Monday, 9 April 2012

ESWT, a treatment option?

Today I am going to have a look at the use of Extracorporeal Shockwave treatment for use with Dupuytren's and Ledderhose. I am not going to do the usual layout for treatments (at least at the moment) as to be honest I am not sure what information there is out there for this kind of treatment.

It is listed on the international Dupuytren's page of treatments where they say that some patients it helps and others it is painful and doesn't help. Remember I am not a doctor and I am trying to draw on my scientific background and papers on the internet to compile this information together.

As a result of the lack of information out there I will mainly be discussing what I have found in the article:

And an abstract I found from what I think is a much earlier paper. 

What is Shockwave treatment?

So from (3) I found that a Shockwave is a sonic pulse where there is high pressure, short life and a broad frequency and that this pulse needs to be focused to be used in the treatment process. This still didn't mean much to me so I had a quick look on the net and for those than don't know the Extracorporeal bit just means out of the body, the shock wave bit as defined here just means the use of "a very short length energy energy wave travelling at faster than the speed of sound". So basically for you and me it is the use of Shockwaves to treat injuries.

What is the idea? 

Well going on what they say in (1) the idea is that the use of shock wave therapy may reduce Dupuytren's contracture and improve hand function. Whether this is just from the Shockwaves bashing the lump/cords or whether it has something to do with the continued waves encouraging blood flow to the area (I read that somewhere about something) I am not sure but the idea sounds good in principle.  

Any Results to speak of? 

Well as a matter of fact this is why I mentioned what I called the old paper, you see this abstract from 1999 has the following conclusion.

"The results were subdivided in degree of contraction, mobility and level of pain. In opposite to the urological experiences we could not see a significant benefit in mobility, pain or degree of the fibromatous contractures. As a conclusion of our results we can not advise the shock wave therapy in the therapy of the Dupuytren's or Ledderhose’s Contracture."

So it would appear that this has been used before and it was proven to not be very useful.

Other useful bits of information from the paper (1).

  • They say that in 69% of Dupuytren's patients that have had radiotherapy and have had a 13 year follow up 69% were still happy with the result (no progression or improvement). In my book this is a good result, if I were to have RT treatment and have a 2/3 chance of still being in a good position in 13 years time that is great. 
  • Local resection of Ledderhose has a 100% recurrence rate. Well nothing we didn't already know here. It doesn't say after how many years but just goes to show that it is silly in my opinion that some places still offer this. 
  • Ledderhose Disease and Dupuytren's disease are commonly found together, especially in patients with diabetes. I knew the first bit but had not heard the second part, luckily they do of course reference a paper which I am sure to check out and report back on if I find anything interesting. 

Ok so that is all for today, check back later as there may be a Gary's Feet logo on the way for the people that are running 5km or 10km to support me. This logo may be adapted to make a Ledderhose blog and I have Ledderhose disease logo as well.

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