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Can we use shock wave on patients having a pacemaker?

A cardiac pacemaker is not a contraindication for the Swiss DolorClast method. However, direct exposure of a pacemaker and its wires to shock waves must be avoided at all cost. Accordingly, treatment of the left shoulder should be performed with great care in case the patient has a cardiac pacemaker.

Is a "mild thinning" of the supraspinatus tendon a contraindication?

No, mild thinning of a tendon is not a contraindication for careful and mild use of the Swiss DolorClast method. On the other hand, treatment of pre-ruptured tendons is a contraindication. As a general rule, tendons with a tear of more than 50% of the cross-sectional area must not be treated with shock waves. This is because due to pain relief, the tendon could rupture during augmented physical strain.

Can we use the Swiss DolorClast on erectile dysfunction?

The Swiss DolorClast has not yet been approved for the treatment of erectile dysfunction. This is because there is no sufficient clinical evidence to predict a good treatment outcome with a high enough probability.

Women who have had a mastectomy, with or without axillary node clearance often develop a frozen shoulder - either fairly soon after surgery or a few months to a year later. Would ESWT help in this situation?

A real frozen shoulder cannot be successfully treated with shock waves; this indication requires manual mobilization (under general anesthesia). On the other hand, it should be carefully evaluated whether the patient really suffers from a frozen shoulder. If there is only partial immobilization, treatment with the Swiss DolorClast method can substantially improve the situation. Other women may experience pain during shoulder movements because of an incipient or existing secondary lymphedema (due to resection of regional lymph nodes as part of the mastectomy surgery). The Swiss DolorClast is approved for the treatment of primary and secondary lymphedema, and good results were reported by Prof. Sandro Michelini (Rome, Italy).

Is there a risk of lymphedema from ESWT treatment if there is no lymphedema in the first place? If the patient already has lymphedema, would ESWT help? Does the treatment parameter depend on whether the patient has had full axillary lymph node dissection or just the sentinel nodes removal?

Development of lymphedema due to shock wave treatment has never been reported. The treatment of lymphedema with the Swiss DolorClast method has been reported to be efficient and safe in the literature15. The Swiss DolorClast is approved for this indication. It does not matter whether the patient has had full axillary node clearance or just the sentinel nodes removed; what is relevant is the clinical picture (i.e. the development of a secondary lymphedema). As a rule, the earlier the treatment is started, the better the outcome.

15) Michelini S, Failla A, Moneta G, et al.: Treatment of primary and secondary lymphedema with shockwave therapy. Eur J Lymphol 2008;19:10.

Is cording a contraindication or does the treatment help in this case?

Cording (axillary web syndrome) is not a contraindication of ESWT. Whether ESWT is successful in this case needs to be established. No data have been reported on the subject so far.

How soon after surgery can ESWT treatment be performed? After surgery, some patients have to delay radiotherapy treatment as they are unable to lift their arm above their head for treatment. Physiotherapy is a good first option but if there is little or no positive response to physiotherapy, is ESWT a useful tool in conjunction with physiotherapy?

There is no clear answer to this question. In any case, ESWT should not interfere with wound healing (although ESWT could improve wound healing after surgery). On the other hand, ESWT can be applied on those parts of the shoulder and arm that are not directly affected by the surgery itself (such as the deltoid and upper trapezius muscles).

Does radiotherapy play any part in the treatment parameters?  What is the timing between radiotherapy and the start of ESWT?

There are no data available to answer this question. Because radiotherapy can damage tissue considerably, no shock waves should be applied to the same tissue during a course of radiotherapy. The time interval between the last radiotherapy session and the first ESWT session should be at least one week in order to prevent potential negative interference between ESWT and healing of radiotherapy-induced tissue damage.

The patient is 8 weeks post-op after a subacromial decompression or rotator cuff repair. Is it OK to have RSWT?

This question cannot be answered without taking the status of the rotator cuff into account. Tendons with a tear of more than 50% of the cross-sectional area must not be treated with shock waves. Accordingly, ESWT after subacromial decompression or rotator cuff repair must be preceded by diligent diagnostic imaging (MRT). If there are no signs of tendon tear of the supraspinatus tendon and rotator cuff, ESWT is possible 8 weeks after subacromial decompression or rotator cuff repair.

A customer was asking about pelvic floor treatment with rESWT. She heard about this treatment for vulvodynia in particular. Can you check for any info/ treatment protocols?

According to Wikipedia, “vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. For the diagnosis to be made symptoms must last at least 3 months. The exact cause is unknown but is believed to involve a number of factors, including genetics, immunology, and possibly diet. Diagnosis is by ruling out other possible causes. This may or may not include a biopsy of the area. Treatment may involve a number of different measures; however, none is universally effective, and the evidence to support their effectiveness is often poor. Some of these measures include improved vulvar care, dietary changes, medications, counselling, and, if conservative treatment is not effective, surgery. It is estimated to affect up to 16% of women.” The Swiss DolorClast method is not approved for this condition because there is no data available demonstrating efficacy and safety when treating this condition.