Extracorporeal shockwave therapy in musculoskeletal disorders

Extracorporeal shockwave therapy (ESWT) began with an incidental observation of osteoblastic response pattern during animal studies in the mid-1980 that generated an interest in the application of ESWT to musculoskeletal disorders. In the past 10 to 15 years, shockwave therapy had emerged as the leading choice in the treatment of many orthopedic disorders including proximal plantar fasciitis of the heel [1-6], lateral epicondylitis of the elbow [7-10], calcific tendinitis of the shoulder [11,12] and. non-union of long bone fracture [13-15]. More recently, the use of ESWT had expanded to the treatment of patellar tendinopathy (jumper's knee) and Achilles tendinopathy [16-19], and avascular necrosis of the femoral head [20-22]. ESWT has gained significant acceptance from Europe (Germany, Austria, Italy and others) to South America (Brazil, Columbia, Argentina and others), Asia (Korea, Malaysia, Taiwan and others) and North America (Canada and USA), and this had led to the change of European Society for Musculoskeletal Shockwave Therapy to International Society for Musculoskeletal Shockwave Therapy (ISMST) in 2000. In USA, FDA (Food and Drug Administration) first approved the specific shockwave device, OssaTron (High Medical Technology, Lengwil, Switzerland, now Sanuwave/Alpharetta, GA) for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis of the elbow in 2003. FDA also approved Epos (Dornier Medical System, Kennesaw, GA) for the treatment of plantar fasciitis and Sonocur (Siemens Medical Systems, Iselin, NJ) for the treatment of lateral epicondylitis of the elbow in 2002, Orthospec (Medispec, Germantown, MD) and Orbasone (Orthometrix, White Plains, NY) for the treatment of plantar fasciitis in 2005. In the meantime, many off-label uses of ESWT were also studied including calcific tendinitis of the shoulder, patellar tendinopathy, Achilles tendinopathy, and non-union of long bone fracture, avascular necrosis of the femoral head and others. T