Low-Energy Versus Middle-Energy Extracorporeal Shockwave Therapy for Treating Pes Anserine Bursitis
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Abstract
Introduction: Pes anserine bursitis (PAB) is a painful status inside the knee that may interfere with functional activities. Extracorporeal shockwave therapy (ESWƬ) may treat this disorder.
Objective: Comparing the effects of low- versus middle-energy ESWƬ on pain and functional activity in patients with sub-acute PAB.
Materials and Methods The study was a single-blind randomized trial. Twenty-eight patients with sub-acute PAB were randomly divided into two groups and received either low or middle-energy ESWƬ for three weeks. The numeric pain rating scale (NPRS), short-form McGill pain questionnaire (SF-MPQ), timed up and go (TUG) test, and Western Ontario and McMaster universities index (WOMAC) were evaluated before and 2 and 3 weeks after the intervention.
Results: A significant improvement was observed for low-energy ESWT in terms of NPRS (P=0.001), SF-MPQ (P<0.001), WOMAC (P<0.001), and TUG (P<0.001) 3 weeks after the intervention. Also, a significant improvement was observed following middle-energy ESWT application on NPRS (P=0.003), SF-MPQ (P<0.001), WOMAC (P<0.001), and TUG (P<0.001) 3 weeks after the intervention. A similar trend was observed between study time points and for all variables in each group. The only exception was the TUG, which showed no improvement between 2 and 3 weeks after the intervention for each study group. A significant improvement was observed in the NPRS between the two groups after 2 weeks (P=0.001) and 3 weeks (P=0.006), both favoring the middle-energy ESWT application.
Conclusion: Low- and middle-energy ESWT can effectively improve pain, functional activity, and mobility in patients with PAB.
Rennie WJ, Saifuddin A. Pes anserine bursitis: Incidence in symptomatic knees and clinical presentation. Skeletal Radiology. 2005; 34(7):395-8. [DOI:10.1007/s00256-005-0918-7] [PMID]
Huang TW, Wang CJ, Huang SC. Polyethylene-induced pes anserinus bursitis mimicking an infected total knee arthroplasty: A case report and review of the literature. The Journal of Arthroplasty. 2003 ; 18(3):383-6. [DOI:10.1054/arth.2003.50062] [PMID]
Osman MK, Irwin GJ, Huntley JS. Swelling around a child's knee. Clinical Anatomy. 2011; 24(7):914-7. [DOI:10.1002/ca.21184] [PMID]
Alvarez-Nemegyei J, Canoso JJ. Evidence-based soft tissue rheumatology IV: Anserine bursitis. Journal of Clinical Rheumatology. 2004; 10(4):205-6. [DOI:10.1097/01.rhu.0000135561.41660.b0] [PMID]
Helfenstein M Jr, Kuromoto J. [Anserine syndrome (English, Portuguese)]. Revista Brasileira de Reumatologia. 2010; 50(3):313-27. [DOI:10.1590/S0482-50042010000300011] [PMID]
Mohseni M, Mabrouk A, Li DD, Graham C. Pes anserine bursitis. Treasure Island: StatPearls Publishing; 2024. [Link]
Saggini R, Di Stefano A, Dodaj I, Scarcello L, Bellomo RG. Pes Anserine Bursitis in Symptomatic Osteoarthritis Patients: A mesotherapy treatment study. The Journal of Alternative and Comlementary Medicine. 2015, 21(8):480–4. [PMID]
Ariff MAM, Ros MIAC, Yahaya NHM. Painful pes anserine bursitis following total knee replacement surgery: Two cases. Sultan Qaboos University Medical Journal. 2018; 18(1):e97-9. [DOI:10.18295/squmj.2018.18.01.016] [PMID] [PMCID]
Uysal F, Akbal A, Gökmen F, Adam G, Reşorlu M. Prevalence of pes anserine bursitis in symptomatic osteoarthritis patients: An ultrasonographic prospective study. Clinical Rheumatology. 2015; 34(3):529-33. [DOI:10.1007/s10067-014-2653-8] [PMID]
Wood LR, Peat G, Thomas E, Duncan R. The contribution of selected non-articular conditions to knee pain severity and associated disability in older adults. Osteoarthritis and Cartilage. 2008; 16(6):647-53. [DOI:10.1016/j.joca.2007.10.007] [PMID]
