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Iuamoto LR, Hsing WT. Penetration Depth and Tissue Interaction of Focused Extracorporeal Shock Waves: An In-vitro Investigation. Cureus 2025; 17:e80205. [PMID: 40196067 PMCID: PMC11973608 DOI: 10.7759/cureus.80205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2025] [Indexed: 04/09/2025] Open
Abstract
INTRODUCTION Extracorporeal shock wave therapy (ESWT) is a non-invasive therapeutic approach with minimal consequences, extensively utilized for the management of musculoskeletal problems. Focused ESWT (f-ESWT) is known to have regenerative effects on muscle and bone tissues; however, little is known about its penetration and propagation in different tissues. OBJECTIVE To assess the reach of f-ESWT in soft tissues and bone tissues. METHODS An in-vitro observational study was conducted. A piezoelectric shock wave device was used to evaluate the penetration and visual propagation of shock waves in an aquarium with water in muscle tissues (ham) of different thicknesses, and bone tissues (scapula and femur). High-resolution images and videos were captured to observe the penetration of mechanical waves into the different tissues. RESULTS Light beams and air bubbles were observed, consistent with the propagation of f-ESWT through different tissues. The f-ESWT was able to penetrate wide bones such as the femur and thin bones such as the scapula. CONCLUSION F-ESWT is capable of penetrating soft tissues and bone tissues depending on the depth. This is an important study for the safe application of f-ESWT by a healthcare professional with prior anatomical knowledge.
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Affiliation(s)
- Leandro R Iuamoto
- Acupuncture Center, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BRA
| | - Wu T Hsing
- Acupuncture Center, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BRA
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Jorgensen JE, Larsen P, Elsoe R, Mølgaard CM. Callus formation and bone remodeling in a tibial nonunion after minimal invasive percutaneous screw fixation followed by extracorporeal shockwave therapy 17-months after initial trauma - A case report. Physiother Theory Pract 2024; 40:395-407. [PMID: 35969158 DOI: 10.1080/09593985.2022.2112117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The treatment of tibial nonunion is challenging and treatment may be conservative or surgical. Conservative strategies include functional braces and weight bearing, or focused extracorporeal shockwave therapy (fESWT). CASE DESCRIPTION A 45-year-old male patient sustained spiral tibial shaft fractures and was treated surgically within 24 hours after the initial accident with intramedullary nails. The tibial fracture was later classified as nonunion after 11 months. Radiologic evaluation 17 months after the initial trauma demonstrated clinical nonunion, and subsequently the patient was offered a conservative approach with fESWT to facilitate an increase in callus formation. The handpiece was fitted with a stand-off II (long), penetration depth of 15 mm. Three cycles were administered in month 17, 19 and 20 after baseline. Each cycle consisted of three treatments sessions spaced with 6-8 days apart, and consisted of 3000 to 4000 impulses each given at 0.25-0.84 mJ/mm2. The number of impulses and the power at the focus point varied according to the pain response. OUTCOMES The patient achieved union 23 months after fracture. A clinical important improvement was observed with both Lower Extremity Functional Scale (LEFS) (18-point difference) and Patient Specific Functional Scale (PSFS) (average: 4.7 points,) The "worst pain last 24 hours" was reduced by 5 points. These values express minimal clinically important difference (MCID) values in these functional patient-reported outcome measures. CONCLUSION This treatment strategy may be viable in a broader setting, including private practice physiotherapy thereby treating the patient in close proximity to the patient's everyday life.
