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39

 

calcium deposits in 57.6%, partial elimination or fragmentation in 15.1%, and unchanged 
in 27.3% for the shockwave group. For the control group, the calcium deposit was frag-
mented in 1 (16.7%) and unchanged in 5 (83.3%). None showed recurrence of calcium 
deposit 2 years after shockwave therapy. There was a correlation of functional improve-
ment with the elimination of calcium deposit [

94

]. Jurgowski and Loew treated patients 

with two sessions of 2,000 impulses each of shockwave and reported a marked reduction 
of symptoms with an average of 30% improvement in the Constant score at the 12

-

week 

follow

-

up. Radiographs showed complete elimination of the calcification in seven pa-

tients, and partial elimination in five patients. Magnetic resonance imaging did not show 
any lasting damage to bone or soft tissue [

95

, 

96

]. Rompe et al reported significant im-

provement in 72.5% of the patients and only six (15%) of 40 patients treated with 1,500 
impulses of shockwaves reported no improvement. Complete or partial disintegration of 
the calcium deposits was observed in 62.5% of the patients [

74

]. In another study, Rompe 

et al reported that shockwave therapy provides equal or better results than surgery in pa-
tients with calcifying tendonitis of the shoulder [

97

].

 

Patellar tendinopathy (Jumper's knee) and Achilles tendinopathy

 

Several studies have reported favorable results of shockwave therapy in athletes with 
Jumper's knee (patellar tendinopathy) with the success rate ranged from 73.5% to 87.5% 
[

16

, 

19

, 

43

, 

98

, 

99

, 

100

]. ESWT was also utilized in patients with patellar tendinopathy 

secondary to harvesting of the patellar tendon for ACL reconstruction. Wang et al com-
pared 30 knees in 27 patients treated with ESWT with 

24 knees in 23 patients treated con-

servatively, the results at 2

-

 to 3

-

year follow

-

up showed 43% excellent, 47% good, 10% 

fair and none poor for the study group, and none excellent, 50% good, 25% fair and 25% 
poor for the control group (

P

 < 0.05). Ultrasonographic examination showed a significant 

increase in the vascularity of the patellar tendon and a trend of reduction in the patellar 
tendon thickness after ESWT as compared to conservative treatments [

43

]. Peers KH et al 

compared 13 knees treated surgically with 15 knees received ESWT, and reported a com-
parable functional outcome in patient with patellar tendinopathy resistant to conservative 
treatments [

100

]. It appears that ESWT is effective in the management of patients with 

chronic patellar tendinopathy.

 

Many studies investigated the effect of ESWT in 

Achilles tendinopathy, 

and most report-

ed favorable results with similar success rate as patellar tendinopathy [

17

, 

18

, 

101

, 

102

, 

103

]. Rompe et al compared 25 patients treated by eccentric stretching exercises with 25 

patients treated with repetitive ESWT, and the results showed that eccentric loading is 
inferior to ESWT in the treatment of patients with chronic recalcitrant Achilles tendi-
nopathy [

101

].

 

ESWT in bone disorders

 

Non

-

union and delayed union of long bone fracture

 

Several studies investigated the effect of shockwave therapy for non

-

union and delayed 

union of long bone fractures, and reported the success rate of achieving bony union 
ranged from 50% to 85% [13, 14, 104, 105, 106, 107, 108, 109, 110]. Schaden et al re-
ported a success of 85% in the treatment of 115 delayed and non

-

unions [106]. Valchanou 

et al [107] reported bony unions in 70 of 82 patients with delayed or chronic nonunion of 

Содержание VIPP

Страница 1: ...CellSonic VIPP Owner s Manual ...

Страница 2: ...2 ...

Страница 3: ...int Pain Osteoarthritis Rheumatoid Arthritis 19 Jumpers Knee Patellar Tendonitis 20 Lower Back Pain 20 Neck Pain 21 Osteomyelitis of the Jaw Bones 22 Peripheral Neuropathy 22 Phantom Limb Pain 23 Shoulder Calcification Calcific Tendinitis 23 Shoulder Pain Rotator Cuff inflammation Impingement Syndrome 24 Sprains 25 Tennis Elbow Chronic Lateral Epicondylitis 25 Wounds Chronic non healing 26 Wounds ...

