冲击波疼痛治疗汇总课件

1、RSWT WORKSHOP体外冲击波疗法RSWT WORKSHOP体外冲击波疗法有效治疗范围Radial ExtensionHandpiece 手柄表面，高能流密度surface, high ED0,35 mJ/mm2深度，低能流密度depth, low ED 探头Transmitter在组织中传播spreads in the tissueED: 能流密度ED: energy flux density有效治疗范围Radial ExtensionHandpi生物效应Biological effects声学边界的能量释放Energy release at acoustic boundaries空化

2、作用Cavitation 增加细胞壁的通透性Increase of cell wall permeability刺激微循环（血液、淋巴）Stimulation of Microcirculation (Blood, Lymph) 释放P物质Release of Substance P 减少非髓鞘神经Reduction of unmyelinated nerves释放一氧化氮（血管舒张，细胞新陈代谢增加，血管新生，抗炎作用）Release of Nitric oxide (vasodilation, increased cell metabolism, neoangogenesis, anti-

3、inflammatory effect)抗菌作用Antibacterial effect 刺激生长因子（血管、骨骼、胶原蛋白新生）Stimulation of Growth factors (neogenesis of vessels, bone, collagen)刺激干细胞Stimulation of Stem cells 生物效应Biological effects声学边界的能量释绝对禁忌症ABSOLUTE CONTRAINDICATIONS妊娠Pregnancy血栓症thrombosis血凝固紊乱（血友病）coagulation disorders (haemophilia)肿瘤疾病t

4、umour diseases 急性炎症acute inflammation目标治疗区脓肿pus focus in the target area绝对禁忌症妊娠Pregnancy相对禁忌症RELATIVE CONTRAINDICATIONS抗凝血剂使用者，特别是苯丙香豆素（维生素K拮抗剂） use of anticoagulants, especially marcumar (vitamin k antagonist)有多发性神经病的糖尿病 polyneuropathy in case of diabetes mellitus可的松治疗结束六周后才能使用体外冲击波治疗 cortisone the

5、rapy up to 6 weeks before first ESWT treatment风湿性疾病 rheumatic disease相对禁忌症肿胀swelling变红reddening血肿haematomas瘀点petechiae灼伤般疼痛感pain like sunburn治疗初期病情恶化first worsening副作用SIDE EFFECTS肿胀swelling副作用冲击波治疗的益处Benefits of Shock Wave Treatment 几次治疗后，疼痛即得到缓解/减轻 pain relief/ reduction after a few treating sessio

6、ns 治疗依从性好 the compliance is very good 治疗后病人能直接感受到第一疗效 the patients can feel first effects directly after the treatment 能治疗复杂症状及相关适应症 treatment of complex symptoms/ indications possible冲击波治疗的益处 几次治疗后，疼痛即得到缓解/减轻冲击波治疗的益处Benefits of Shock Wave Treatment治疗结缔组织 treatment of connective tissue活化淋巴系统 activat

7、ion of lymphatic system大面积治疗 treatment of large areas possible作用于神经系统（门控制、疼痛记忆） effects on the nervous system (gate control, pain memory?)冲击波治疗的益处Benefits of Shock Wav经典适应症CLASSIC INDICATIONS经典适应症经典适应症Classic Indications Calcific tendonitis/ shoulder pain钙化性肌腱炎/肩痛Achillodynia 跟腱痛Plantar fasciitis 足底

8、筋膜炎Ulnar humeral epicondylitis肱骨内上踝炎Tibial stress syndrome胫骨压力症候群Radial humeral epicondylitis肱骨外上髁炎Trochanteric tendonitis转子肌腱炎Patellar tendonitis髌腱炎经典适应症Calcific tendonitis/ shou治疗方法 PROTOCOL 查找主要痛点和其他痛点look for the main and other pain points 与病人密切交谈close dialogue with the patient 生物反馈biofeedback 2