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Affiliation(s)
| | - Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Carsten M Mølgaard
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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3
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Ramon S, Lucenteforte G, Alentorn-Geli E, Steinbacher G, Unzurrunzaga R, Álvarez-Díaz P, Barastegui D, Grossi S, Sala E, Martinez-De la Torre A, Mangano GRA, Cuscó X, Rius M, Ferré-Aniorte A, Cugat R. Shockwave Treatment vs Surgery for Proximal Fifth Metatarsal Stress Fractures in Soccer Players: A Pilot Study. Foot Ankle Int 2023; 44:1256-1265. [PMID: 37905784 DOI: 10.1177/10711007231199094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND To compare the clinical, radiologic, and functional outcomes between shockwave and operative treatments for proximal fifth metatarsal stress fractures in soccer players in a pilot study. METHODS Between 2017 and 2019, 18 soccer players with fifth metatarsal stress fractures attended at Mutualidad de Futbolistas Españoles-Delegación Catalana were included. Patients were randomly assigned into 2 groups receiving either surgery with an intramedullary screw (group 1) or high-energy focused extracorporeal shockwave treatment (group 2 performed once a week for 3 weeks using 2000 impulses at an energy flux density of 0.21 mJ/mm2 and 4 Hz frequency). Clinical (pain), radiologic (bone healing), and functional (Tegner Activity Scale and American Orthopaedic Foot & Ankle Society [AOFAS] ankle-hindfoot scales) outcomes before and after receiving the treatment were compared between both groups. In addition, ability and time to return to play was also compared between groups. RESULTS No patients were lost to follow-up. There were no statistically significant differences at last follow-up between surgery and extracorporeal shockwave treatment for bone healing, pain relief, AOFAS ankle-hindfoot score, Tegner score, and time return to play. No complications were reported in either of the 2 groups. CONCLUSION In this pilot study, extracorporeal shockwave treatment and operative treatment were found to be equally effective at reducing pain, achieving bone healing, and allowing the soccer players to return to play after proximal fifth metatarsal stress fractures. This study suggests that ESWT may be a good option for the management of proximal fifth metatarsal stress fractures in soccer players. If this approach proves successful in larger trials, the shockwave approach might help avoid known complications of the surgical treatment like wound problems, nerve injury, and hardware intolerance. Further investigations with larger sample size should be conducted in order to confirm the present conclusions. LEVEL OF EVIDENCE Level II, therapeutic, pilot randomized controlled trial.
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Affiliation(s)
- Silvia Ramon
- Department of Physical Medicine and Rehabilitation, Hospital Quirónsalud Barcelona, Spain
- Fundación García-Cugat, Barcelona, Spain
| | - Giacomo Lucenteforte
- Policlinico Vittorio Emanuele, Università degli Studi di Catania, Catania, Italy
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, Education & Research Department, Bologna, Italy
| | - Eduard Alentorn-Geli
- Fundación García-Cugat, Barcelona, Spain
- Mutualidad de Futbolistas Españoles-Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain
- Instituto Cugat, Hospital Quirónsalud Barcelona, Barcelona, Spain
| | - Gilbert Steinbacher
- Fundación García-Cugat, Barcelona, Spain
- Mutualidad de Futbolistas Españoles-Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain
| | - Rocío Unzurrunzaga
- Department of Physical Medicine and Rehabilitation, Hospital Quirónsalud Barcelona, Spain
- Fundación García-Cugat, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, MC Mutual, Barcelona, Spain
| | - Pedro Álvarez-Díaz
- Fundación García-Cugat, Barcelona, Spain
- Mutualidad de Futbolistas Españoles-Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain
- Instituto Cugat, Hospital Quirónsalud Barcelona, Barcelona, Spain
| | - David Barastegui
- Fundación García-Cugat, Barcelona, Spain
- Mutualidad de Futbolistas Españoles-Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain
- Instituto Cugat, Hospital Quirónsalud Barcelona, Barcelona, Spain
| | - Sebastián Grossi
- Fundación García-Cugat, Barcelona, Spain
- Mutualidad de Futbolistas Españoles-Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain
| | - Esther Sala
- Fundación García-Cugat, Barcelona, Spain
- Mutualidad de Futbolistas Españoles-Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain
- Escola Universitària Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Barcelona, Spain
| | - Adrián Martinez-De la Torre
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | | | - Xavier Cuscó
- Fundación García-Cugat, Barcelona, Spain
