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New indications for RSWT

New indications for RSWT. Prof. Dr. Christoph Schmitz Full Professor and Head Department of Neuroanatomy, Ludwig-Maximilians University of Munich, Munich, Germany Adjunct Professor Department of Neuroscience, Mount Sinai School of Medicine,New York, NY, USA Medical Scientific Officer

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New indications for RSWT

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  1. New indications for RSWT Prof. Dr. Christoph Schmitz Full Professor and Head Department of Neuroanatomy, Ludwig-Maximilians University of Munich, Munich, Germany Adjunct Professor Department of Neuroscience, Mount Sinai School of Medicine,New York, NY, USA Medical Scientific Officer EMS Electro Medical Systems, Nyon, Switzerland

  2. Orthopaedic indications for RSWT®(1) Tennis elbow (Epicondilitis humeri radialis) Subacromial pain syndrome Golfer‘s elbow (epicondylitis humeri ulnaris) Greater trochanteric pain syndrome Medial tibial stress syndrome Patellar tip syndrome Achilles tendinopathy Plantar fasciopathy

  3. Orthopaedic indications for RSWT®(2) Common extensor tendon Supraspinatus tendon Achilles tendon Plantar fascia Patella tendon

  4. RSWT®: RCTs with positive outcome • Chronic plantar fasciopathy: • Gerdesmeyer et al., Am J Sports Med 2008; 36: 2100-2109 • Chow and Cheing, Clin Rehab 2007;21: 131-141 • Greve et al., Clinics 2009; 64: 97-103 • Midportion Achilles tendinopathy: • Rompe et al., Am J Sports Med 2007;35:374-381 • Rompe et al., Am J Sports Med 2009;37:463-470 • Insertion Achilles tendinopathy: • Rompe et al., Am J Bone Joint Surg 2008;90:52-61 • Medial tibial stress syndrome: • Rompe et al., Am J Sports Med 2009 [Epub Sep 23] • Greater trochanteric pain syndrome: • Furia et al., Am J Sports Med 2009;37:1806-1813 • Rompe et al., Am J Sports Med 2009;37:1981-1990 • Subacromial pain syndrome: • Engebretsen et al., Brit Med J 2009:339:b3360

  5. RSWT® for chronic plantar fasciopathy (1) n=251 (129 vs. 122)

  6. RSWT® for chronic plantar fasciopathy (2) n=251 (129 vs. 122)

  7. RSWT® for chronic insertional Achilles tendinopathy n=50 (25 vs. 25) EL: 3 x 15 repetitions x 2/d x 7d/w x 12w = 7,560 repetitions

  8. RSWT® for chronic midportion Achilles tendinopathy (1) n=75 (25 vs. 25 vs. 25) EL: 3 x 15 repetitions x 2/d x 7d/w x 12w = 7,560 repetitions

  9. RSWT® for chronic midportion Achilles tendinopathy (2) n=68 (34 vs. 34) EL: 3 x 15 repetitions x 2/d x 7d/w x 12w = 7,560 repetitions

  10. Approved Indications • Calcifying tendonitis of the shoulder / subacromial pain syndrome • Tennis elbow (Epicondylitis humeri radialis) • Greater trochanteric pain syndrome • Patella tip syndrome • Osgood-Schlatter disease* • Medial tibial stress syndrome • Insertional Achilles tendinopathy • Midportion Achilles tendinopathy • Plantar fasciopathy • Myofascial pain syndrome / trigger point treatment • Idiopathic lower back pain / pseudoradicular syndrome • Peyronie‘s disease (Induratio penis plastica)* • Acute and chronic soft tissue wounds (including diabetic foot ulcera)* • Primary and secundary lymphedema* • Cellulite* • *Approval for the Swiss Dolorclast Smart (SD Classic and Master will get approval soon)

  11. Calcifying tendonitis of the shoulder

  12. Calcifying tendonitis of the shoulder (1) (the same recommendations apply for the subacromial pain syndrome) Palpation of the painful region

  13. Calcifying tendonitis of the shoulder (4) (the same recommendations apply for the subacromial pain syndrome) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 2 - 4 bar • Literature: Magosch et al., 2003 Z Orthop 141:629-633 (in PubMed)

  14. Calcifying tendonitis of the shoulder (5) (the same recommendations apply for the subacromial pain syndrome) • Treatment with the Power+ handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 1.5 - 3 bar • Literature: Magosch et al., 2003 Z Orthop 141:629-633 (in PubMed)

  15. Tennis elbow (Epicondylitis humeri radialis)

  16. Tennis elbow (Epicondylitis humeri radialis) (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 1.5 - 3 bar • Literature: Söller, 2003 In: Maier M, Gillesberger F: Abstracts 2003 zur Muskuloskelettalen Stosswellentherapie. Kongressband des 3. Dreiländertreffens der Österreichischen, Schweizer und Deutschen Fachgesellschaften. Books on Demand, Norderstedt, 2003, pp 121-122.