Страница 4: ...endon Sprains Heel spur Joint pain osteoarthritis Dupuytren s contracture Gout Jumper s knee Rheumatoid arthritis Lower back pain Carpal tunnel Tennis elbow Wounds chronic non healing wounds including diabetic ulcers and surgical Phantom limb pain Peripheral neuropathy ...

Страница 5: ...rs changed everything a new era of medicine was born Dornier a German company created that first shockwave medical device to break up kidney stones The energy pulse breaks the sound barrier which results in a pressure pulse which we hear as a sound The event is identical only on a smaller scale to the boom sound made when a plane is flying faster than the speed of sound The effect produced by the ...

Страница 6: ...Piezoelectricity is the creation of voltage across the sides of a crystal when you subject the crystal to mechanical stress In ultrasound equipment a piezoelectric transducer converts electrical energy into extremely rapid mechanical vibrations These ultrasound vibrations can be used for scanning cleaning and all kinds of other things In therapeutic applications this involves a large number of pie...

Страница 7: ...t generates a very intense pressure pulse VIPP These intense pulses are generated at a rate of 4 per second The rise time the amount of time it takes for the pulse to reach maximum pressure is faster than other machines on the market Decades of observation in the therapeutic arena demonstrate that what matters most is the suddenness of the rise time the speed at which the pressure has increased wh...

Страница 8: ...ue such as tendons ligaments and fascia 2 3 ESWT has been found to more effective than transcutaneous electric nerve stimulation TENS therapy for treating chronic calcific tendinitis 4 ESWT has emerged as a favorable treatment modality for erectile dysfunction ED because it offers the possibility of permanent restoration of erectile function The stress and microtrauma triggered by ESWT induces bio...

Страница 9: ...lbow Calcific tendonitis of the shoulder Trochanteric bursitis Myofascial trigger points Dermatology Non healing wounds Chronic diabetic and non diabetic ulcers Psoriasis Toe nail fungus Scars Non union fractures Dupuytren s contracture Erectile dysfunction Peyronie s disease Tendonitis of the iliotibial tract Patellar syndrome Avascular necrosis of the femoral head Other Sports injuries Bone heal...

Страница 10: ... where regenerative effects are desirable especially when some other noninvasive conservative therapies have failed d Agostino MC Craig K et al Shock wave as biological therapeutic tool From mechanical stimulation to recovery and healing through mechanotransduction International Journal of Surgery Dec 2013 M D D O D C D P M D D S D M D Naturopaths ND or NMD Nurse Practitioners Physician Assistants...

Страница 11: ... perhaps because you are working in several different locations you would shake the shockhead at the start of each series of 300 Each shockhead will deliver 50 000 pulses over its lifetime the spark plug wears out Keep new unused shockheads in the refrigerator they keep fresh for 4 months There are 4 different shockheads The diameter of each shockhead is the same However each has a different focal...

Страница 12: ...r the 20mm head because it spreads the pulses over a wider area It seems that for physiotherapy it is less painful on patients For problems closer to the skin surface the 5mm head is often used If the patient says Ouch that is normal However if they are exclaiming consistently because of pain that is too much Treatment of soft tissues cause no pain It is when the pulses hit bone that the treatment...

Страница 13: ...ber of pulses 6 Set the energy level 7 Place the shockhead against the area to be treated and press the start button 8 The shockhead should be moved around the treatment area to change the angle of the wave This also prevents the echo effect of returning waves 9 When treatment is completed remove the cling wrap from the shockhead and dispose of it in a secure bin Provide patients with a towel to r...

Страница 14: ...14 ...

Страница 15: ... scale of the injured area In general a maximum number of pulses will be administered for the very first treatment in the tendon often in more than one area For the second and possibly third and fourth treatment the number of pulses needed per tendon area will decrease as well as the energy setting The first treatment will stimulate tissue growth and the body will then start to heal itself subsequ...

Страница 16: ...to a repetitive use injury DUPUYTREN S CONTRACTURE Aim the shockhead on the area of the palm and the fingers where the tightening is apparent keeping the shockhead sliding gently around on the gel If another treatment will help do it 2 weeks after the first AFTER THE TREATMENT Improvements will continue 1 year after the last treatment because the intense pulses are causing new cells to grow thanks...

