neurology

Nerve transplantation
Dermatology
Orthopedics
Odontology
Neurology

At the Ludwig-Boltzmann-Institut in Vienna rats were treated. The sciata nerve was
cut, turned by 180 and reimplanted. After ESWT clear advantages of the treated
animals in comparison with the control group were measured (Step-test, Catwalk,
Plain-test).

Cardiology

Peripheral nerve
system

Spinal cord

ESWT Work in Progress

Brain

ESWT forecast
Cardiology
Heart surgery
Dermatology
Orthopedics
Odontology
Neurology
Cardiology

At the Allgemeinen Krankenhaus Vienna an artificial infarction of the heart was


induced with rats and pigs by blocking the coronary vessel.
All ESWT treated animals showed significant growth of new blood vessels in the
infarct area. The remarkable results were shown officially at the ISMST-Congres
in Toronto June 2007.
First human treatment (open heart surgery) in December 2007.

ESWT forecast
furthermore

Plants
Dermatology
Orthopedics
Dentistry
Neurology

Soja bean sprouts were treated


with ESWT. A clearly faster
growth of the treated plants
was registered in comparison
to the control group.

Cardiology
furthermore

In Krnten currently wounds on


trees are treated with ESWT,
results in late summer 2007

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