Imani F, Rahimzadeh P, Abolhasan Gharehdag F, Faiz SH. Sonoanatomic variation of pes anserine bursa. The Korean Journal of Pain. 2013; 26(3):249-54. [DOI:10.3344/kjp.2013.26.3.249] [PMID] [PMCID]
Alvarez-Nemegyei J. Risk factors for pes anserinus tendinitis/bursitis syndrome: A case control study. Journal of Clinical Rheumatology. 2007; 13(2):63-5. [DOI:10.1097/01.rhu.0000262082.84624.37] [PMID]
Sapp GH, Herman DC. Pay attention to the pes anserine in knee osteoarthritis. Current Sports Medicine Reports. 2018; 17(2):41. [DOI:10.1249/JSR.0000000000000449] [PMID]
Sarifakioglu B, Afsar SI, Yalbuzdag SA, Ustaömer K, Bayramoğlu M. Comparison of the efficacy of physical therapy and corticosteroid injection in the treatment of pes anserine tendino-bursitis. Journal of Physical Therapy Science. 2016; 28(7):1993-7. [DOI:10.1589/jpts.28.1993] [PMID] [PMCID]
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: A systematic review of randomized controlled trials. The American Journal of Sports Medicine. 2004; 32(1):251-61. [DOI:10.1177/0363546503260757] [PMID]
Dykstra JH, Hill HM, Miller MG, Cheatham CC, Michael TJ, Baker RJ. Comparisons of cubed ice, crushed ice, and wetted ice on intramuscular and surface temperature changes. Journal of Athletic Training. 2009; 44(2):136-41. [DOI:10.4085/1062-6050-44.2.136] [PMID] [PMCID]
Brookler MI, Mongan ES. Anserina bursitis. A treatable cause of knee pain in patients with degenerative arthritis. California Medicine. 1973; 119(1):8-10. [PMID] [PMCID]
Homayouni K, Foruzi S, Kalhori F. Effects of kinesiotaping versus non-steroidal anti-inflammatory drugs and physical therapy for treatment of pes anserinus tendino-bursitis: A randomized comparative clinical trial. The Physician and Sportsmedicine. 2016; 44(3):252-6. [DOI:10.1080/00913847.2016.1199251] [PMID]
Nakamura K, Arai S, Tozawa R. [Result of treatment of Pes Anserinus tendinopathy syndrome using radial pressure wave therapy—72 cases-84 knees-and changes in pain status before and after treatment (Japanese)]. Journal of Electrophysical Agents. 2023; 30(1):50-6. [Link]
Chaussy C, Eisenberger F, Forssmann B. Extracorporeal shockwave lithotripsy (ESWL): A chronology. Journal of Endourology. 2007; 21(11):1249-53. [DOI:10.1089/end.2007.9880] [PMID]
Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. Journal of Orthopaedic Surgery and Research. 2012; 7:11. [DOI:10.1186/1749-799X-7-11] [PMID] [PMCID]
Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles, Ligaments and Tendons Journal. 2012; 2(1):33-7. [PMID] [PMCID]
Ogden JA, Tóth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clinical Orthopaedics and Related Research. 2001; (387):8-17. [DOI:10.1097/00003086-200106000-00003] [PMID]
Magosch P, Lichtenberg S, Habermeyer P. [Radial shock wave therapy in calcifying tendinitis of the rotator cuff--A prospective study (German)]. Zeitschrift Fur Orthopadie und Ihre Grenzgebiete. 2003; 141(6):629-36.[DOI:10.1055/s-2003-812407] [PMID]
Speed C. A systematic review of shockwave therapies in soft tissue conditions: Focusing on the evidence. British Journal of Sports Medicine. 2014; 48(21):1538-42. [DOI:10.1136/bjsports-2012-091961] [PMID]
Albert JD, Meadeb J, Guggenbuhl P, Marin F, Benkalfate T, Thomazeau H, et al. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: A randomised trial. The Journal of Bone and Joint Surgery. British Volume. 2007; 89(3):335-41. [DOI:10.1302/0301-620X.89B3.18249] [PMID]
Ioppolo F, Tattoli M, Di Sante L, Venditto T, Tognolo L, Delicata M, et al. Clinical improvement and resorption of calcifications in calcific tendinitis of the shoulder after shock wave therapy at 6 months' follow-up: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2013; 94(9):1699-706. [DOI:10.1016/j.apmr.2013.01.030] [PMID]
