Shockwave therapy is a relatively new treatment option in orthopedic and rehabilitation medicine. The effect of shockwaves was first documented during World War II when the lungs of castaways were noted to be damaged without any superficial evidence of trauma. It was discovered the shockwaves created by depth charges were responsible for the internal injuries. This created a great deal of interest and research into the biological effects of shockwaves on living tissue. The first medical treatment developed from this research was lithotripsy. This allowed focused shockwaves to essentially dissolve kidney stones without surgical intervention. Today, over 98% of all kidney stones are treated with this technology. The use of shockwaves to treat tendon related pain began in the early 1990s.
A clinical shockwave is nothing more than a controlled explosion that creates a sonic pulse, much like an airplane breaking the sound barrier. The primary effect of a shockwave is a direct mechanical force. The exact mechanism by which shockwave therapy acts to treat tendon pathology is not known. The leading explanation is based on the inflammatory healing response. It is felt the shockwaves cause microtrauma to the diseased tendon tissue. This results in inflammation, which allows the body to send healing cells and increase the blood flow to the injured site.
Shockwaves are used to treat many orthopedic conditions, including plantar fasciitis (heel spurs), patellar tendinitis (jumper’s knee), lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow) and shoulder tendinitis. Multiple studies have been conducted to assess the efficacy of shockwave therapy. Many have shown a positive response versus placebo treatment and others have shown no benefit over placebo. No studies have reported any significant side effects when utilized for orthopedic conditions. Contraindications to shockwave therapy include bleeding disorders and pregnancy.
There are two main types of shockwave machines, low and high energy. High-energy treatments are administered in the operating room with regional or general anesthesia. Low-energy treatments are administered in the clinic and do not require anesthesia or injections. We use a low-energy machine and a technician will place the probe on the area of greatest tenderness and the shockwaves are delivered over 10-20 minutes. Occasionally, patients will relate mild transient discomfort at the treatment site. Patients are usually treated with 3-5 sessions separated by a week. Between treatments, patients are able to perform all normal daily activities. Some patients report immediate pain relief but the healing response usually requires 6-8 weeks. Early results are encouraging and research continues at multiple sites around the country.
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The FAST or focused aspiration of scar tissue procedure is a minimally invasive procedure that removes tendon scar tissue from the elbow and allows you to return to your active lifestyle.
The FAST procedure uses the TX1 Tissue Removal System which is a portable, self-contained device that offers precise removal of diseased tendon tissue for use in the elbow, knee, ankle, foot and shoulder. The TX1 System removes scar tissue with an ultrasonic aspirator which emulsifies and removes soft tissue.
The TX1 Tissue Removal System is comprised of a console, ultrasonic handpiece, tube set, and foot pedal to control the functions of the system. The TX1 interface has four modes of operation including irrigation, aspiration, debridement, and coagulation. The TX1 consolehasa touch-screen interfacefor selection of settings. The handpiece kit consists of a TX1 disposable handpiece, tubing, cartridge, single-use antiseptic and applicator, single-use local anesthesia and syringe, 16-guaze dilator, and single use ultrasonic gel.
The goal of the FAST procedure is to remove diseased tissue around the affected joint and alleviate the patient’s symptoms.
This procedure takes about 20 minutes and is usually performed under local anesthesia to numb the area. Ultrasound is used to identify the exact area of the joint where scar tissue is causing pain. A small cut of less than 5 mm is made in the skin at the elbow. After locating the scar tissue, the TX-1 micro tip is inserted into the skin. The computer console delivers ultrasonic energy through the micro tip to break up the scar tissue. A sterile fluid is injected into the area through a saline delivery system housed in the micro tip. A hollow needle also within the micro tip pulls out the fluid along with the emulsified scar tissue. After the scar tissue is removed, the tiny opening is closed with an adhesive bandage.
Following the procedure you will be allowed to go home.If you experience any discomfort, your doctor will recommend over the counter pain medications. You should avoid any weight-bearing activities for at least 2 weeks after the procedure. After undergoing FAST procedure, you may be asked to follow certain instructions depending on your condition, type of your work and lifestyle. Most people can returnto work and theactivitiesof daily living without the use of prolonged medications and physical therapy.
Benefits of FAST procedure include:
- Faster recovery
- Less pain
- Early return to normal activities
- Requires less surgical time
- Low risk of infection
The FAST procedure is designed to remove the source of pain faster and safer than traditional open surgery. The FAST procedure is an innovative and effective treatment option for patients with tendon related injuries. This new treatment option delivers excellent outcomes and improved quality of life to patients.
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