Orthopedic Applications in Lithotripsy

Global Lithotripsy Services is pioneering the use of Extracorporeal Shock Wave Therapy (ESWT) utilizing its network of physicians and hospitals. The Dornier Compact S used by GLS for ESWL is ideally suited to ESWT applications. 

Note: ESWT is not yet approved by the US FDA and the treatment is not available in the United States. GLS performs ESWT in Thailand only.

What is ESWT?

Extracorporeal shock wave therapy refers to the clinical use of shock waves for orthopedic applications. ESWT developed from studies on the possible side effects of ESWL to the spine and pelvis. These studies attracted the interest of Orthopedic Surgeons in Germany, and eventually led to wide scale research and use of ESWT as an alternative to surgery.

In 1989, shock wave therapy was introduced for clinical use at various test sites in Germany for the treatment of pseudoarthrosis and slow healing fractures. Success in this area led physicians to explore the capabilities of ESWT on other chronic disorders, like Tendinitis, shoulder calcification and heel spurs.

To date, over 50,000 ESWT procedures have been performed in Germany, where there is a growing body of clinical evidence supporting the efficacy of shock wave therapy for orthopedic use. In a clear sign of support for ESWT, the German Health Insurance Program now covers ESWT therapy 100%.

How does ESWT work?

Unlike ESWL for urinary calculi, the mechanics of ESWT are not yet fully understood.

Dornier MedTech and others are conducting research to determine how exactly shock waves work to alleviate pain. Currently, there are three hypotheses:

1. Shock waves stimulate the metabolic reaction of tissue, causing development of stress fibers and/or change in membrane permeability
2. Shock waves create cavitation bubbles which break down/change the consistency of calcific deposits
3. Shock waves induce an analgesic effect by over-stimulating the axons (Gate-control Theory), thereby increasing a person’s pain threshold.

What are the Indications for ESWT?

Standard indications of ESWT are:

• Pseudoarthrosis
• Tendinitis calcarea
• Epicondylitis humeri radialis (tennis elbow)
• Epicondylitis humeri ulnaris (golf elbow)
• Plantar and dorsal heel spurs

Who is a Candidate for ESWT?

ESWT is recommended for patients suffering from chronic pain, who have not responded to conservative treatment for a period of at least three months. Up until now, surgery was the only option for these patients.

How is Treatment Performed?

ESWT is a non-invasive procedure. Patients are treated on an outpatient basis using the Dornier Compact S lithotripter provided by Global Lithotripsy Services. The average treatment time is about 30 minutes and the procedure is performed using local anesthesia (e.g. Lignocain) where necessary.

ESWT therapy usually consists of 1-3 sessions, during which low energy shock wave blasts are administered to the point of pain – normally 2000 blasts. Localization of the treatment area is accomplished using fluoroscopy and bio-feedback.

What are the Results?

Most clinical work and scientific papers on ESWT originate from Germany. Success rates for ESWT are good to excellent; however, it must be stated that ESWT is still in a developmental stage and research is on going. Nevertheless, as numerous scientific papers attest, ESWT is a legitimate and useful non-invasive therapy for people suffering from chronic pain and an alternative to surgery.

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