Mouzopoulos G, Stamatakos M, Mouzopoulos D, Tzurbakis M. Extracorporeal shock wave treatment for shoulder calcific tendonitis: A systematic review. Skeletal Radiology. 2007; 36(9):803-11. [DOI:10.1007/s00256-007-0297-3] [PMID]
Verstraelen FU, In den Kleef NJ, Jansen L, Morrenhof JW. High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: Which is superior? A meta-analysis. Clinical Orthopaedics and Related Research. 2014; 472(9):2816-25. [DOI:10.1007/s11999-014-3680-0] [PMID] [PMCID]
Poenaru D, Sandulescu MI, Cinteza D. Biological effects of extracorporeal shockwave therapy in tendons: A systematic review. Biomedical Reports. 2023, 18(2):15. [PMID]
Acar N. Low-energy versus middle-energy extracorporeal shockwave therapy for the treatment of snapping scapula bursitis. Pakistan Journal of Medical Sciences. 2017; 33(2):335-40. [DOI:10.12669/pjms.332.12262] [PMID] [PMCID]
Khan KM, Scott A. Mechanotherapy: How physical therapists' prescription of exercise promotes tissue repair. British Journal of Sports Medicine. 2009; 43(4):247-52. [DOI:10.1136/bjsm.2008.054239] [PMID] [PMCID]
Thompson WR, Scott A, Loghmani MT, Ward SR, Warden SJ. Understanding mechanobiology: Physical therapists as a force in mechanotherapy and musculoskeletal regenerative rehabilitation. Physical Therapy. 2016; 96(4):560–9. [PMID]
Mittermayr R, Hartinger J, Antonic V, Meinl A, Pfeifer S, Stojadinovic A, et al. Extracorporeal shock wave therapy (ESWT) minimizes ischemic tissue necrosis irrespective of application time and promotes tissue revascularization by stimulating angiogenesis. Annals of Surgery. 2011; 253(5):1024-32. [DOI:10.1097/SLA.0b013e3182121d6e] [PMID]
Vetrano M, d'Alessandro F, Torrisi MR, Ferretti A, Vulpiani MC, Visco V. Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes. Knee Surgery, Sports Traumatology, Arthroscopy. 2011; 19(12):2159-68. [DOI:10.1007/s00167-011-1534-9] [PMID]
Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. Journal of Orthopaedic Research. 2003; 21(6):984-9. [DOI:10.1016/S0736-0266(03)00104-9] [PMID]
Ito Y, Ito K, Shiroto T, Tsuburaya R, Yi GJ, Takeda M, et al. Cardiac shock wave therapy ameliorates left ventricular remodeling after myocardial ischemia-reperfusion injury in pigs in vivo. Coronary Artery Disease. 2010; 21(5):304-11. [DOI:10.1097/MCA.0b013e32833aec62] [PMID]
Hausdorf J, Lemmens MA, Kaplan S, Marangoz C, Milz S, Odaci E, et al. Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5. Brain Research. 2008; 1207:96-101. [DOI:10.1016/j.brainres.2008.02.013] [PMID]
Hausdorf J, Lemmens MA, Heck KD, Grolms N, Korr H, Kertschanska S, et al. Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system. Neuroscience. 2008; 155(1):138-44. [DOI:10.1016/j.neuroscience.2008.03.062] [PMID]
Wang CJ, Wang FS, Yang KD, Weng LH, Sun YC, Yang YJ. The effect of shock wave treatment at the tendon-bone interface-an histomorphological and biomechanical study in rabbits. Journal of Orthopaedic Research. 2005; 23(2):274-80. [DOI:10.1016/j.orthres.2004.07.004] [PMID]
Haupt G. Use of extracorporeal shock waves in the treatment of pseudarthrosis, tendinopathy and other orthopedic diseases. The Journal of Urology,. 1997; 158(1):4-11. [DOI:10.1097/00005392-199707000-00003] [PMID]
Weihs AM, Fuchs C, Teuschl AH, Hartinger J, Slezak P, Mittermayr R, et al. Shock wave treatment enhances cell proliferation and improves wound healing by ATP release-coupled extracellular signal-regulated kinase (ERK) activation.The Journal of Biological Chemistry. 2014; 289(39):27090-104. [DOI:10.1074/jbc.M114.580936] [PMID] [PMCID]
Frairia R, Berta L. Biological effects of extracorporeal shock waves on fibroblasts. A review. Muscles, Ligaments and Tendons Journal. 2012; 1(4):138-47. [PMID] [PMCID]
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care & Research. 2011; 63(Suppl 11):S240-52. [DOI:10.1002/acr.20543] [PMID]