9、000次发散式冲击波 radial shocks 2000 多数学派的治疗方法protocol of the most studies 传统派old school新派：联合疗法，治疗扳机点 new: combined therapy, trigger points治疗方法 PROTOCOL 查找主要痛点和其他痛点loo治疗方法PROTOCOL治疗间隔：5-7天 interval5 7days治疗次数：3-5次 sessions3 5最晚在第5次治疗后进入休息期 break latest after 5th session治疗方法治疗间隔：5-7天 钙化肌腱炎/肩痛Calcific tendon

10、itis/Shoulder pain前期超声或X线定位/决定治疗区域与深度Preliminary ultrasound orx-ray localization/ determination of penetration depth and treatment area在皮肤上标记出治疗区域Marking of therapeutic window on the skin在90%的例子中，旋转套的冈上肌腱感染，需要治疗。In approx. 90% of the casesthe supraspinatus tendon of the rotator cuff is affected and

11、has to be treated 钙化肌腱炎/肩痛前期超声或X线定位/决定治疗区域与深度Pre钙化肌腱炎/肩痛Calcific tendonitis/Shoulder pain钙化肌腱炎/肩痛钙化肌腱炎/肩痛Calcific tendonitis/Shoulder pain钙化肌腱炎/肩痛钙化肌腱炎/肩痛Calcific tendonitis/Shoulder pain钙化肌腱炎/肩痛钙化肌腱炎/肩痛Calcific tendonitis/Shoulder pain钙化肌腱炎/肩痛Calcific tendonitis /Shoulder pain 钙化性肌腱炎/肩痛Sessions 治疗次

12、数Energy 能级(bar)Pulses/ session 每次治疗使用脉冲数Freq 频率(Hz)Trans-mitter 探头Supraspinatus tendon 冈上肌腱1. Pain points 痛点3 51.8 4.01500 300012 15R15, DI152. Muscles 肌肉1.8 3.02000 300015 21D20-STreatment interval: 5 - 7day 治疗间隔：5 -7天病人仰卧位 R-SW应用 于腹外侧位Supine patient positioning R-SW application in ventrolateral po

13、sition 钙化性肌腱炎/肩痛Calcific tendonitis/Shoulder pain 仅使用发散性冲击波疗法Only with radial shock wave therapyCalcific tendonitis /ShoulderTenderness in the region of thelateral epicondyle确定上踝侧 位区柔软度Greatest tension is elicited withthe elbow in extension, forearmin pronation, and wrist in flexion肘部外展、前臂转至手掌向下、腕关节

14、弯曲，造成最大张力状态Preliminary ultrasound/x-ray for localization ofepicondyle 前期上踝超声或x线定位Marking of therapy region 标记治疗区域 肱骨外上踝炎Radial humeral epicondylitisTenderness in the region of th肱骨内上髁炎Radial humeral epicondylitis DD肱骨内上髁炎Radial humeral epicondylRadial humeral epicondylitis 肱骨外上髁炎Sessions 治疗次数Energy

15、能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头Tendon insertion (painful spot) 腱附着端（痛点）1. Pain points 痛点5 81.8 4.01500 300012 15R151.8 3.02000 300015 21D20-SAdjacent upper arm and forearm muscles邻近的上臂与前臂的肌肉2. Muscles 肌肉Treatment interval: 5 - 7 days 治疗间隔： 5 - 7天病人仰卧位 肘部弯曲大约130度，手掌向下。R-SW（R1

16、5）应用于腱附着端。接着使用D20-S治疗邻近的上臂与前臂的肌肉。肱骨外上髁炎Radial humeral epicondylitis 仅使用发散性冲击波疗法Only with radial shock wave therapy Radial humeral epicondylitis 肱病人仰卧位-肘关节外展。用V-ACTOR按摩邻近肌肉。Supine patient positioning Extension of elbow joint. Smoothing of surrounding muscles with the V-ACTOR. 肱骨外上髁炎Radial humeral epi

