Shockwave Therapy

Question 1

Extracorporeal shockwave therapy is an ______ _____ wave applied externally to the body, leading to _____ transmission within and absorption by the body tissues for the purpose of promoting tissue healing

Answer 1

acoustic pressure; energy

Question 2

2 types of shockwave therapy?

Answer 2

1. radial

2. focussed

Question 3

In a tendon, up to ___ mJ/mm^2 is considered safe

Answer 3

0.28

Question 4

There is major gross cortical bone changes at ___mJ/mm^2

Answer 4

0.6

Question 5

Both focussed and radial shockwaves are sued in the management of soft tissue disorders (T/F).

Answer 5

TRUE

Question 6

Where is the point of max energy flux density in focussed shock waves?

Answer 6

at target within pathological tissue

Question 7

Where is the point of max energy flux density in radial shock waves?

Answer 7

at shock wave source

Question 8

Focussed shock waves = a ____ pulse with a wide frequency range (from approx __kHz to ___ MHz)

Answer 8

single; 150; 100

Question 9

Focussed shock waves = high pressure _______ (up to ___MPa)

Answer 9

amplitude; 150

Question 10

Focussed shock waves = low ____ wave (up to -___MPa)

Answer 10

tensile; 25

Question 11

Focussed shock waves = small pulse ____ and a short ____ time of up to a few hundred nanoseconds

Answer 11

width; rise

Question 12

Radial shockwaves = ordinary _____ waves with pressures of up to ___MPa

Answer 12

sound; 30

Question 13

Radial shockwaves have a much higher rise time of about __ micro seconds

Answer 13

3

Question 14

High energy shockwaves = ?

Answer 14

around 0.6 mJ/mm^2

Question 15

When would you use high energy shock waves?

Answer 15

physician delivers!!! Requires anesthesia; would use for disorders of bone and soft tissue calcification

Question 16

Low - medium energy shock waves?

Answer 16

0.04 - 0.28 mJ/mm^2

Question 17

When would you use low-medium energy shockwave?

Answer 17

PT delivers, no anaesthesia required; varies soft tissue disorders

Question 18

3 production methods of focussed shock waves?

Answer 18

1. electrohydraulic
2. electromagnetic
3. piezoelectric

Question 19

2 production methods of radial shock waves?

Answer 19

1. pneumatic

2. ballistic

Question 20

Do PT’s deliver focussed shockwaves, radial shockwaves or both?

Answer 20

RADIAL !

Question 21

fESWT has been shown to have a favourable treatment outcome for orthopaedic disorders (T/F).

Answer 21

FALSE - no observed diff between rESWT and fESWT

Question 22

What are the 4 phases of physiological effects of shockwaves in tissues?

Answer 22

1. direct effect
2. physical-chemical phase
3. chemical phase
4. biological phase

Question 23

Direct effect = _____ effect

Answer 23

mechanical

Question 24

_______-______ phase - a change in membrane permeability in response to cavitation, leading to movement of ions across the membrane

Answer 24

physical-chemical

Question 25

________ phase = intracellular reaction and molecular changes

Answer 25

chemical

Question 26

______ phase = leading to physiological changes

Answer 26

biological

Question 27

_______ effects = shockwaves at sufficient intensity (eg 0.6mJ/mm^2) will disrupt calcifications within tendons, used to treat non-union of long bone #’s; requires analgesia or anaesthesia; delivered by physicians

Answer 27

direct (mechanical)

Question 28

_____ wave from the rapid rise time of the initial phase of the shockwave is formed

Answer 28

pressure

Question 29

Rapid ______ pressure phase (______ phase) causes tissue cavitation

Answer 29

negative; tensile

Question 30

Tissue cavitation from shock wave forms what int he tissues? Does this happen in both focussed and radial shockwave?

Answer 30

tiny gas bubbles; yes

Question 31

Gas bubbles ______ at end of tensile phase, causing _____ forces, potentially leading to controlled damage within tissues

Answer 31

collapse; shear

Question 32

Cellular damage results in release of ____ ______ which stimulate an inflammatory response, which may lead to tissue healing

Answer 32

free radicals

Question 33

Shockwaves cause mechanical deformation of cells –> ________ –> cell ______ –> tissue regeneration and tendon remodelling

Answer 33

mechanotransduction ; signalling

Question 34

3 most important physical parameters determining cellular effects?

Answer 34

1. pressure distribution
2. energy density
3. total acoustic energy

Question 35

3 observed cellular effects from shockwave?

Answer 35

1. increased local blood flow
2. induce reversible conformational and possibly orientation changes in collagen
3. angiogenic response

Question 36

3 main categories for indications for shockwave therapy ?

Answer 36

1. chronic tendinopathies
2. bone pathologies
3. skin pathologies

Question 37

6 CI’s to shockwave ?

Answer 37

1. over or near bone grown center until bone growth is complete (epiphysis)
2. malignancy
3. infection in area to be treated
4. over ischemic tissues in individuals with vascular disease
5. coagulation disorder or taking anti-coagulant meds
6. prosthetic device in area to be treated

Question 38

____ tissue is highly susceptible to disruption by ESWT

Answer 38

lung

Question 39

There are serious adverse effects on ____ from ESWT in vitro

Answer 39

embryos

Question 40

Most common side effects of ESWT?

Answer 40

1. pain during

2. transient red skin

Question 41

Studies have shown that both low and high dose ESWT are safe treatments for PF, which can be extrapolated to other tissues (T/F).

Answer 41

TRUE

Question 42

4 ways by which any electro physical modality may cause unanticipated harm?

Answer 42

1. application in the presence of a CI
2. inappropriate dose for condition/ pt at time
3. inappropriate body area / tissue
4. faulty equipment

Question 43

4 things you need to decide when applying ESWT?

Answer 43

1. applied energy (in mJ/mm^2)
2. number of shocks
3. number of treatment sessions
4. if using fESWT will need to choose spacer to focus at required depth

Question 44

Low energy ESWT = up to __ mJ/mm^2

Answer 44

0.08

Question 45

Medium energy ESWT = up to __ mJ/mm^2

Answer 45

0.28

Question 46

Shock number in ESWT?

Answer 46

usually 1000-1500

Question 47

Number of treatments for ESWT? Time between treatments?

Answer 47

generally bw 3-5; 5-10 to allow tissue healing

Question 48

4 conditions where ESWT has strongest evidence?

Answer 48

1. PF
2. lateral epicondylitis
3. achilles tendinopathy
4. patellar tendinopathy