Melzack R. The short-form McGill pain questionnaire. Pain. 1987; 30(2):191-7. [DOI:10.1016/0304-3959(87)91074-8] [PMID]
Bellamy N. Pain assessment in osteoarthritis: Experience with the WOMAC osteoarthritis index. Seminars in Arthritis and Rheumatism. 1989; 18(4 Suppl 2):14-7. [DOI:10.1016/0049-0172(89)90010-3] [PMID]
Angst F, Aeschlimann A, Steiner W, Stucki G. Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Annals of the Rheumatic Diseases. 2001; 60(9):834-40. [Link]
Ryser L, Wright BD, Aeschlimann A, Mariacher-Gehler S, Stucki G. A new look at the Western Ontario and McMaster Universities osteoarthritis index using rasch analysis. Arthritis Care and Research. 1999; 12(5):331-5. [DOI:10.1002/1529-0131(199910)12:53.0.CO;2-W] [PMID]
Wolfe F, Kong SX. Rasch analysis of the Western Ontario MacMaster questionnaire (WOMAC) in 2205 patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Annals of the Rheumatic Diseases. 1999; 58(9):563-8. [DOI:10.1136/ard.58.9.563] [PMID] [PMCID]
Kear BM, Guck TP, McGaha AL. Timed up and go (TUG) test: Normative reference values for ages 20 to 59 years and relationships with physical and mental health risk factors. Journal of Primary Care & Community Healthh. 2017; 8(1):9-13. [DOI:10.1177/2150131916659282] [PMID] [PMCID]
Maffulli G, Padulo J, Iuliano E, Furia J, Rompe J, Maffulli N. Extracorporeal shock wave therapy in the treatment of trochanteric bursitis: The ASSERT database. MLTJ Muscles, Ligaments and Tendons Journal. 2018; 8(3):444-50. [DOI:10.32098/mltj.03.2018.12]
Vitali M, Caforio M, De Bartolomeo O, Pozzi A, Fraschini G, Albisetti W. Extracorporeal shock waves therapy in the treatment of trochanteric bursitis: A pilot study. Medical Rehabilitation. 2009; 13:17-21. [Link]
Acar N, Karaarslan AA, Karakasli A. The effectiveness of extracorporeal shock wave therapy in snapping scapula. Journal of Orthopaedic Surgery. 2017; 25(1):2309499016684723. [DOI:10.1177/2309499016684723] [PMID]
Chahar S, Sharma M. Effectiveness of shockwave therapy along with contrast bath and static achilles stretch in patients with retrocalcaneal bursitis. International Journal of Physical Education, Sports and Health. 2019; 6(4):92-6. [Link]
Khosrawi S, Taheri P, Ketabi M. Investigating the effect of extracorporeal shock wave therapy on reducing chronic pain in patients with pes anserine bursitis: A randomized, clinical- controlled trial. Advanced Biomedical Research. 2017; 6:70. [DOI:10.4103/2277-9175.190999] [PMID] [PMCID]
Toghtamesh M, Bashardoust Tajali S, Jalaei Sh. Comparing between the effects of dry needling and shock wave in the treatment of trapezius myofascial pain. Journal of Modern Rehabilitation. 2020; 14(4):225-32. [DOI:10.18502/jmr.v14i4.7720]
Salvioli S, Guidi M, Marcotulli G. The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: A systematic review with meta-analysis. Foot. 2017; 33:57-67. [DOI:10.1016/j.foot.2017.05.004] [PMID]
Cheng JH, Wang CJ. Biological mechanism of shockwave in bone. International Journal of Surgery. 2015; 24(Pt B):143-6. [DOI:10.1016/j.ijsu.2015.06.059] [PMID]
Simplicio CL, Purita J, Murrell W, Santos GS, Dos Santos RG, Lana JFSD. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. Journal of Clinical Orthopaedics and Trauma. 2020; 11(Suppl 3):S309-18. [DOI:10.1016/j.jcot.2020.02.004] [PMID] [PMCID]
Eftekharsadat B, Jahanjoo F, Toopchizadeh V, Heidari F, Ahmadi R, Babaei-Ghazani A. Extracorporeal shockwave therapy and physiotherapy in patients with moderate knee osteoarthritis. Crescent Journal of Medical & Biological Sciences. 2020; 7(4):518-26. [Link]
| Issue | Vol 18 No 2 (2024) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v18i2.15983 | |
| Keywords | ||
| Shockwave Pes anserine Bursitis Pain Function | ||
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