While RPW is suitable for treating large areas, focused shockwaves can be concentrated deep inside the body. F-ESWT and RPW may complement each other. The modes of action and the effects of RPW on living tissue may differ from those of focused shockwaves because bioeffects are related to the pressure waveform. Illustration showing the difference in pressure waveform between a shockwave and a radial pressure wave as used in medical applications. Superposition of all pressure pulses and nonlinear effects produce a shockwave at focal region. Each element expands, generating a pressure pulse that propagates toward the center, or focal region, of the arrangement. 1-C) produce shockwaves by a high-voltage discharge across a pattern of piezoelectric elements mounted on the inner surface of a spherical backing that is placed inside a fluid-filled cavity. An acoustic pulse emerges radially, and it is concentrated onto the focus of the system after reflection off the reflector. The membrane is accelerated away from the coil by a magnetic field. The second electromagnetic generation source consists of a cylindrical coil and metallic membrane that is arranged inside a fluid-filled parabolic reflector. The waves are focused by a lens and steepen into a shockwave near the focus. The coil produces a magnetic field, resulting in a sudden deflection of the membrane and generating pressure waves in a fluid. In the first system, a high-voltage pulse is sent through a coil, which is opposite a metallic membrane. 1-B) with flat or cylindrical coils are also used. The plasma expansion generates a shock front, which is reflected off the reflector and focused on a second focus at the target tissue. 1-A) produce a plasma bubble by high-voltage discharge between 2 electrodes in water at the focus closest to a paraellipsoidal reflector. These 2 technologies differ in their generation devices, physical characteristics, and mechanism of action, but they share several indications.Īs shown in Figure 1, the following 3 shockwave-generation principles are used for F-ESWT 6, 7:
Two types of technical principles are included in ESWT-focused ESWT (F-ESWT) and radial pressure waves (RPW), which are often referred to in the literature as radial shockwaves. The purpose of this article was to provide current evidence on the physical and biological principles, mechanism of action, clinical indications, and controversies of ESWT. Increasing evidence suggests that extracorporeal shockwave treatment (ESWT) is safe and effective for treating several musculoskeletal disorders 3 - 5. Its mechanism of action is based on acoustic mechanical waves that act at the molecular, cellular, and tissue levels to generate a biological response 2. Since then, there has been remarkable progress regarding the knowledge of its biological and therapeutic effects. Shockwave therapy was originally developed to disintegrate urinary stones 4 decades ago 1.
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