- Instituto Cugat, Hospital Quirónsalud Barcelona, Barcelona, Spain
| | - Marta Rius
- Fundación García-Cugat, Barcelona, Spain
- Mutualidad de Futbolistas Españoles-Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain
| | - Alfred Ferré-Aniorte
- Fundación García-Cugat, Barcelona, Spain
- Instituto Cugat, Hospital Quirónsalud Barcelona, Barcelona, Spain
| | - Ramón Cugat
- Fundación García-Cugat, Barcelona, Spain
- Mutualidad de Futbolistas Españoles-Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain
- Instituto Cugat, Hospital Quirónsalud Barcelona, Barcelona, Spain
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Gao C, Feng LL, Zheng JH, Cao J, Sun HJ. Case report: A rare Salter-Harris V metaphyseal fatigue fracture of the knee in an adolescent patient with obesity. Front Pediatr 2023; 11:1209369. [PMID: 37425269 PMCID: PMC10323821 DOI: 10.3389/fped.2023.1209369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
Stress fractures are rare, occurring in 1.5/100,000 high school athletes. High impact, repetitive loading participation in woman's sports, and being a white athlete have been identified as risk factors for stress fractures. Mostly treated conservatively, they are more common in the tibia (33%). Stress fractures requiring surgery, which are extremely rare, have been reported in the scaphoid, fifth metatarsal, and neck of femur. Herein, a 16-year-old adolescent patient with obesity presented with atypical knee pain after prolonged exercise. Advanced imaging revealed a stress fracture of the left tibia with a Salter-Harris type V fracture and varus deformity of the knee. We initially managed the fatigue fracture conservatively, followed by surgical correction of the varus deformity in the knee joint. The patient made a satisfactory recovery with equal limb length and no evidence of claudication. This is the first case of a proximal tibial metaphyseal stress fracture requiring surgery. The clinical manifestations of proximal tibial metaphyseal stress fractures and potential treatment strategies and the use of magnetic resonance for tibial stress fractures have been discussed. Understanding the location of unusual stress fractures can improve early diagnostic efficiency and reduce complication rates, healthcare costs, and recovery time.
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Affiliation(s)
- Chao Gao
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Ling Le Feng
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Jiang Hua Zheng
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Jin Cao
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Hua Jing Sun
- Department of Clinical Laboratory, Wu Xiang Health Center, Ningbo University Affiliated People's Hospital, Ningbo, China
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Abstract
Stress fractures are a common injury that present in athletes because of the high intensity and repetitive nature of many sports. These injuries require a high index of suspicion in the treating clinician to allow for timely management. Though most low-risk fractures heal well with conservative management, high-risk stress fractures as well as any fracture in the elite athlete may warrant surgical intervention as well as an augmented treatment and rehabilitation regimen.
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Affiliation(s)
- Eric Shi
- Sutter East Bay Medical Foundation, 20101 Lake Chabot Road, Castro Valley, CA 94546, USA.
| | - Lawrence M Oloff
- Sutter Health Palo Alto Medical Foundation, Callan Boulevard, Daly City, CA 94015, USA
| | - Nicholas W Todd
- Sutter Health Palo Alto Medical Foundation, 701 East El Camino Real, Mountain View, CA 94040, USA
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Meng J, Jin C, Li J, Zhang S, Zhang M, Hao Z, Chen X, Song Z, Zhang L, Liang C. Metabolomics Analysis Reveals the Differential Metabolites and Establishes the Therapeutic Effect Prediction Nomogram Among CP/CPPS Patients Who Respond or Do Not Respond to LiST. Front Immunol 2022; 13:953403. [PMID: 35911714 PMCID: PMC9332892 DOI: 10.3389/fimmu.2022.953403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Low-intensity shockwave therapy (LiST) has been applied in the clinical treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but few studies have focused on the prediction of its therapeutic effect before treatment. Methods Seventy-five CP/CPPS patients from our institute between July 2020 and May 2021 were enrolled and received 3 Hz, 0.25 mJ/mm2 LiST once a week over the course of four weeks. The scores of the NIH-CPSI, IPSS questionnaire and demographic features before treatment were recorded. The plasma before LiST treatment was also collected, while liquid chromatography-tandem mass spectrometry was used to detect the metabolites. Least absolute shrinkage and selection operator (LASSO) regression analysis was employed to identify the prediction metabolites and generate the metabolism score. Receiver