, Volume 33, Issue 3, pp 201–206 | Cite as

L’E.S.W.T.: Extracorporeal Shock Wave Therapy

  • G. P. CerveraEmail author
  • N. Tammaro
  • L. Romano
  • G. Toro
  • A. Pellegrino


Extracorporeal Shock Wave Therapy (ESWT) is an effective and safe non-invasive therapeutic option for various musculoskeletal pathologies. Extracorporeal shockwave therapy has been widely used in many musculoskeletal problems over the last 25–30 years, for example in case of pseudoarthrosis, plantar fasciitis, lateral epicondylitis, shoulder calcific tendinitis, Achilles tendinopathy, and osteonecrosis of the femoral head. Though the exact effects have not been proven, it has been suggested that shock waves accelerate tissue healing, reduce calcification, and inhibit pain receptors with denervation. As an economic and noninvasive physical therapy with good clinical effects, applications of ESWT have gradually increased in recent years.

L’E.S.W.T.: Extracorporeal Shock Wave Therapy


Conflitto di interesse

Gli autori G.P. Cervera, N. Tammaro, L. Romano, G. Toro e A. Pellegrino dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto essere umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and Animal Rights

L’articolo non contiene alcuno studio eseguito su esseri umani e su animali da parte degli autori.


  1. 1.
    Rader GP, Gomille T, Eggert-Durst M et al. (1997) Results of hip joint boring in femur head necrosis in the adult: 4 to 18 years di follow-up. Z Orthop Ihre Grenzeb 135:494–498 CrossRefGoogle Scholar
  2. 2.
    Chaussy C, Brendel W, Schmiedt E (1980) Extracorporeal induced destruction of kidney stones by shock-waves. Lancet 2:1265–1268 CrossRefGoogle Scholar
  3. 3.
    Delius M, Brendel W (1989) Mechanism of action in extracorporeal shock-wave lithotripsy: experimental studies. Biliar Lithotripsy, Chicago Google Scholar
  4. 4.
    Kaulesar Sukul DM, Johannes EJ, Pierik EG et al. (1993) The effect of high energy shock waves focussed on cortical bone. An vitro study. J Surg Res 54:46 CrossRefGoogle Scholar
  5. 5.
    Russo S, Gigliotti S, de Durante C (1996) L’uso delle onde d’urto nelle patologie ortopediche. In: Atti seminari chirurgia arto superiore Napoli, pp 129–134 Google Scholar
  6. 6.
    Buch M (1997) Extracorporeal shock-waves in orthopaedics. In: Atti I kassele shock waves symposium, pp 3–53 Google Scholar
  7. 7.
    Delius M, Draenert K, Al Diek Y, Draenert Y (1995) Biological effects of shock waves: in vivo effect of high energy pulses on rabbit bone. Ultrasound Med Biol 21:1219–1225 CrossRefGoogle Scholar
  8. 8.
    Haupt G, Haupt A, Ekkernkamp A et al. (1992) Influence of shock waves on fracture healing. Urology 39:529–532 CrossRefGoogle Scholar
  9. 9.
    Wang CJ, Wang FS, Yang KD et al. (2003) Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res 21:984–989 CrossRefGoogle Scholar
  10. 10.
    Johannes EJ, Kaulesar Sukul DM, Matura E (1994) High-energy shock waves for the treatment of nonunions: an experiment on dogs. J Surg Res 57:246–252 CrossRefGoogle Scholar
  11. 11.
    Hsu RW, Tai CL, Chen CY et al. (2003) Enhancing mechanical strength during early fracture healing via shockwave treatment: an animal study. Clin Biomech 18:S33–S39 CrossRefGoogle Scholar
  12. 12.
    Wang CJ, Huang HY, Chen HH et al. (2001) Effect of shock wave therapy on acute fractures of the tibia: a study in a dog model. Clin Orthop Relat Res 387:112–118 CrossRefGoogle Scholar
  13. 13.
    Burger EH, Klein-Nulend J (1999) Mechanotransduction in bone—role of the lacuno-canalicular network. FASEB J 13(Suppl l):S101–S112 CrossRefGoogle Scholar
  14. 14.
    van der Worp H, van den Akker-Scheek I, van Schie H, Zwerver J (2013) ESWT for tendinopathy: technology and clinical implications. Knee Surg Sports Traumatol Arthrosc 21:1451–1458 CrossRefGoogle Scholar
  15. 15.
    Ogden JA, Toth-Kischkat A, Schultheiss R (2001) Principles of shock wave therapy. Clin Orthop Relat Res 387:8–17 CrossRefGoogle Scholar
  16. 16.
    Wang CJ, Wang FS, Yang KD (2008) Biological effects of extracorporeal shockwave in bone healing: a study in rabbits. Arch Orthop Trauma Surg 128:879–884 CrossRefGoogle Scholar
  17. 17.
    Wang CJ, Yang KD, Ko JY et al. (2009) The effects of shockwave on bone healing and systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions. Nitric Oxide 20:298–303 CrossRefGoogle Scholar