17、condylitisESWT New Treatment Guide病人仰卧位-肘关节外展。肱骨外上髁炎ESWT New TPreliminary ultrasound/x-ray for localization of epicondyle 前期上髁超声或x线定位Marking of therapy region 标记治疗区域肱骨内上髁炎Ulnar humeral epicondylitis ESWT New Treatment GuidePreliminary ultrasound/x-ray Ulnar humeral epicondylitis 肱骨内上髁炎Sessions 治疗次数E

18、nergy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头Tendon insertion (painful spot) 腱附着端1. Pain points 痛点5 81.8 4.01500 300012 15R15Adjacent upper arm and forearm muscles邻近的上臂与前臂的肌肉2. Muscles 肌肉1.8 3.02000 300015 21D20-STreatment interval: 5 - 7 days 治疗间隔：5 - 7 天Supine patient positioning

19、Flexion of elbow joint approx. 30 to 40 degree, supination position. R-SW (R15) application at the tendon insertion. 病人仰卧位 肘关节弯曲大约30-40度，手心向上。R-SW(R15)应用于腱附着端。Supine patient positioning Extension of elbow joint, supination position. Smoothing of forearm muscles with D20-S.病人仰卧位 肘关节外展，手心向上。用D20-S按摩前臂

20、肌肉。 肱骨内上髁炎Ulnar humeral epicondylitis仅使用发散性冲击波疗法Only radial shock wave therapy Ulnar humeral epicondylitis 肱骨肱骨内上髁炎Ulnar humeral epicondylitis病人仰卧位-肘关节外展。用V-ACTOR按摩邻近肌肉。Supine patient positioning Extension of elbow joint. Smoothing of surrounding muscles with the V-ACTOR。肱骨内上髁炎Ulnar humeral epicondy

21、liPreliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超声或X线定位，确定治疗深度Marking of therapy region 标记治疗区域转子肌腱炎Trochanteric Tendonitis ESWT New Treatment GuidePreliminary ultrasound/x-ray 转子肌腱炎Trochanteric Tendonitis DD转子肌腱炎Trochanteric Tendonitis Trochanteric tendonitis 转子肌腱

22、炎Sessions 治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头Tendon insertion 腱附着端1. Pain points 痛点6 82.8 3.52000 300015 21R15, DI15Adjacent muscles 相关肌肉2. Muscles 肌肉2.0 3.52000 400021D20-S, D35-STreatment interval: 5 - 7 days 治疗间隔： 5 - 7天Lateral patient positioning Smoothing of asso

23、ciated muscles with D35.病人侧卧位 用D35按摩相关肌肉。Lateral patient positioning R-SW application (DI15) on the tip of the trochanter, M. piriformis and associated muscles.病人侧卧位 R-SW（DI15）应用于转子尖、梨状肌及相关肌肉。转子肌腱炎 Trochanteric Tendonitis 仅使用发散式冲击波疗法Only radial shock wave therapy Trochanteric tendonitis 转子肌腱炎SPatell

24、ar tendonitis (Jumpers Knee) 髌骨肌腱炎（跳跃膝）Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超声或x线定位，确定治疗深度Marking of therapy region 标记治疗区域Patellar tendonitis (Jumpers 髌骨肌腱炎（跳跃膝）Patellar tendonitis (Jumpers Knee)髌骨肌腱炎（跳跃膝）Patellar tendonitis 髌骨肌腱炎Sessions 治疗次数Energy 能级(ba

25、r)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头Patella, tibial tendon insertion 髌骨、胫骨腱附着端1. Pain points 痛点6 82.8 3.52000 300015 21R15, DI15Adjacent muscles 相邻肌肉2. Muscles 肌肉2.0 3.52000 400021D20-S, D35-STreatment interval: 5 - 7 days 治疗间隔：5 - 7 天Supine patient positioning with the knee on a half