  17. Greater trochanteric pain syndrome

  18. Greater trochanteric pain syndrome (1) Palpation of the painful region

  19. Greater trochanteric pain syndrome (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 3 - 4 bar • Literature: Furia et al., 2009 Am J Sports Med 37:1806-1813; Rompe et al., 2009 Am J Sports Med 2009;37:1981-1990 (both in PubMed)

  20. Patella tip syndrome

  21. Patella tip syndrome (1) Palpation of the painful region

  22. Patella tip syndrome (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 2 - 3 bar • Literature: Lohrer et al., 2002 Sportverl Sportschad 16:108-114 (in PubMed)

  23. Osgood-Schlatter disease

  24. Osgood-Schlatter disease (1) Palpation of the painful region

  25. Osgood-Schlatter disease (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000-3,000 • Frequency: 5 - 10 Hz • Air pressure: 2 - 3 bar • Literature: Titov and Litvinenko (2007) Abstracts 10th International Congress of the International Society for Musculoskeletal Shockwave Therapy, Toronto, Canada, 2007, pp. 46-47.

  26. Medial tibial stress syndrome

  27. Medial tibial stress syndrome (1) Palpation of the painful region

  28. Medial tibial stress syndrome (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 2.5 - 3 bar • Literature: Rompe et al., 2010 Am J Sports Med 38:125-132 (in PubMed)

  29. Insertional Achilles tendinopathy

  30. Insertional Achilles tendinopathy (1) Palpation of the painful region

  31. Insertional Achilles tendinopathy (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 2.5 - 3 bar • Literature: Rompe et al., 2008 J Bone Joint Surg Am 90:52-61 (in PubMed)

  32. Midportion Achilles tendinopathy

  33. Midportion Achilles tendinopathy (1) Palpation of the painful region

  34. Midportion Achilles tendinopathy (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 2 - 3 bar • Literature: Rompe et al., 2007 Am J Sports Med 35:374-383; Rompe et al., 2009 Am J Sports Med 37:463-470 (both in PubMed)

  35. Plantar fasciopathy

  36. Plantar fasciopathy(1) Palpation of the painful region

  37. Plantar fasciopathy (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 2.5 - 4 bar • Literature: Gerdesmeyer et al., 2008 Am J Sports Med 36:2100-2109; Ibrahim et al., 2010 Foot & Ankle Int 31:391-397 (both in PubMed)

  38. Plantar fasciopathy (5) • Treatment with the Power+ handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 5 - 10 Hz • Air pressure: 2 - 3 bar • Literature: Gerdesmeyer et al., 2008 Am J Sports Med 36:2100-2109; Ibrahim et al., 2010 Foot & Ankle Int 31:391-397 (both in PubMed)

  39. Myofascial pain syndrome / trigger point treatment

  40. Myofascial pain syndrome / trigger point treatment (1) (treatment of the piriformis muscle shown as example) Palpation of the painful region

  41. Myofascial pain syndrome / trigger point treatment (4) (treatment of the piriformis muscle shown as example) • Treatment with the Power+ handpiece • Applicator: 15 mm Trigger • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 300 – 1,000 per trigger point • Frequency: 8 - 20 Hz • Air pressure: 2.5 - 4 bar • Literature: Bauermeister, 2003 In: Maier M, Gillesberger F: Abstracts 2003 zur Muskuloskelettalen Stosswellentherapie. Kongressband des 3. Dreiländertreffens der Österreichischen, Schweizer und Deutschen Fachgesellschaften. Books on Demand, Norderstedt, 2003, pp 24-28.

  42. Idiopathic lower back pain / pseudoradicular syndrome

  43. Idiopathic lower back pain / pseudoradicular syndrome (1) Palpation of the painful region

  44. Idiopathic lower back pain / pseudoradicular syndrome (4) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (at weekly intervals) • Number of impulses per treatment: 2,000 • Frequency: 8 - 20 Hz • Air pressure: 2 - 3 bar • Literature: Bauermeister, 2003 In: Maier M, Gillesberger F: Abstracts 2003 zur Muskuloskelettalen Stosswellentherapie. Kongressband des 3. Dreiländertreffens der Österreichischen, Schweizer und Deutschen Fachgesellschaften. Books on Demand, Norderstedt, 2003, pp 29-34.

  45. Peyronie‘s disease (Induratio penis plastica)

  46. Peyronie‘s disease (Induratio penis plastica) • Treatment with the Radial handpiece • Applicator: 15 mm • Number of treatments: 3 (in weekly intervals) • Number of impulses: 2,000 • Frequency: 10 - 15 Hz • Air pressure: 2 - 3 bar • Literature: Haupt et al., 2001Abstracts 19th World Congress on Endourology and SWL, Bangkok, Thailand, 2001.

  47. Acute and chronic soft tissue wounds

  48. Acute and chronic soft tissue wounds (1) (treatment of diabetic foot ulcer shown as example) Perform standard wound cleaning and debridement

  49. Acute and chronic soft tissue wounds (2) (treatment of diabetic foot ulcer shown as example) Place a sterile plastic film on the wound and the surrounding tissue (the plastic film should overlap the wound edges by at least 5 cm)

  50. Acute and chronic soft tissue wounds (3) (treatment of diabetic foot ulcer shown as example) Apply sterile coupling gel to the film

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