operating characteristic curves and calibration curves were drawn to assess the prediction accuracy of the nomogram. Results Twelve metabolites were identified at incomparable levels before and after LiST treatment. The metabolism score generated by LASSO analysis presented a perfect prediction value (AUC: 0.848, 95% CI: 0.719-0.940) in the training cohort and further increased to 0.892 (95% CI: 0.802-0.983) on the nomogram, which accompanied with the NIH-CPSI scores and age. Similar results of the metabolism score (AUC: 0.732, 95% CI: 0.516-0.889) and total nomogram (AUC: 0.968, 95% CI: 0.909-1.000) were obtained in the testing cohort. Further enrichment of the 12 metabolites indicated that the glycine and serine metabolism pathway was involved in the LiST treatment. Conclusion We used our system to accurately and quantitatively measure plasma metabolites and establish a predictive model to identify suitable patients for LiST treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Zhengyao Song
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
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Update on Management of Leg Pain in Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tang MT, Liu CF, Liu JL, Saijilafu, Wang Z. Multiple stress fractures of unilateral femur: A case report. World J Clin Cases 2022; 10:4280-4287. [PMID: 35665126 PMCID: PMC9131223 DOI: 10.12998/wjcc.v10.i13.4280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stress fractures of the femoral neck are not common in clinical practice, and simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur are even more rare. We introduce a case of this type of fracture that was treated in our department, analyze the causes, and review similar stress fractures reported in the literature to provide references for the diagnosis and treatment of such conditions.
CASE SUMMARY A 62-year-old female, with a free medical history, was admitted to the hospital mainly due to pain in the right hip and worsening pain in the right thigh. The patient had no obvious history of trauma. X-ray and computed tomography showed fracture of the femoral neck and proximal femur. The patient had undergone surgery 1 year prior to address a fracture of the left proximal femur that had occurred in a traffic accident. Our first consideration was stress fracture of the femoral neck; however, simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur were seen. The femoral neck stress fracture was a tension fracture, with obvious displacement and varus deformity of the hip. Considering that the patient was an elderly female, we performed total hip arthroplasty. Follow-up X-rays showed that the stress fracture of the proximal femur had mostly healed after 3 mo.
CONCLUSION Muscle fatigue and hip varus deformity provide an anatomical basis for the occurrence of femoral neck stress fractures.
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Affiliation(s)
- Mao-Ting Tang
- Department of Orthopaedics, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Chun-Feng Liu
- Department of Orthopaedics, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Jin-Lian Liu
- Department of Orthopaedics, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Saijilafu
- Orthopaedic Institute, Medical College, Soochow University, Suzhou 215007, Jiangsu Province, China
| | - Zhen Wang
- Department of Orthopaedics, Suzhou Kowloon Hospital Shanghai Jiao Tong University School of Medicine, Suzhou 215028, Jiangsu Province, China
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Chun YS, Lee DH, Won TG, Kim Y, Shetty AA, Kim SJ. Current Modalities for Fracture Healing Enhancement. Tissue Eng Regen Med 2021; 19:11-17. [PMID: 34665454 DOI: 10.1007/s13770-021-00399-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 01/14/2023] Open
Abstract
Previously, most fractures have been treated through bone reduction and immobilization. With an increase in the patients' need for an early return to their normal function, development in surgical techniques and materials have accelerated. However, delayed union or non-union of the fracture site sometimes inhibits immediate return to normal life. To enhance fracture healing, diverse materials and methods have been developed. This is a review on the current modalities of fracture healing enhancement, which aims to provide a comprehensive knowledge regarding fracture healing for researchers and health practitioners.
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Affiliation(s)
- You Seung Chun
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Dong Hwan Lee
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Tae Gu Won
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Yuna Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Asode Ananthram Shetty
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, UK
| | - Seok Jung Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, Republic of Korea.