26、 roll. Fixation of patellar zone with a cuff. R-SW (R15) application at the patella (tip, basis) and tibial tendon insertion.病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。R-SW(R15)应用于髌骨（尖部、底部）及胫骨腱附着端。Supine patient positioning with the knee on a half roll. Fixation of paellar zone with a cuff. Smoothing of adjacent m

27、uscles with D20.病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。用D20按摩相邻肌肉。髌骨肌腱炎Patellar tendonitis (Jumpers Knee) 仅使用发散式冲击波疗法Only radial shock wave therapy Patellar tendonitis 髌骨肌腱炎Sessi Preliminary ultrasound/ x-ray 前期超声/X线定位 Marking of therapy region 标记治疗区域胫骨压力综合征（胫骨疲劳性骨膜炎）Tibial stress syndrome (Shin splint) ESWT N

28、ew Treatment Guide Preliminary ultrasound/ x-rayTibial stress syndrome 胫骨压力综合征Sessions 治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头Medial, inner edge of shin bone 胫骨内缘1. Pain points 痛点6 82.8 3.52000 300015 21R15, DI15Adjacent muscles 相邻肌肉2. Muscles 肌肉2.0 3.52000 400021D20-S, D

29、35-STreatment interval: 5 - 7 days 治疗间隔：5 - 7 天Supine patient positioning with knee on a half roll. R-SW application.病人仰卧位，膝盖置于半圆柱形物上。使用R-SW。胫骨压力综合征（胫骨疲劳性骨膜炎） Tibial stress syndrome (Shin splint)仅使用发散式冲击波疗法Only radial shock wave therapy Tibial stress syndrome 胫骨压力综合征跟腱痛AchillodyniaPreliminary ultras

30、ound / x-ray 前期超声/x线定位Marking of therapy region 标记治疗区域跟腱痛Preliminary ultrasound / x-跟腱痛Achillodynia跟腱痛跟腱痛Achillodynia跟腱痛足底筋膜炎Plantar fasciitisPreliminary ultrasound/ x-ray 前期超声/x线定位Localization of pain points withbio-feedback 根据人体生物反馈定位痛点Marking of therapy region 标记治疗区域足底筋膜炎Plantar fasciitisPrelimin

31、足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur足底筋膜炎，跟骨骨刺Plantar fasciitis, H足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur足底筋膜炎，跟骨骨刺Plantar fasciitis, HPlantar fasciitis 足底筋膜炎Sessions 治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头Acute and chronic

32、 pain 急性与慢性疼痛1. Pain points 痛点3 - 52.0 3.03000 350012 15R15, DI152. Muscles 肌肉1.8 3.02000 300015 21D20-SAbdominal patient position with foot on a half roll. R-SW (DI15) application. Localization of patients with bio-feedback.病人腹卧们，脚置于半圆柱形物上。使用R-SW(DI15)。利用生物反馈进行痛点定位。Treatment interval: 5 - 7 days 治疗

33、间隔： 5 - 7天足底筋膜炎Plantar fasciitis 仅使用发散式冲击波疗法Only radial shock wave therapy Plantar fasciitis 足底筋膜炎Session研究Studies研究Improvement %改善度RSW发散式冲击波2 month2个月55.26 month6个月72.912 month12个月84.02000次冲击波，治疗3次，一周一次2000, 3 sessions, 1/ week跟骨骨刺Heel SpurImprovement %改善度RSW发散式冲击波2 m肱骨外上髁炎HERImprovement %改善度Verum冲

34、击波治疗组Control对照组1 week1周73284 weeks4周634852 weeks52周81发散式冲击波，2000次，治疗3次，1周1次RSW, 2000, 3 sessions, 1/ week肱骨外上髁炎HERImprovement %改善度Ver肩袖钙化性肌腱炎Calcific Tendinitis of Rotator Cuff%Pain free 无疼痛感Improvement有明显改善Unchanged无变化Worse恶化4 weeks 4周25.7 54.314.25.73 month 3个月5014.330.710.76 month 6个月59.325.914.8

