Ismst 2007 Bursite Quadril

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Ismst 2007 Bursite Quadril

  1. 1. Shockwave Therapy for Trochanteric Bursitis Ana Cláudia Souza Flavia Arkader Paulo Rockett Paulo Santos
  2. 2. Anatomy
  3. 4. Some cases of bursitis happened with tendinosis of the gluteus tendon calcifications and
  4. 5. <ul><li>Collagen degeneration </li></ul><ul><li>Necrosis </li></ul><ul><li>Pseudochondroid metaplasy </li></ul><ul><li>Angiofibroblastic hyperplasia </li></ul><ul><li>vascularisation and inflammatory cells. </li></ul><ul><li>Calcifications </li></ul>Histological Findings
  5. 6. What is the mechanism of shockwave therapy in Hip Bursitis?
  6. 7. Microbiological Theory eNOS PHISYCAL ENERGY Biological Response VEGF PCNA Neo vascular Improved blood supply Bone repair tendon repair Tissue regeneration BMP-2
  7. 8. International Society for Musculoskeletal Shockwave Therapy - ISMST NEWSLETTER
  8. 9. <ul><li>Retrospective study </li></ul><ul><li>Electro hydraulic high-energy device REFLECTRON – HMT </li></ul><ul><li>3 Brazilian Centers </li></ul>
  9. 10. <ul><li>Jun 2002 – Feb 2006 = 44 months </li></ul><ul><li>64 Hips treated </li></ul><ul><li>56 with follow up </li></ul><ul><li>6 bilateral </li></ul><ul><li>41 women – 9 men </li></ul><ul><li>Average age 61: range, 27-79 </li></ul>
  10. 11. Conditions for ESWT of Soft Tissue pathologies <ul><li>Pain for at least 6 months </li></ul><ul><li>Unsuccessful regular conservative therapy over a period of at least 3 months </li></ul><ul><li>unsuccessful surgery </li></ul><ul><li>At least 3 of the following therapies : </li></ul><ul><li>physiotherapy thermotherapy </li></ul><ul><li>infiltration acupunture </li></ul><ul><li>medication immobilization </li></ul><ul><li>electrotherapy neural therapy </li></ul><ul><li>ultrasound low dose X-ray treatment </li></ul>
  11. 12. <ul><li>Inflammatory arthritis and Gout </li></ul><ul><li>Previous corticosteroid injection in the </li></ul><ul><li>last 6 weeks </li></ul><ul><li>Acute infection </li></ul><ul><li>Blood coagulation disorders </li></ul><ul><li>Pregnancy </li></ul><ul><li>Neurological Abnormality </li></ul><ul><li>Tumor </li></ul>
  12. 13. Diagnosis <ul><li>Medical history and clinical presentation </li></ul><ul><li>X-ray </li></ul><ul><li>Ultrasound </li></ul><ul><li>MRI </li></ul>
  13. 14. <ul><li>X -rays and ultrasound : before treatment, 90 and 180 days after </li></ul><ul><li>Patients were review ed at 45 , 90 and 180 days </li></ul><ul><li>Evaluation of subjective pain by visual analog scale (VAS) </li></ul><ul><li>Roles and Maudsley score </li></ul>
  14. 15. Roles and Maudsley score Grade 1 E xcellent no pain, full movement and activity Grade 2 Good occasional pain, full movement and activity Grade 3 A cceptable some discomfort after prolonged activity Grade 4 Poor pain limiting activity
  15. 16. Protocol Application One application Local Anaesthesia 1200 impulses Energy flux 0.130 to 0.144 mJ/mm² Reapplication after 3 months of follow-up
  16. 17. 56 Trochanteric Bursitis No significant adverse affect was observed Treatments Cases 45 days 90 days 180 days 1 52 68% 76% 83% 2 4 63% 73% 88% 3 0
  17. 18. <ul><li>Complications </li></ul><ul><li>Local swelling </li></ul><ul><li>Local hematoma </li></ul><ul><li>Petechial hemorrhage </li></ul>
  18. 19. Final Results Roles and Maudsley score
  19. 20. Final Results – 180 days Roles and Maudsley score 50 / 89% 49 = No corticosteroide Injection 7 = Corticosteroide Injection
  20. 21. Final Results – 180 days Roles and Maudsley score 6 cases=poor or acceptable
  21. 22. Previous Corticosteroid Injection Excellent / Good Poor / Acceptable 6 <ul><li>Previous corticoid injection treatment doesn’t change ours results </li></ul>
  22. 23. CONCLUSION <ul><li>ESWT must be considered as an alternative in the treatment of chronic trochanteric bursitis . </li></ul><ul><li>ESWT presents advantages for not being invasive, not presenting significant complications beyond lesser operational costs; more over preventing the significant potential risks described in the literature of the traditional surgical procedures. </li></ul>
  23. 24. Muito Obrigada
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