ESWT History

Shockwaves were first identified during World

War II. Submarine crews exposed to

detonation of Hydrogen bombs incurred

shockwave induced injury to lungs.

By „accident“, Dornier Systems develop the basic

physical understanding for the

interaction of shockwaves with tissue, materials.

Observation of increasedbone density following

lithotripsy treatment leads to investigation of possible orthopedic applications.

1989 the first treatments of non-healing fractures

(pseudarthrosis).

ESWT treatment of mycardial Infarctionduring open heart

surgery

December 2007

1940 1966 1989 2007

Continued Application of

ESWT in Orthopedics

including frozen shoulder, tennis elbow, heel spur, bursitis, jumpers

knee and achillodynia

1992

Application of ESWT in Dermatology

including non-healing wounds, diabetic foot

ulcers, decubital ulcers and burns.

2004

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.

1980

ESWT Introduction

The reflector geometry enables generation of either highly focused shock waves (Urolithiasis or Pseudarthrosis) or soft focused shock waves (for most soft tissue applications)

Electrohydraulic shockwaves are generated by an electrical discharge in water.(other means of shockwave generation include piezoelectric and electromagnetic principles)

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 )

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

• Female patient• Age 94 • Chronic skin lesion withstaph. aureus infection

• Chronic leukemia• Chronic obstructive

pulmonary disease( COPD )

• Cortisone therapy

3 treatments with Soft Focus ESWT

without anesthesia

After 7 weeks

Pre-treatment

After 4 weeks

Chronic Infectious Skin UlcerAfter 2 weeks

Pre-treatment

After 4 weeks After 6 weeks3 treatments with soft focus ESWT without

anesthesia

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

ESWT Clinical Results

After 2 weeks

3 treatments with soft focus ESWT without anesthesia

Chronic Ulcer• Male patient• Age 47• Trauma caused by

boating accident• Primary treatment with

ESWT

Pre treatment

After 5 weeks

After 2 weeks

After 11 weeks

ESWT Clinical Results

5 treatments with soft focus ESWT without anesthesia

Decubital Ulcer• Male patient• Age 20• Paraplegic due to bullet

wound incurred 2 yearsearlier

• Decubital ulcer since 5 months

Pre treatment

ESWT Clinical Results

After 1 week

After 5 weeksAfter 3 weeks

Pre treatment

Chronic infected ulcer

ESWT Clinical Results

After 6 weeks

Decubital ulcer

Pre-treatment

After 6 months

Burn wounds

Pre-treatment

After 6 months

Non-healing wound post fracture

Pre-treatment

After 6 months

PseudarthrosisPre-treatment

After 3 monthsAfter 5 months

After 1 year

• Male patient• Age 59• Talus fracture

Pre treatment

• Female Patient• Age 36• Sub-total amputation

• Replantation• K-Wire• Spongio-plasty• Plating• Ext. Fixator• After 4 years

ESWT application

After 3 months

After 6 months

Pseudarthrosis

Pre treatment

After 6 months

Pseudarthrosis

Pseudarthrosis

After 6 months

After 3 months

• Female patient• Age 59• Injury due to a fall• Diabetic

Pre treatment

Pseudarthrosis• Male Patient• Age 46• Motorcycle accident• Tibia fracture• External fixator• After 8 weeks removal offixator and cast

• After 9 months ESWTapplication

After 2 months After 4

months

CT 4 months post ESWT

Pseudarthrosis

CT pre treatment

• Male Patient• Age 46• Motorcycle accident• Tibia fracture• External fixator• After 8 weeks removaland cast

• After 9 months ESWT application

Study Results

Orthopedics

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

Achilles tendonBursitisFasciitis plantarisTendinosis calcareaNon-union (Pseudarthroses)PPS (Patella tip syndrom)Epicondylopathia humeri radialisEpicondylopathia humeri ulnaris

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

Dermatology

Achilles tendonBursitisFasciitis PlantarisTendinosis calcareaPseudarthrosisPPSEpicondylopathia humeri radialisEpicondylopathia humeri ulnaris

Non-healing woundsPost-traumatic lesionsUlcersDecubitusBurns

ESWT forecast

Da Vinci projects

Dermatology

Orthopedics

Odontology

Neurology

Cardiology

ESWT forecast

Combat Wound Initiative 2007

• Extensive survey on ESWT • 3-years´study 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

Walter Reed Army Medical Center

Dermatology

Dermatology

Orthopedics

Odontology

Neurology

Cardiology

ESWT forecast

Dermatology

CelluliteCurrently numerous studies running regarding the effectivness of the ESWT in cellulite care

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

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

Dermatology

Orthopedics

Odontology

Neurology

Cardiology

ESWT forecast

Orthopedics

ArthrosisIn a study in Berlin a patient´s knee was treated with ESWT

The knee was re-arthroscoped after 1 year. The cartilage was almost totally recovered.

Dermatology

Orthopedics

Odontology

Neurology

Cardiology

ESWT forecast

Dentistry

Bacterial Parodontitis

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.

Dermatology

Orthopedics

Odontology

Neurology

Cardiology

ESWT forecast

Neurology

Peripheral nerve system Spinal cord Brain

ESWT Work in Progress

Nerve transplantation

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).

Dermatology

Orthopedics

Odontology

Neurology

Cardiology

ESWT forecast

Cardiology

Heart surgery

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.

Dermatology

Orthopedics

Odontology

Neurology

Cardiology

ESWT forecast

furthermore…

Plants

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

In Kärnten currently wounds on trees are treated with ESWT, results in late summer 2007

Dermatology

Orthopedics

Dentistry

Neurology

Cardiology

furthermore…