35、012 month 12个月80.319.2RSW, 5 sessions, 1/ weekCalcium deposit % 钙沉积Gone钙化消失Disintegration分解No Change无变化4 weeks 4周17.620.961.53 month 3个月44.86.948.36 month 6个月65.34.430.412 month 12个月7525RSW, 2000, 3 sessions, 1/ week 发散式冲击波，2000次，治疗3次，1周1次肩袖钙化性肌腱炎Calcific Tendinitis o钙化性肌腱炎，聚焦式冲击波Tendinosis Calcarea

36、, FSWAfter 1 year1年之后反馈Recalcification再钙化5 %OP骨质疏松5 %Resorption骨吸收90 %钙化性肌腱炎，聚焦式冲击波Tendinosis Calca夹挤综合症，聚焦式冲击波Impingement Syndrome, FSWFollow up追踪观察Verum 冲击波治疗组Placebo安慰剂组Mid中期75.4 % good 良好52.3 %Long term长期80.7 %40.9 %夹挤综合症，聚焦式冲击波Impingement SyndrSports-Induced Diseases1 yearfollow up1年后反馈Achillod

37、ynia跟腱痛Patella tip syndrome髌骨尖综合征Tibialis anterior syndrome胫前综合征Pain free 疼痛消失60 %40 %58.8 %Improvement 有改善12.5 %24.4 %17.7 %No change 无明显变化27.5 %35.6 %23.5 %发散式冲击波，治疗5次，1周1次RSW, 5 sessions, 1/ weekSports-Induced Diseases1 yearA肌筋膜疼痛综合症Myofascial pain syndrome扳机点治疗Trigger point treatment肌筋膜疼痛综合症扳机点治

38、疗肌筋膜疼痛综合征Myofascial pain syndrome可用RSWT成功治愈的骨科适应症 Orthopaedic indications which can be treated successfully with RSWT 上位及低位颈部综合征Upper and lower Cervical-Syndrome肩周痛Periarticular shoulder pain前臂屈伸肌腱炎Tendomyosis in the extensor and flexor region of the forearm 上踝病变Epicondylopathy背痛Dorsalgia (Back pain

39、)臀肌痛Glutealgia肌筋膜疼痛综合征Myofascial pain syndro肌筋膜疼痛综合征Myofascial pain syndrome可用RSWT成功治愈的骨科适应症 Orthopaedic indications which can be treated successfully with RSWT 内收肌疼痛Pain in the adductor muscles 股屈伸肌痉挛Shortenings in the femoral flexor and extensor muscles 小腿筋膜间室综合征Peroneal compartment syndrome胫前综合征T

40、ibial anterior syndrome 胫骨压力综合征（胫骨疲劳性骨膜综合征）Tibial stress syndrome (Shin splint)伴有/不伴有跟腱痛的小腿肌肉萎缩Shortening of the calf muscle with and without Achillodynia 跖骨痛Metatarsalgia肌筋膜疼痛综合征Myofascial pain syndro肌筋膜疼痛综合征Myofascial pain syndrome治疗长度Length of treatment取决于肌肉刺激的持续范围和时间Depending on the extent and d

41、uration of the muscle irritation早期疼痛可经过1-2次治疗成功治愈。Early stage complaints can be treated successfully with 1 - 2 treatments sessions 多数案例中，痛点的缓解/解除需要4-8次治疗（一周12次治疗）In most cases several treatment sessions (4 - 8) are required to release/eliminate the pain points (1 -2 treatments / week).建议尽早采用扳机点治疗It

42、 is recommended to start trigger point treatment at the most possible early stage肌筋膜疼痛综合征治疗长度取决于肌肉刺激的持续范围和时间Dep肌筋膜疼痛综合征Myofascial pain syndrome 冲击波治疗的优点Benefits of shock wave therapy 促进组织再生Strong regenerative effect on the tissue可深入组织治疗，而不伤皮肤Penetrate deep inside the tissue without harming the skin