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10
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Holsapple JS, Cooper B, Berry SH, Staniszewska A, Dickson BM, Taylor JA, Bachoo P, Wilson HM. Low Intensity Shockwave Treatment Modulates Macrophage Functions Beneficial to Healing Chronic Wounds. Int J Mol Sci 2021; 22:ijms22157844. [PMID: 34360610 PMCID: PMC8346032 DOI: 10.3390/ijms22157844] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022] Open
Abstract
Extracorporeal Shock Wave Therapy (ESWT) is used clinically in various disorders including chronic wounds for its pro-angiogenic, proliferative, and anti-inflammatory effects. However, the underlying cellular and molecular mechanisms driving therapeutic effects are not well characterized. Macrophages play a key role in all aspects of healing and their dysfunction results in failure to resolve chronic wounds. We investigated the role of ESWT on macrophage activity in chronic wound punch biopsies from patients with non-healing venous ulcers prior to, and two weeks post-ESWT, and in macrophage cultures treated with clinical shockwave intensities (150–500 impulses, 5 Hz, 0.1 mJ/mm2). Using wound area measurements and histological/immunohistochemical analysis of wound biopsies, we show ESWT enhanced healing of chronic ulcers associated with improved wound angiogenesis (CD31 staining), significantly decreased CD68-positive macrophages per biopsy area and generally increased macrophage activation. Shockwave treatment of macrophages in culture significantly boosted uptake of apoptotic cells, healing-associated cytokine and growth factor gene expressions and modulated macrophage morphology suggestive of macrophage activation, all of which contribute to wound resolution. Macrophage ERK activity was enhanced, suggesting one mechanotransduction pathway driving events. Collectively, these in vitro and in vivo findings reveal shockwaves as important regulators of macrophage functions linked with wound healing. This immunomodulation represents an underappreciated role of clinically applied shockwaves, which could be exploited for other macrophage-mediated disorders.
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Affiliation(s)
- Jason S. Holsapple
- School of Medicine, Medical Sciences & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (J.S.H.); (A.S.); (S.H.B.); (B.M.D.); (J.A.T.)
| | - Ben Cooper
- Department of Vascular Surgery, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN, UK; (B.C.); (P.B.)
| | - Susan H. Berry
- School of Medicine, Medical Sciences & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (J.S.H.); (A.S.); (S.H.B.); (B.M.D.); (J.A.T.)
| | - Aleksandra Staniszewska
- School of Medicine, Medical Sciences & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (J.S.H.); (A.S.); (S.H.B.); (B.M.D.); (J.A.T.)
| | - Bruce M. Dickson
- School of Medicine, Medical Sciences & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (J.S.H.); (A.S.); (S.H.B.); (B.M.D.); (J.A.T.)
| | - Julie A. Taylor
- School of Medicine, Medical Sciences & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (J.S.H.); (A.S.); (S.H.B.); (B.M.D.); (J.A.T.)
| | - Paul Bachoo
- Department of Vascular Surgery, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN, UK; (B.C.); (P.B.)
| | - Heather M. Wilson
- School of Medicine, Medical Sciences & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (J.S.H.); (A.S.); (S.H.B.); (B.M.D.); (J.A.T.)
- Correspondence:
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Abstract
In an era of continual single-sport specialization and year-round training, overuse injuries, including stress injuries of bone, are increasingly common. These injuries can be season- or even career-ending. For many elite and professional athletes, the traditional treatment strategy of immobilization and extended rest from sports participation is often not practical or acceptable. An understanding of modern strategies for evaluating and treating stress fractures is paramount for maintaining athletic participation and optimal athletic performance. This begins with the ability to categorize and stratify bony stress injuries by both severity and risk of fracture progression. Surgical procedures such as open reduction and internal fixation or intramedullary fixation with possible bone grafting remain the standard of care for chronic or severe stress fractures. However, emerging techniques to augment the biologic environment are a minimally invasive adjunct for stimulating and supporting bone healing in elite-level athletes to optimize bone health, expedite recovery, and decrease the risk of nonunion or catastrophic fracture.
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12
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Management of Femoral Neck Stress Fracture in an Athlete Using Clodronic Acid: a Clinical Case Report. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42399-019-00160-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Stress fractures are common injuries caused by repetitive micro-traumas of the bone. Nowadays, they are widespread amongst the athletes and their treatment is mostly based on the limitation of physical activity, the application of ice, and the administration of analgesics and anti-inflammatory drugs. We present a case of a 26-year-old woman who reported a mono-cortical stress fracture in the anatomical neck portion of the right femur treated with Clody® 200 mg/4 ml. The patient is an amateur runner who complained a progressive pain and functional limitation of the hip joint. No history of recent trauma was present as well as X-rays evidence of fractures. A subsequent magnetic resonance imaging study showed the presence of a mono-cortical stress fracture in the anatomical neck portion of the right femur. The patient was treated with 1 vial of Clody® 200 mg/4 ml a day for 7 days, following 1 vial every 15 days for 2 months without any further therapy as well as physical activity limitation, showing a faster clinical and radiological recovery compared with the most of therapies described in the literature. Concerning our positive experience, the purpose of this study is to give a starting point for further research in order to enlarge the number of studies about that specific approach.
