Shockwave Therapy Flashcards
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
acoustic pressure; energy
2 types of shockwave therapy?
- radial
2. focussed
In a tendon, up to ___ mJ/mm^2 is considered safe
0.28
There is major gross cortical bone changes at ___mJ/mm^2
0.6
Both focussed and radial shockwaves are sued in the management of soft tissue disorders (T/F).
TRUE
Where is the point of max energy flux density in focussed shock waves?
at target within pathological tissue
Where is the point of max energy flux density in radial shock waves?
at shock wave source
Focussed shock waves = a ____ pulse with a wide frequency range (from approx __kHz to ___ MHz)
single; 150; 100
Focussed shock waves = high pressure _______ (up to ___MPa)
amplitude; 150
Focussed shock waves = low ____ wave (up to -___MPa)
tensile; 25
Focussed shock waves = small pulse ____ and a short ____ time of up to a few hundred nanoseconds
width; rise
Radial shockwaves = ordinary _____ waves with pressures of up to ___MPa
sound; 30
Radial shockwaves have a much higher rise time of about __ micro seconds
3
High energy shockwaves = ?
around 0.6 mJ/mm^2
When would you use high energy shock waves?
physician delivers!!! Requires anesthesia; would use for disorders of bone and soft tissue calcification
Low - medium energy shock waves?
0.04 - 0.28 mJ/mm^2
When would you use low-medium energy shockwave?
PT delivers, no anaesthesia required; varies soft tissue disorders
3 production methods of focussed shock waves?
- electrohydraulic
- electromagnetic
- piezoelectric
2 production methods of radial shock waves?
- pneumatic
2. ballistic
Do PT’s deliver focussed shockwaves, radial shockwaves or both?
RADIAL !
fESWT has been shown to have a favourable treatment outcome for orthopaedic disorders (T/F).
FALSE - no observed diff between rESWT and fESWT
What are the 4 phases of physiological effects of shockwaves in tissues?
- direct effect
- physical-chemical phase
- chemical phase
- biological phase
Direct effect = _____ effect
mechanical
_______-______ phase - a change in membrane permeability in response to cavitation, leading to movement of ions across the membrane
physical-chemical
________ phase = intracellular reaction and molecular changes
chemical
______ phase = leading to physiological changes
biological
_______ 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
direct (mechanical)
_____ wave from the rapid rise time of the initial phase of the shockwave is formed
pressure
Rapid ______ pressure phase (______ phase) causes tissue cavitation
negative; tensile
Tissue cavitation from shock wave forms what int he tissues? Does this happen in both focussed and radial shockwave?
tiny gas bubbles; yes
Gas bubbles ______ at end of tensile phase, causing _____ forces, potentially leading to controlled damage within tissues
collapse; shear
Cellular damage results in release of ____ ______ which stimulate an inflammatory response, which may lead to tissue healing
free radicals
Shockwaves cause mechanical deformation of cells –> ________ –> cell ______ –> tissue regeneration and tendon remodelling
mechanotransduction ; signalling
3 most important physical parameters determining cellular effects?
- pressure distribution
- energy density
- total acoustic energy
3 observed cellular effects from shockwave?
- increased local blood flow
- induce reversible conformational and possibly orientation changes in collagen
- angiogenic response
3 main categories for indications for shockwave therapy ?
- chronic tendinopathies
- bone pathologies
- skin pathologies
6 CI’s to shockwave ?
- over or near bone grown center until bone growth is complete (epiphysis)
- malignancy
- infection in area to be treated
- over ischemic tissues in individuals with vascular disease
- coagulation disorder or taking anti-coagulant meds
- prosthetic device in area to be treated
____ tissue is highly susceptible to disruption by ESWT
lung
There are serious adverse effects on ____ from ESWT in vitro
embryos
Most common side effects of ESWT?
- pain during
2. transient red skin
Studies have shown that both low and high dose ESWT are safe treatments for PF, which can be extrapolated to other tissues (T/F).
TRUE
4 ways by which any electro physical modality may cause unanticipated harm?
- application in the presence of a CI
- inappropriate dose for condition/ pt at time
- inappropriate body area / tissue
- faulty equipment
4 things you need to decide when applying ESWT?
- applied energy (in mJ/mm^2)
- number of shocks
- number of treatment sessions
- if using fESWT will need to choose spacer to focus at required depth
Low energy ESWT = up to __ mJ/mm^2
0.08
Medium energy ESWT = up to __ mJ/mm^2
0.28
Shock number in ESWT?
usually 1000-1500
Number of treatments for ESWT? Time between treatments?
generally bw 3-5; 5-10 to allow tissue healing
4 conditions where ESWT has strongest evidence?
- PF
- lateral epicondylitis
- achilles tendinopathy
- patellar tendinopathy