  18. 18.
    Mittermayr R, Antonic V, Hartinger J et al. (2012) Extracorporeal shock wave therapy (ESWT) for wound healing: technology, mechanisms, and clinical efficacy. Wound Repair Regen 20:456–465 PubMedGoogle Scholar
  19. 19.
    Wang CJ (2012) Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res 7:11 CrossRefGoogle Scholar
  20. 20.
    Wang CJ, Kuo YR, Wu RW et al. (2009) Extracorporeal shockwave treatment for chronic diabetic foot ulcer. J Surg Res 152(1):96–103 CrossRefGoogle Scholar
  21. 21.
    Holfeld J, Zimpfer D, Albrecht Schgoer K et al. (2014) Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease. J Tissue Eng Regen Med 10(12):1057–1064 CrossRefGoogle Scholar
  22. 22.
    Gruenwald I, Appel B, Kitrey ND, Vardi Y (2013) Shockwave treatment of erectile dysfunction. Ther Adv Urol 5:95–99 CrossRefGoogle Scholar
  23. 23.
    Ogden JA, Alvarez RG, Levitt R, Marlow M (2001) Shock wave therapy (orthotripsy) in musculoskeletal disorders. Clin Orthop 387:22–40 CrossRefGoogle Scholar
  24. 24.
    Sturtevant B (1996) Shock wave physics of lithotriptors. In: Smith AD (ed) Smith’s text book of endurology, vol 1. Quality Medical Publishing, Saint Louis, pp 529–552 Google Scholar
  25. 25.
    Delius M, Draenert K, Al Diek Y, Draenert Y (1995) Biological effects of shock waves: in vivo effect of high energy pulses on rabbit bone. Ultrasound Med Biol 21(9):1219–1225. CrossRefGoogle Scholar
  26. 26.
    Seidl M, Steinbach P, Wörle K, Hofstädter F (1994) Induction of stress fibers and intercellular gaps in human vascular endothelium by shock waves. Ultrasonics 32(5):397–400 CrossRefGoogle Scholar
  27. 27.
    Russo S et al. (1998) Meccanismo d’azione delle onde d’urto sul tessuto osseo. In: Atti del corso interdisciplinare, Parma 27/02/1998, pp 12–16 Google Scholar
  28. 28.
    Eid J (2016) Consensus statement on EWST. In: Indication and contraindications, ISMST Naples, p 2016 Google Scholar
  29. 29.
    Rompe JD, Kirpratrick CJ, Kullmr K et al. (1998) Dose-related effects of shock waves on rabbit tendo achilles, a sonographic and histological study. J Bone Jt Surg, Br 80:546–552 CrossRefGoogle Scholar
  30. 30.
    Chao YH, Tsuang YH, Sun JS et al. (2008) Effects of shock tenocyte waves on proliferation and extracellular matrix metabolism. Ultrasound Med Biol 34:841–852 CrossRefGoogle Scholar
  31. 31.
    Vetrano M, D’Alessandro F, Torrisi MR et al. (2011) Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes. Knee Surg Sports Traumatol Arthrosc 19:2159–2168 CrossRefGoogle Scholar
  32. 32.
    Hofmann A, Ritz U, Hessmann MH et al. (2008) Extracorporeal shock wave-mediated changes in proliferation, differentiation, and gene expression of human osteoblasts. J Trauma 65:1402–1410 PubMedGoogle Scholar
  33. 33.
    Evens DM, Ralston SH (1996) Nitric oxide and bone. J Bone Miner Res 11:300–305 CrossRefGoogle Scholar
  34. 34.
    Thomson EC, Crawford F, Murray GD (2005) The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 6:19 CrossRefGoogle Scholar
  35. 35.
    Speed C (2014) A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. Br J Sports Med 48:1538–1542 CrossRefGoogle Scholar
  36. 36.
    Wang CJ (2003) An overview of shock wave therapy in musculoskeletal disorder. Chang Gung Med J 26:220–232 PubMedGoogle Scholar
  37. 37.
    Wang CJ, Wang FS, Ko JY et al. (2008) Extracorporeal shockwave therapy shows regeneration in hip necrosis. Rheumatology 47:542–546 CrossRefGoogle Scholar
  38. 38.
    Mont M, Jones LC, Seyler TM et al. (2007) New treatment approaches for osteonecrosis of the femoral head: an overview. Instr Course Lect 56:197–212 PubMedGoogle Scholar

Copyright information

© Società Italiana Ortopedici Traumatologi Ospedalieri d’Italia 2019

Authors and Affiliations

  • G. P. Cervera
    • 1
    Email author
  • N. Tammaro
    • 2
  • L. Romano
    • 3
  • G. Toro
    • 2
  • A. Pellegrino
    • 1
  1. 1.UOC di Orto-TraumatologiaASL CE Ospedale “S.G. Moscati”AversaItalia
  2. 2.UO Ortopedia, DAI di Ortopedia, Riabilitazione e OdontoiatriaAOU Università degli Studi della Campania “Luigi Vanvitelli”NapoliItalia
  3. 3.UOC di Ortopedia e TraumatologiaAORN “Santobono-Pausilipon”NapoliItalia

Personalised recommendations