Applications in Musculoskeletal Disorders - part 1 doc

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Shock Wave Applications
in Musculoskeletal Disorders
Jan-Dirk Rompe, M.D.
Associate Professor
Department of Orthopedics
Johannes Gutenberg University
School of Medicine
Mainz, Germany
82 illustrations
17 tables
Thieme
Stuttgart · New York
IV
Library of Congress Cataloging-in-Publication Data is
available from the publisher
Any reference to or mention of manufacturers or
specific brand names should not be interpreted as
an endorsement or advertisement for any company
or product.
Some of the product names, patents, and regis-
tered designs referred to in this book are in fact reg-
istered trademarks or proprietary names even
though specific reference to this fact is not always
made in the text. Therefore, the appearance of a
name without designation as proprietary is not to be
construed as a representation by the publisher that
it is in the public domain.

This book, including all parts thereof, is legally
protected by copyright. Any use, exploitation, or
commercialization outside the narrow limits set by
copyright legislation, without the publisher’s con-
sent, is illegal and liable to prosecution. This applies
in particular to photostat reproduction, copying,
preparation of microfilms, and electronic data pro-
cessing and storage.
Important Note: Medicine is an ever-changing sci-
ence undergoing continual development. Research
and clinical experience are continually expanding
our knowledge, in particular our knowledge of
proper treatment and drug therapy. Insofar as this
book mentions any dosage or application, readers
may rest assured that the authors, editors, and pub-
lishers have made every effort to ensure that such
references are in accordance with the state of
knowledge at the time of production of the book.
Nevertheless this does not involve, imply, or
express any guarantee or responsibility on the part
of the publishers in respect of any dosage instruc-
tions and forms of application stated in the book.
Every user is requested to examine carefully the
manufacturers’ leaflets accompanying each drug
and to check, if necessary in consultation with a
physician or specialist, whether the dosage sched-
ules mentioned therein or the contraindications
stated by the manufacturers differ from the state-
ments made in the present book. Such examination
is particularly important with drugs that are either

rarely used or have been newly released on the mar-
ket. Every dosage schedule or every form of applica-
tion used is entirely at the user’s own risk and
responsibility. The authors and publishers request
every user to report to the publishers any discrepan-
cies or inaccuracies noticed.
Cover drawing by Martina Berge, Erbach
© 2002 Georg Thieme Verlag, Rüdigerstraße 14,
D-70469 Stuttgart, Germany
Thieme, 333 Seventh Avenue,
New York, NY 10001, USA.
Typesetting by Mitterweger & Partner, Plankstadt
Printed in Germany by Gulde Druck, Tübingen
ISBN 3-13-130121-X (GTV)
ISBN1-58890-079-7(TNY) 12345
To
My father, Professor Gerhard Rompe,
on the occasion of his 70th birthday.
He has stimulated my orthopedic
and scientific thinking for decades.
To
Myorthopedicmentorsatthe
Johannes Gutenberg University
School of Medicine, and particularly
to Professor Jochen Heine who
introduced me to the intriguing
world of orthopedic shock wave
therapy.
My present colleagues at the
Department of Orthopedics who

have generously referred to me
interesting shoulder, elbow, and heel
problems throughout the years.
All orthopedic surgeons throughout
the world who have shared their
interesting cases with me, so that
some strides might be made in the
diagnosis and non-invasive
treatment of these often neglected
patients.
My colleague and friend, Lowell
Weil Sr. who encouraged me to
write down our experiences in
English and share them with
physicans in Anglo-American
countries.
And my wife and our children who
understand and support me in my
endeavors.
VI
Foreword
For more than 20 years extracorporeal shock
wave lithotripsy has been the standard tool
for dealing with calculi in the kidney and in
the ureter. Today, surgical therapy plays only a
minor role in the treatment of this disease.
About a decade ago, extracorporeal shock
wave application (ESWA) was transferred
from urology to other medical fields, includ-
ing gastroenterology and orthopedics.

The aim of this book is to assess, from a sci-
entific point of view, past efforts in experi-
mental research and clinical application of
shock waves related to chronic musculoskele-
tal disorders, and to point out future fields of
interest.
Only recently have prospective randomized
studies been released concerning effective
treatment protocols for patients suffering
from chronic painful heel, tennis elbow, and
calcifying tendinitis of the shoulder. The
author presents his own extraordinary experi-
ence, discussing the advantages and disadvan-
tages of various concepts, thus giving the
reader extensive information about possibili-
ties and limitations of shock wave application
(SWA) presently available.
The animal experiments presented in this
book clearly demonstrate the possible damag-
ing effects of shock waves on tendons and on
peripheral nerves and point out to the reader
the close relationship between physical
parameters and tissue reaction.
I consider it important that the author
addresses problems related to SWA for mus-
culoskeletal disorders, while simultaneously
pointing to the beneficial effects of this new,
noninvasive procedure.
This book will form the scientific basis for
restrictive indications, for medical quality

assessment, and for familiarizing doctors with
an innovative treatment concept.
Mainz, December 2001 Prof. Jochen Heine, MD
Director
Department of Orthopedics
Johannes Gutenberg University
School of Medicine
Mainz, Germany
VII
Preface
Plantar fasciitis is one of the most common
conditions presenting to foot and ankle spe-
cialists. Although the condition is usually
responsive to conservative and nonoperative
care, recalcitrant plantar fasciitis occurs in
10–20 % of the patients treated.
Until recently, plantar fasciotomy, with or
without spur resection or release of nerve
entrapments, has been the only option for this
ever-increasing patient population.
For 6 years we have patiently awaited the
opportunity to evaluate this new modality of
extracorporeal shock wave therapy (ESWT).
As one would expect, skepticism and cynicism
prevailed until our first 10 patients rendered
favorable responses within days of treatment.
Lowell Weil, Jr., one of my associates,
embraced this technology and we traveled to
Naples,Italy,inJuneof2000toattendthe2nd
International Meeting of the International

Musculoskeletal Shock Wave Association. We
were thoroughly impressed with the honesty
and attempt at providing results according to
evidence-based medicine.
Upon meeting Jan Rompe, we found an indi-
vidual who was energetic, bright, and honest.
With the recent application and ongoing
clinical trials of ESWT occurring in the United
States, I encouraged Dr. Rompe to write a book
in English as a work of reference for those of
us who are monolingual.
As an author of more than 12 papers on
ESWT, Jan Rompe was able to write this text,
which is a combination of a current literature
review and the results of clinical trials at his
medical institution, on virtually every appli-
cation of musculoskeletal ESWT. With more
than 200 relevant references, this book will be
a “must read” for those wishing to learn more
and apply this exciting and new technology.
Chicago, December 2001 Lowell Scott Weil, Sr., DPM
Editor-in-Chief
Weil Foot & Ankle Institute
Des Plaines, IL, USA
VIII
Acknowledgments
A heartfelt thank-you to Lowell Weil Sr. for
giving me the courage to write a book in a for-
eign language, for reviewing this work, and
for his invaluable help in handling many

details with Thieme Publishers.
It is with grateful appreciation that I
acknowledge the skill and dedication of Erwin
Scholtz and Barbara Hof-Barocke in rendering
the medical illustrations. They gave the art for
this book high priority, and I am appreciative
of their devotion to this work.
A note of appreciation is also given to Dr.
Clifford Bergman who served as an invaluable
interface with Thieme Publishers in taking
care of numerous details that led to the com-
pletion of this book. In the shortest time pos-
sibleheinitiatedpublicationofthiswork.