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Beech M, Nagra NS, Wedatilake T, Kluzek S. Symptomatic stress reaction of the humerus in a professional cricketer. BMJ Case Rep 2019; 12:12/9/e227088. [PMID: 31537584 DOI: 10.1136/bcr-2018-227088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A symptomatic bone stress reaction is an early pathological feature, which can lead to stress fractures. It typically affects bones of the lower limbs in response to unaccustomed disproportional compressive loading. Professional sportspeople are susceptible to both bone stress reaction and stress fractures, where training regimes and competition predispose to overuse injuries. We discuss a unique case of a professional cricketer developing pain in the throwing arm due to bone stress reaction in the distal humerus, as confirmed on MRI. Modification of the patient's training regime, presented in this case, facilitated complete recovery within 6 weeks. The positive response to modified training suggests a biomechanical origin of the pain. This case illustrates that tensile stress associated with throwing activities can result in a symptomatic bone stress reaction of the humerus in elite cricketers.
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Affiliation(s)
- Matthew Beech
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Navraj S Nagra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford University Hospitals, Oxford, UK
| | | | - Stefan Kluzek
- The Botnar Research Centre (NDORMS), Oxford University Hospitals, Oxford, UK
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Tanaka K, Kanamori A, Yamamoto Y, Hara Y, Nishiura Y, Nishino T, Yamazaki M, Miyakawa S. Extracorporeal shock wave therapy for avulsion fractures of the sublime tubercle of the ulna in high school baseball players: A report of two cases. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2018; 10:1-3. [PMID: 29392108 PMCID: PMC5780296 DOI: 10.1016/j.asmart.2017.05.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/07/2017] [Accepted: 05/26/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Kenta Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuki Yamamoto
- Sports Research & Development Core, University of Tsukuba, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Yasumasa Nishiura
- Tsuchiura Clinical Education and Training Center, Tsukuba University Hospital, Japan
| | - Tomofumi Nishino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Shumpei Miyakawa
- Faculty of Health and Sport Sciences, University of Tsukuba, Japan
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Slavich M, Giannini F, Godino C, Pizzetti G, Gramegna M, Fragasso G, Margonato A. Reducer, extracorporeal shockwave therapy or stem cells in refractory angina: a retrospective study. J Cardiovasc Med (Hagerstown) 2017; 19:42-44. [PMID: 29028786 DOI: 10.2459/jcm.0000000000000577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Massimo Slavich
- Division of Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Saunier J, Chapurlat R. Stress fracture in athletes. Joint Bone Spine 2017; 85:307-310. [PMID: 28512006 DOI: 10.1016/j.jbspin.2017.04.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/24/2017] [Indexed: 12/20/2022]
Abstract
Stress fractures are widely encountered in sport medicine and rheumatology. Stress fractures result from abnormal and repetitive loading on normal bone that lead to microdamage and then fracture. They occur after sudden increase in physical activity. They appear mostly at lower limbs. Women are at higher risk than men. Patients complain of mechanical pain. Clinical findings include focused pain and sometimes swelling. No biological test is useful for diagnosis. Plain radiographs are normal in early stage disease. MRI is the gold standard to confirm stress fracture. Treatments of stress fracture always involve rest and analgesics. Non-steroidal anti-inflammatory should be use cautiously because they may inhibit callus formation. Extracorporeal shockwave may be a new approach for SF not healing with rest. Surgical treatment is often needed in high risk stress fracture of delayed healing, non-union or complete fracture.
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Affiliation(s)
- Jordane Saunier
- Service de rhumatologie, CHU Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - Roland Chapurlat
- Service de rhumatologie, CHU Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
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