Shockwaves - again?

Sure that I have covered shockwaves before but today I came across (part of) an article and all I can see is that 2 patients were successfully treated. For now I will wait for results of a more comprehensive study as most other treatment options have 100's of patients that have been treated. 

http://journals.lww.com/jclinrheum/Citation/2017/01000/Plantar_Fascial_Fibromatosis__Two_Cases_Treated.15.aspx

I have looked at this other times in the following posts:

http://ledderhose.blogspot.co.uk/2012/04/eswt-treatment-option.html

http://ledderhose.blogspot.co.uk/2012/10/high-energy-focussed-extracorporeal.html

http://ledderhose.blogspot.co.uk/2014/09/shockwaves-for-dupuytrens-ledderhose.html

Shockwaves for Dupuytren's, Ledderhose and related conditions

Recently I came into contact with a gentleman at Cell Sonic, they manufacture the equipment used to treat with Shock-Waves. This is an interesting treatment which has very little documented evidence. My gut says that this is a treatment that is worth a try. From what I have read it appears that there is very little to lose in terms of side effects or aggravating the condition but it could potentially help. Really what is need is a bigger and better study than the one I discussed before. 

Anyway the guy that I spoke to is extremely passionate about this technology and it was clear to me that he really thought that it could be a great way to treat many different problems. 

Below is a copy of some information that I received from CellSonic and have published with their full permission. If there are any doctors that are interested in using this treatment then please get in touch. I have been told it is a diverse piece of equipment and that it would pay for itself without even taking into account the conditions I am interested in. Then again the person selling it is of course going to say that. 

Doing a bit of research and a quick search of PubMed certainly shows that there is a lot of information out there and it has been used to treat scar tissue and many other conditions. 

http://www.cellsonic-medical.com/cellsonic.htm

Dupuytren's contracture can be almost totally cured using CellSonic’s electro-hydraulic shockwaves. This is a non-invasive, drug free treatment that takes about five minutes. Sudden bursts of sound are directed into the palm and fingers to loosen the tightening cells pulling the fingers. The vital characteristic of a shockwave is that from zero decibels to high must happen in a few nanoseconds. To achieve that, CellSonic flashes 25,000 volts across a one millimeter gap inside water and the sound wave projected through gel into the hand which is also acting as water. The fast moving sound wave hits the tightened cord and stretches it. Moreover, it activates stem cells to migrate to the site because through the nerves the brain has detected a problem and is  instructing white blood cells to make a repair. The patient will feel the shockwaves and it will be uncomfortable, some would say painful, but do tolerate it because the nerves are sending a necessary message to the brain. An anesthetic would block that message and the immune system will not be activated. The fastest rise time of decibels is achieved with the CellSonic machine so fewer shocks and fewer treatments are needed. The recommendation is for 1,000 shocks at energy level 5 using a shock head focused at 5 mm. Aim the shocks on the area of the palm and the fingers where the tightening is apparent, keeping the shock head sliding gently around on the gel. If another treatment will help, do it two weeks after the first. Improvements are still taking place a year after the last treatment. This is because the shockwaves are causing new cells to grow thanks to the stem cells. Dupuytren's contracture involves similar cell damage to that experienced with plantar fasciitis, Ledderhose Disease and Peyronie’s disease. They can all be treated with the same protocol described above except Peyronies needs fewer shocks at lower energy level.

There are no side effects and that has been proved over the last 40 years because the same technology has been used with much more powerful machines to break kidney stones and millions of patients have been treated without side effects. Other applications with shockwaves include healing wounds because they kill infection, repairing broken bone, treating sports injuries and releasing pain. In Germany, CellSonic shockwaves are being used to reduce cellulite and this will soon be marketed in other countries.

The shockwaves will do two things. Firstly they will damage, soften, loosen and release the tightening tendons and cells which are causing pain and problems. This is an alternative to the scalpel which certainly has side effects.

Secondly, the immune system is triggered because the brain senses that the body has been attacked. It is the immune system that causes new cells to grow and that is achieved by causing stem cells to be released by the pelvic bone where they are stored. It has been shown that zapping the pelvic bone is helpful.

The distributor who can arrange for doctors to try the machine is:

Mark Wilson, Managing Director

Cellsonic Ltd

M            07794822295

E              mark@cellsonic-medical.com

W            www.cellsonic-medical.com

T              @cellsonicESWT

F              https://www.facebook.com/pages/Cellsonic-Ltd/382099131900991

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:

(1) Knobloch et al, 2011, Focusedextracorporeal Shockwave therapy in Dupuytren’s disease –A hypothesis, Medical Hypotheses, Volume 76, Issue 2, May 2011, P635-637.

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

(2) Haist, 1999, THE EXTRACORPOREAL SHOCK WAVE THERAPY IN THE TREATMENT OFTHE DUPUYTREN’S AND LEDDERHOSE’S CONTRACTION, which I found on - International Society for Medical Shockwave Treatment. (3)

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.