Страница 17: ...igrate to the site GOUT With gout you are using CellSonic s VIPP to break up crystals similar to how lithotripsy breaks up kidney stones Use the 5mm shockhead in areas that more superficial 20mm in areas that are deeper If a 5mm or 20mm is not available you can use an infinity shockhead AFTER THE TREATMENT Instruct the patient in a diet for the prevention of further gout symptoms PATIENT INSTRUCTI...

Страница 18: ...NS For the first 4 6 weeks after treatment the patient should walk a little during the day maybe doing only half of what they were used to and trying to build it up slowly getting rid of crutches no cast maybe soft sport shoes No walking on bare feet jumping standing on one spot for too long or sports like tennis etc When the heel is hot cool it with an icepack for 15 to 20 minutes resting the foo...

Страница 19: ...TERVAL BETWEEN TREATMENTS NUMBER OF TREATMENTS AVERAGE 20 mm or Infinity 500 1 000 4 3 weeks 3 to 6 JOINT PAIN OSTEOARTHRITIS RHEUMATOID ARTHRITIS On smaller joints a 5mm or 20mm may be your best choice although the infinity shockhead can be used on most joints It depends how intense you want the pulse to be Bigger joints will require more pulses The CellSonic VIPPs will work to break up scar tiss...

Страница 20: ...cipating in jumping sports such as basketball volleyball or high or long jumping Jumper s knee is occasionally found in soccer players and in rare cases it may be seen in athletes in non jumping sports such as weight lifting and cycling LOWER BACK PAIN First position the patient Have the patient sit on a chair or stool with their back toward you and have the patient point to the area of pain The s...

Страница 21: ...imilar to treating back pain but be careful because you are getting close to the brain First position the patient on a chair or stool with their back toward you Identify the area of pain As you move up and down the spine also work the shockhead a bit from left and right to angle the delivery of pulses between the vertebrae of the spine PATIENT INSTRUCTIONS Instruct the patient on range of motion e...

Страница 22: ...n improves eventually Pain reduces and bones strengthen but it takes time a few months CellSonic can heal and cure problems in the mouth that are impossible by other means because the VIPP generates a healing electromagnetic pulse that travels through bone PERIPHERAL NEUROPATHY Plan to use 500 to 2 000 pulses depending upon the area being treated If you are treating just the foot perhaps just 500 ...

Страница 23: ...e you may wish to offer the patient ear plugs or noise blocking headphones Locations of the calciferous deposits will be determined by palpation or ultrasound AFTER THE TREATMENT The patient should not wear a sling or cast The patient has to stay in motion with his her treated arm shoulder from day one PATIENT INSTRUCTIONS The patient should be instructed in gentle range of motion exercises and co...

Страница 24: ...wish to offer the patient ear plugs or noise blocking headphones PATIENT INSTRUCTIONS Instruct the patient in gentle range of motion exercises Shoulder impingement syndrome also called subacromial impingement painful arc syndrome supraspinatus syndrome swimmer s shoulder and thrower s shoulder is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inf...

Страница 25: ...ONDYLITIS The 5mm head is preferred because this is a superficially located condition Inject a local anesthetic Some patients note improvement with less pain after about a week To become complaint free takes at least 4 to 6 weeks perhaps more About 70 of patients report no more pain after 1 treatment There may be a second treatment after 6 weeks for some patients PATIENT INSTRUCTIONS It is importa...

Страница 26: ...ound until you see closure some close quickly others more slowly Clean the wound thoroughly Old flaky pieces of skin must be removed Apply a non bubbly anti infective agent such as Octenisept that can be left in the wound after treatment Over this lay a sheet of cling wrap such as Saran Wrap to act as a germ barrier Atop the cling wrap spread the ultrasound gel to carry the pressure waves Apply 10...

Страница 27: ...critical short analysis Phlebologie January 2017 In that 2017 study CellSonic VIPP was used on chronic wounds venous and arterial ulcers More than 90 showed a positive response with 41 showing complete healing The use of CellSonic VIPP was found to Influence the cellular morphology of human fibroblasts keratinocytes and dermal microvascular endothelial cells Activate cell migration in fibroblasts ...

