Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions.

©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B2. 14253 $2.00 J Bone Joint Surg [Br] 2004;86-B:165-71. Extracorporeal shock waves are focused, single-pressure pulses of microsecond duration. They were first utilised for medical purposes over two decades ago in the treatment of renal calculi by lithotripsy. Soon afterwards shock waves were used in the management of ununited fractures.1,2 In the 1990s extracorporeal shock-wave therapy (ESWT) became popular in Germany for certain soft-tissue disorders, including calcifying tendonitis of the rotator cuff, humeral epicondylitis and plantar fasciitis. It is now employed worldwide for the treatment of musculoskeletal complaints. In the USA the Federal Drug Administration gave permission for its use in the treatment of chronic proximal plantar fasciitis in 2000.3,4 Although ESWT has become increasingly popular there is considerable debate as to its appropriate usage and efficacy. This review addresses issues relating to its use in soft-tissue complaints including the technical features, economic aspects, effects on tissue, potential adverse effects and the current evidence for its use.