ESWT History

Shockwaves were first
identified during World
War II. Submarine
crews exposed to
detonation of Hydrogen
bombs incurred
shockwave induced
injury to lungs.

1940

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.

1966
By „accident“,
Dornier Systems
develop the basic
physical
understanding for the
interaction of
shockwaves with
tissue, materials.

1980

1989

Continued
Application of
ESWT in
Orthopedics
including frozen
shoulder, tennis
elbow, heel spur,
bursitis, jumpers
knee and
achillodynia

1992

Observation of increased
bone density following
lithotripsy treatment leads to
investigation of possible
orthopedic applications.
1989 the first treatments of
non-healing fractures
(pseudarthrosis).

ESWT treatment of
mycardial Infarction
during open heart
surgery

December 2007

2004

2007

Application of ESWT
in Dermatology
including non-healing
wounds, diabetic foot
ulcers, decubital ulcers
and burns.

ESWT Introduction
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 )

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

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

In addition to orthopedic applications since 1992. . bone and nerve tissue.Biologic Effects of ESWT • Change of cell membrane permeability • Release of neurotransmitters • Antibacterial effects • Release of NO (nitrogen oxyde) • Release of growth factors (VEGF. BMP-2. ESWT is nowadays used in Dermatology. eNOS. skin. PCNA) • Induction of vessel growth • Stem cell migration and differentiation Regeneration of vessels.

ESWT Clinical Results Chronic Infectious Skin Ulcer • Female patient • Age 94 • Chronic skin lesion with staph. aureus infection • Chronic leukemia • Chronic obstructive pulmonary disease ( COPD ) • Cortisone therapy 3 treatments with Soft Focus ESWT without anesthesia Pre-treatment After 2 weeks After 4 weeks After 7 weeks .

ESWT Clinical Results Chronic Ulcer • Male patient • Age 57 • >1 year conservative unsuccessful treatment 3 treatments with soft focus ESWT without anesthesia Pre-treatment After 2 weeks After 4 weeks After 6 weeks .

ESWT Clinical Results Chronic Ulcer • Male patient • Age 47 • Trauma caused by boating accident • Primary treatment with ESWT 3 treatments with soft focus ESWT without anesthesia Pre treatment After 2 weeks After 5 weeks After 11 weeks .

ESWT Clinical Results Decubital Ulcer • Male patient • Age 20 • Paraplegic due to bullet wound incurred 2 years earlier • Decubital ulcer since 5 months 5 treatments with soft focus ESWT without anesthesia Pre treatment After 1 week After 3 weeks After 5 weeks .

ESWT Clinical Results Chronic infected ulcer After 6 weeks Pre treatment .

Decubital ulcer After 6 months Pre-treatment .

Burn wounds After 6 months Pre-treatment .

Non-healing wound post fracture After 6 months Pre-treatment .

Pseudarthrosis • Male patient • Age 59 • Talus fracture Pre-treatment After 3 months After 5 months After 1 year .

Fixator • After 4 years ESWT application After 6 months Pre treatment After 3 months .Pseudarthrosis • Female Patient • Age 36 • Sub-total amputation • Replantation • K-Wire • Spongio-plasty • Plating • Ext.

Pseudarthrosis After 6 months Pre treatment .

Pseudarthrosis • Female patient • Age 59 • Injury due to a fall • Diabetic Pre treatment After 3 months After 6 months .

Pseudarthrosis • Male Patient • Age 46 • Motorcycle accident • Tibia fracture • External fixator • After 8 weeks removal of fixator and cast • After 9 months ESWT application After 2 months After 4 months .

Pseudarthrosis • Male Patient • Age 46 • Motorcycle accident • Tibia fracture • External fixator • After 8 weeks removal and cast • After 9 months ESWT application CT pre treatment CT 4 months post ESWT .

74% patients reported positive to very positive therapeutic results .Study Results Orthopedics Achilles tendon Bursitis Fasciitis plantaris Tendinosis calcarea Non-union (Pseudarthroses) PPS (Patella tip syndrom) Epicondylopathia humeri radialis Epicondylopathia humeri ulnaris Over a period of 2 years. 409 patients were treated for a variety of sports related injuries at the sports medicine clinic in Hellersen.

Wolfgang Schaden. Richard Thiele.Study Results Dermatology Clinical studies conducted by Dr. .5% of the wounds healed completely within 2-12 weeks. Vienna and Dr. Berlin Total 200 patients 74.

ESWT Indications Orthopedics Achilles tendon Bursitis Fasciitis Plantaris Tendinosis calcarea Pseudarthrosis PPS Epicondylopathia humeri radialis Epicondylopathia humeri ulnaris Dermatology Non-healing wounds Post-traumatic lesions Ulcers Decubitus Burns .

ESWT forecast Da Vinci projects Dermatology Orthopedics Odontology Neurology Cardiology .

“Standard of Care + ESWT” • Budget: 10 Mio. USD • Data: 40.000 data elements per patient .ESWT forecast Dermatology Combat Wound Initiative 2007 Dermatology Orthopedics Odontology Neurology Cardiology Walter Reed Army Medical Center • 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.

very positive results out of running studies in Korea and Italy Burns First.ESWT forecast Dermatology Cellulite Dermatology Currently numerous studies running regarding the effectivness of the ESWT in cellulite care Orthopedics Odontology Neurology Cardiology Adipocellular / Lipolysis First. very positive results out of a running study at the Verbrennungszentrum in Berlin .

. The cartilage was almost totally recovered.ESWT forecast Orthopedics Dermatology Orthopedics Odontology Neurology Cardiology Arthrosis In a study in Berlin a patient´s knee was treated with ESWT The knee was re-arthroscoped after 1 year.

.ESWT forecast Dentistry Dermatology Orthopedics Bacterial Parodontitis Odontology Neurology Cardiology At the University of Kentucky rats were infected during 12 weeks with the bacteria Porphyromonas gingivalis. skeletonized. The bones of the ESWT-treated animals were almost totally reproduced. After 12 weeks the animals were sacrificed. measured on bone reduction and compared with the control group.

turned by 180° and reimplanted. Cardiology Peripheral nerve system Spinal cord ESWT Work in Progress Brain . After ESWT clear advantages of the treated animals in comparison with the control group were measured (Step-test. Plain-test). The sciata nerve was cut. Catwalk.ESWT forecast Neurology Nerve transplantation Dermatology Orthopedics Odontology Neurology At the Ludwig-Boltzmann-Institut in Vienna rats were treated.

All ESWT treated animals showed significant growth of new blood vessels in the infarct area. .ESWT forecast Cardiology Heart surgery Dermatology Orthopedics Odontology Neurology Cardiology At the Allgemeinen Krankenhaus Vienna an artificial infarction of the heart was induced with rats and pigs by blocking the coronary vessel. First human treatment (open heart surgery) in December 2007. The remarkable results were shown officially at the ISMST-Congres in Toronto June 2007.

Cardiology furthermore… In Kärnten currently wounds on trees are treated with ESWT. results in late summer 2007 .ESWT forecast furthermore… Plants Dermatology Orthopedics Dentistry Neurology Soja bean sprouts were treated with ESWT. A clearly faster growth of the treated plants was registered in comparison to the control group.