Страница 28: ...ary to use an antibiotic because the pressure pulses kill bacteria viruses and fungi AFTER THE TREATMENT Remove the cling wrap and dispose of as a contaminated item Remove as much ointment as possible from the wound and dress the wound appropriately Clean the shockhead thoroughly as usual Treat all wounds as internal wounds Healing happens from inside The pressure pulses cause microscopically inte...

Страница 29: ...29 PATIE NT TREATMENT PROTOCOL WORKSHEET 1 ...

Страница 30: ...30 CELLSONIC TREATMENT PROTOCOL patient name Notes DATE SESSION LOCATION SIZE OF SHOCKHEAD NUMBER OF PULSES ENERGY LEVEL 1 Left shoulder Infinity 1200 6 ...

Страница 31: ...til proven otherwise so do as follows After use the needle must be disposed of properly as medical waste Cover the shockhead with cling wrap There might be no seepage of blood from the fine injection holes but nevertheless prevention is sensible and a courtesy to your patient Not only must you avoid cross infection but the shockhead must not be contaminated and the patient should see that nothing ...

Страница 32: ...e has increased by the time it hits the cells It appears that the very rapid rise time is also what makes CellSonic VIPP a more effective device Because CellSonic VIPP is an electrohydraulic device it can go deeper into the tissues than an electromagnetic piezoelectric or radial device Q Why do I have to keep replacing the shockheads A Because the spark plug wears out after 50 000 shocks This is t...

Страница 33: ... be defective in material or workmanship The shockheads have a shelf life of 4 months beyond which they have no warranty Everything CE marked ISO 13485 2016 and ISO 9001 2017 CellSonic VIPP traces its origins back to the early Dornier machines and the first lithotripter in Britain at St Thomas Hospital in London CellSonic s founder Andrew Hague saw the need for a smaller more versatile electrohydr...

Страница 34: ...nge of European Society for Musculoskeletal Shockwave Therapy to International Society for Musculoskeletal Shockwave Therapy ISMST in 2000 In USA FDA Food and Drug Administration first approved the specific shockwave device OssaTron High Medical Technology Lengwil Switzerland now Sanuwave Alpharetta GA for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis of the elbow i...

Страница 35: ...t shockwave devices the important parameters include pressure distribution energy density and the total energy at the second focal point in addition to the principle of shockwave generation of each device Shockwave pattern differs from ultrasound wave that is typically biphasic and has a peak pressure of 0 5 bar Shockwave pattern is uni phasic with the peak pressure as high as 500 bars 26 In essen...

Страница 36: ...l demonstrated dose related effects of shockwave on rabbit tendo Achilles and suggested that energy flux density of more than 0 28 mJ mm2 should not be used clinically in the treatment of tendon disorders 40 In their study a statistically significant increase of capillary formation was noted with higher energy shock wave 0 60 mJ mm2 which also caused more tissue reaction and potential damage to th...

Страница 37: ...fect of ESWT over placebo on pain function and quality of life 24 Haake M et al compared 135 patients allocated to ESWT with 137 patients allocated to placebo and the results showed that ESWT is inef fective in the treatment of chronic plantar fasciitis 64 In a randomised double blind con trol trial Speed CA et al concluded that no treatment effect of moderate dose of ESWT in subjects with plantar...

Страница 38: ...ted no effect of ESWT or less effect comparable to the placebo 78 79 80 81 82 83 In a review of 9 placebo controlled trials Buchbinder et al concluded that there is platinum level that ESWT provides little or no benefit in term of pain and function in lateral elbow pain There is silver level evidence that steroid injection may be more effective than ESWT 7 78 Haake et al in a review of 20 studies ...

Страница 39: ...ellar tendon for ACL reconstruction Wang et al com pared 30 knees in 27 patients treated with ESWT with 24 knees in 23 patients treated con servatively the results at 2 to 3 year follow up showed 43 excellent 47 good 10 fair and none poor for the study group and none excellent 50 good 25 fair and 25 poor for the control group P 0 05 Ultrasonographic examination showed a significant increase in the...

Страница 40: ...hroplasty THA was performed in 3 and 21 P 0 039 in 1 year 10 and 32 P 0 044 in 2 years and 24 and 64 P 0 002 in 8 to 9 year follow up for the ESWT group and the surgical group respectively Significant improvements in pain and function were noted at each time intervals favoring the ESWT There was a trend of decrease in the size of the lesion in the ESWT group 22 117 In animal experiment in rabbits ...