43、因此冲击波操作方便，易于重复治疗。可被大多数患者接受。Therefore shock wave therapy can be easily repeated and is well tolerated by most patients.肌筋膜疼痛综合征Myofascial pain syndro 超声波扫描术Sonography 给病人提供最安全的治疗方案 Gives the patients the most possible treatment safety 可识别不可采用ESWT治疗的结构改变（例如肿瘤） Structural modifications which must not b

44、e treated with RSWT (e.g. tumors) will be recognized肌筋膜疼痛综合征Myofascial pain syndrome 冲击波治疗前的诊断Diagnostics before shock wave therapy 超声波扫描术Sonography肌筋膜疼痛综合征Myofa上位及低位颈部综合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachialgia, dorsalgia and cephalgia 上位及低位颈部综合征Upper and lower CervTrapezius muscl

45、e 斜方肌 Trapezius muscle 斜方肌Sessions治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Trans-mitter 探头Total pulses / treatment 每疗程总脉冲数1. Pain points 痛点4 81.2 3.04000 - 6000 10 15R15, D20-SPulses / trigger point 每扳机点脉冲数2. Pain points 痛点1.2 3.0300 - 100010 15R15, D20-SSmoothing muscles over large area

46、 大面积肌肉按摩3. Muscles 肌肉1.2 2.8200010 21 R15, D20-SRecommended treatment: radial. 使用发散式治疗上位及低位颈部综合征Upper and lower Cervical-Syndrome臂痛、背痛、头痛with brachialgia, dorsalgia and cephalgiaTrapezius muscle 斜方肌 Trapezius半棘肌/夹肌，C3以下Semispinalis/Splenius muscle, caudal C3 上位及低位颈部综合征Upper and lower Cervical-Syndro

47、me 臂痛、背痛、头痛with brachialgia, dorsalgia and cephalgia 半棘肌/夹肌，C3以下Semispinalis/Spleni半棘肌/夹肌，C3以下Semispinalis/Splenius muscle caudal C3 Semispinalis muscle 半棘肌Sessions治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Trans-mitter 探头Total pulses / treatment 每疗程总脉冲数1. Pain points 痛点4 81.2 2.44000 6000

48、 10 15R15, D20-SPulses / trigger point 每扳机点脉冲数2. Pain points 痛点1.2 2.4300 100010 15R15, D20-SSmoothing muscles over large area 大面积肌肉按摩3. Muscles 肌肉1.2 2.2100010 21R15, D20-SRecommended treatment: Radial 使用发散性治疗上位及低位颈部综合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachialgia, dorsalgia and cephal

49、gia 半棘肌/夹肌，C3以下Semispinalis/Spleni三角肌Deltoid muscle 肩周痛Periarticular shoulder pain 三角肌Deltoid muscle 肩周痛Periartic三角肌Deltoid muscle Deltoid muscle 三角肌Sessions治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Trans-mitter 探头Total pulses / treatment 每疗程总脉冲次数1. Pain points 痛点4 81.2 3.04000 6000 10 15

50、R15, D20-SPulses / trigger point 每扳机点脉冲数2. Pain points 痛点1.2 3.0300 100010 15R15, D20-SSmoothing muscles over large area 大面积肌肉按摩3. Muscles 肌肉1.2 2.8100010 21R15, D20-SRecommended treatment: Focused and radial. 使用发散式治疗。肩周痛Periarticular shoulder pain 三角肌Deltoid muscle Deltoid muscforearm muscles 前臂肌Se

51、ssions治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Trans-mitter 探头Total pulses / treatment 每疗程总脉冲次数1. Pain points 痛点4 81.2 2.64000 6000 10 15R15, D20-SPulses / trigger point 每扳机点脉冲数2. Pain points 痛点1.2 2.6300 100010 15R15, D20-SSmoothing muscles over large area 大面积肌肉按摩3. Muscles 肌肉1.2 2.4200010 21R15, D20-SRecommended tr