Detection of joint effusion
Detection of synovial thickening and hypertrophy
Assessment of cartilage lesions
Evaluation of osteophytes and bony cortex involvement
Assessment of periarticular soft-tissue abnormalities in OA (bursitis)
Therapeutic and diagnostic US-guided procedures
Follow-up of the response to local and systemic therapies
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4951794/
https://commons.wikimedia.org/wiki/File:0910_Oateoarthritis_Hip.jpg
檢測關節積液
檢測滑膜增厚和肥大
評估軟骨病變
評估骨刺和骨皮質受影響的情況
評估關節周圍軟組織異常（滑囊炎）
超音波導引下的治療和診斷操作
追蹤局部和系統治療的效果
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4951794/
https://commons.wikimedia.org/wiki/File:0910_Oateoarthritis_Hip.jpg
之前的文章提過
許多病人對於體外震波有一些治療上的迷思
覺得震波的發數越多、效果就越好
而上次的文章也針對震波發數在性功能治療的影響做了文獻上的探討
那麼
一定會有人好奇
震波發數對於軟組織的治療是否也有類似的結果？
雖然目前較缺乏針對不同震波發數在軟組織治療效果的雙盲比較性實驗
然而
的確有研究探討不同震波發數及能量強度在膝骨關節炎的治療效果
這篇論文研究了體外震波治療（rESWT）在不同能量強度及脈衝次數對膝骨關節炎（KOA）疼痛緩解和功能改善的影響
研究分為4個治療組：
低強度（0.12 mJ/mm²）/2000次脈衝、
低強度/4000次脈衝、
高強度（0.24 mJ/mm²）/2000次脈衝、
高強度/4000次脈衝，
以及一個對照組（0.02 mJ/mm² /1000次脈衝）。
所有組別皆接受一週一次、總共4次的治療
而主要的研究結果顯示：
●能量強度對疼痛和功能改善有顯著影響：
－高強度的治療效果明顯優於低強度 。
●脈衝次數對療效的影響較小：
－在疼痛緩解方面，2000次和4000次脈衝的效果無顯著差異，而且就統計圖型來看，2000次在疼痛緩解方面效果略優於4000次。
－在功能改善方面，脈衝次數有一些影響，4000次脈衝略優於2000次 ，但差異並不大。
簡言之，震波的強度比脈衝次數更能影響膝骨關節炎的療效。
●黃醫師點評：
身為疼痛科醫師
我可以理解病患想要追求更好的療效以擺脫疼痛的心情
而體外震波無論在組織修復或降低疼痛
都是一個很好的治療工具
然而
患者應該理解
在軟組織方面
治療成功的關鍵在於適當的衝擊強度
而非盲目增加脈衝次數
過度強調脈衝次數可能不僅無法提升療效
還可能增加不必要的治療時間和費用
實際上
研究中建議的中等強度治療（0.12至0.24 mJ/mm²）已經能夠有效緩解疼痛並改善功能
且更容易被病患耐受
對於軟組織疾病的治療
不必迷信「更多脈衝次數等於更好效果」
適度的治療
往往可以達到最佳效果
也是治療成功的關鍵！
In the previous article, it has been mentioned that many patients have misconceptions about extracorporeal shock wave therapy (ESWT), believing that more shock wave pulses lead to better outcomes.
The article also discussed the effects of pulse count in the treatment of erectile dysfunction based on literature.
Naturally, there will be questions about whether the number of pulses also yields similar results in soft tissue treatments.
Currently, there is a lack of double-blind comparative studies specifically examining the effects of different pulse counts in soft tissue treatments.
However, there is indeed a study exploring the treatment effects of varying pulse counts and energy intensities in knee osteoarthritis (KOA).
This paper investigated the impact of extracorporeal shock wave therapy (rESWT) at different energy intensities and pulse counts on pain relief and functional improvement in KOA.
The study divided participants into four treatment groups:
low intensity (0.12 mJ/mm²) with 2000 pulses, low intensity with 4000 pulses, high intensity (0.24 mJ/mm²) with 2000 pulses, and high intensity with 4000 pulses, along with a control group (0.02 mJ/mm² with 1000 pulses).
All groups received treatment once a week for a total of four sessions.
The main findings of the study showed that:
●Energy intensity significantly affects pain relief and functional improvement: high-intensity treatment was clearly more effective than low-intensity.
●The pulse count had a relatively minor impact on treatment efficacy:
－there was no significant difference in pain relief between 2000 and 4000 pulses, and statistically, the 2000 pulses showed slightly better results for pain relief than 4000.
－In terms of functional improvement, pulse count had some influence, with 4000 pulses performing slightly better than 2000, but the difference was not substantial.
In summary, the intensity of the shock waves has a greater influence on the effectiveness of treatment for knee osteoarthritis than the number of pulses.
Commentary from Dr. Huang:
As a pain management physician, I understand patients’ desire to pursue better outcomes to alleviate pain.
Extracorporeal shock wave therapy is indeed a valuable tool for tissue repair and pain reduction.
However, patients should understand that in soft tissue treatment, the key to successful therapy lies in the appropriate intensity of the shock waves rather than blindly increasing the number of pulses.
Overemphasizing pulse counts may not only fail to enhance efficacy but could also lead to unnecessary treatment time and costs.
In reality, the moderate intensity treatments suggested in the study (0.12 to 0.24 mJ/mm²) can effectively relieve pain and improve function, making them more tolerable for patients.
When it comes to treating soft tissue conditions, it is important not to blindly believe that "more pulses equal better outcomes."
Appropriate treatment often leads to optimal results, which is key to successful therapy!
The following content is excerpted fromBest practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration
【肌腱】
●減少肌腱內的水腫和發炎細胞浸潤
●透過機械刺激轉化為生化訊號進行組織再生
●增加轉化 beta-1 生長因子和類胰島素生長因子 I （insulin‐like growth factor I ）的濃度，以刺激肌腱細胞和膠原蛋白增殖（對癒合很重要）
●Scleraxis轉錄因子上調（促進肌腱生長和發育）：
－抗發炎細胞因子的增殖
－腱源性肌腱細胞的增生和遷移增加
－金屬蛋白酶表現減少（可以降解膠原蛋白的酵素）
－減少發炎性白細胞介素
【骨頭】
●蛋白質上調--> 可能增強骨骼的血管生成和新血管形成
●透過生長因子的釋放進行成骨和骨重塑
－骨形態發生蛋白2 (Bone morphogenic protein 2)
－血管內皮生長因子
●促進骨膜骨形成
－破骨細胞活性降低
－成骨細胞活性增加
【關節（膝）】
●減少發炎
●減少水腫
●軟骨下骨（subchondral bone）結構的改善
●軟骨細胞活性增加（軟骨修復）
【痙攣】
●減少肌肉和神經肌肉接合處的痙攣
●降低結締組織（肌肉層面）的僵硬性
●刺激一氧化氮的合成
－神經肌肉接合處（Neuromuscular junction）的形成
－新生血管形成
有關體外震波的原理，請參照這篇文章
For the principles of ESWT, please refer to this article.