Страница 41: ...1 7 637 44 10 1007 s00132 002 0323 z 2 Perez M Weiner R Gilley JC Extracorporeal shock wave therapy for plantar fasciitis Clin Podi Med Surg 2003 20 2 323 34 10 1016 S0891 8422 03 00002 8 3 Roehrig GJ Baumhauer J DiGiovanni BF Flemister AS The role of extracorporeal shock wave on plan tar fasciitis Foot Ankle Clin 2005 10 4 699 712 10 1016 j fcl 2005 06 002 4 Strash WW Perez RR Extracorporeal shoc...

Страница 42: ...tment for osteonecrosis of the femoral head comparison of extracorporeal shock waves with core decompression and bone grafting J Bone Joint Surg Am 2005 87 11 2380 7 10 2106 JBJS E 00174 23 Ogden JA Alvarez RG Levitt R Marlow M Shock wave therapy lithotripsy in musculoskeletal disorders Clin Orthop 2001 387 22 40 24 Buchbinder R Ptasznik R Gordon J Buchanan J Prabaharan V Forbes A Ultrasound guide...

Страница 43: ... and antinociceptive neuromediators in patellar tendinopathy Am J Sports Med 2006 34 11 1801 8 10 1177 0363546506289169 45 Chen HS Chen LM Huang TW Treatment of painful heel syndrome with shock waves Clin Orthop 2001 387 41 6 46 Chuckpaiwong B Berkson EM Theodore GH Extracorporeal shock wave for chronic proximal plantar fasciitis 225 patients with results and outcome predictors J Foot Ankle Surg 2...

Страница 44: ...thman AM Ragab EM Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis Arch Orthop Trauma Surg 2010 130 11 1343 7 10 1007 s00402 009 1034 2 66 Yucel I Ozturan KE Demiraran Y Degirmenci E Kaynak G Comparison of high dose extracorporeal shockwave therapy and intralesional corticosteroid injection in the treatment of plantar fasciitis J Am ...

Страница 45: ...1016 j jse 2007 03 023 87 Jakobeit C Winiarski B Jakobeit S Welp L Spelsberg G Ultrasound guided high energy extracorpo real shock wave treatment of symptomatic calcareous tendinopathy of the shoulder ANZ J Surg 2002 72 7 496 500 10 1046 j 1445 2197 2002 02423 x 88 Krasny C Enenkel M Aigner N Wlk M Landsiedl F Ultrasound guided needling combined with shock wave therapy for the treatment of calcify...

Страница 46: ...on of extracorporeal shock waves in the treatment of pseudarthrosis of the lower extremity preliminary results Arch Orthop Trauma Surg 1997 116 480 3 10 1007 BF00387581 109 Rompe JD Rosendahl T Schöllner C Theis C High energy extracorporeal shock wave treatment of nonunions Clin Orthop 2001 387 102 111 110 Schleberger R Senge T Noninvasive treatment of long bone pseudoarthrosis by shock waves ESWL...

Страница 47: ...real shockwave for diabetic foot ulcers J Surg Res 2009 152 96 103 10 1016 j jss 2008 01 026 127 Kuo YR Wang CT Wang FS Chiang YC Wang CJ Extracorporeal shock wave therapy enhanced wound healing via increasing topical blood perfusion and tissue regeneration in a rat model of STZ induced diabetes Wound Repair Reg 2009 17 4 522 30 10 1111 j 1524 475X 2009 00504 x 128 Kikuchi Y Ito K Ito Y Shiroto T ...

Страница 48: ...48 In 2017 a European study using CellSonic VIPP on patients with 75 leg ulcers showed the following results We need to get permission to use this for a commercial use ...

Страница 49: ...49 ...

Страница 50: ...50 ...

Страница 51: ...at admin bestanswerforcancer org Best Answer for Cancer Foundation s mission is to improve the quality of life and treatment of cancer and chronic disease patients with a holistic platform targeted therapies and a patient centered approach Best Answer for Cancer Foundation BAFC believes the best standard of care is one that provides the best quality of life during treatment and the best outlook fo...

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