The Electrophysical Forum aims to provide an interactive platform for questions, comments, discussion and opinion related to the use of Electro Physical modalities in therapy. It is supported by an Internationally renowned expert panel and a broad sphere of clinicians, researchers, educators and students. Active participation is welcomed.

Sign up to start posting >>>

Ask a question and get it answered by your peers and respected experts

Answer a question and be recognised, raising your international profile



Create a link to us from your website, blog or social media platform.


Wriiten consent for ESWT?

We (ABMU Health board)take written consent from all our patients pre ESWT due to the reported risk of tendon rupture. However, to date we have not had any complications. Getting the written consent takes up a lot of the consultation time, and we are considering removing it. What are your thoughts please?

Anne-Marie Hutchison

4 months ago

Back to General Electrotherapy

Post a reply

672 views

Cliff Eaton
Cliff Eaton

Dear Anne-Marie In our clinical we provide the patient with a leaflet on ESWT informing them of what ESWT can and cannot be used for and also the potential side effects that you mentioned. This provides informed consent. Written consent is provided when registering at our practice including all our interventions I have to say some of the side effects eg Petechiae and swelling can be avoided by using plenty of gel. Shockwaves travel well through water and not through air. Therapists, in my experience, tend to be very stingy with gel, which is relatively inexpensive! Cliff

Anne-Marie.hutchison210
Anne-Marie.hutchison210

Hi All,

Thank you for your comments. I can comfirm that we use radial ESWT.

Our F and A consultant asked us to take the written consent. Her concern was in relation to the NICE public guidelines, please see below.

Benefits and risks

The studies showed that the risks of the procedure included skin reddening, bruising, pain, calf ache and numbness. These were all temporary symptoms that got better with time. In 2 patients the Achilles tendon broke 2 weeks after the procedure, but this can also happen when the procedure has not been used.

Prof Tim Watson
Prof Tim Watson

The literature on shockwave and linked with 'rupture' is primarily concerned (a) with focused energy delivery and (b) linked to kidney issues (where the treatments were first used). Recent literature - e.g. Schwartz, A., et al. (2015). "Patellar Tendinopathy." Sports Health 7(5): 415 identifies a significant risk with corticosteroid injection, but not with shockwave. Notarnicola + Moretti (2012 The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue." Muscles Ligaments Tendons J 2(1):33) provide useful insight re the mechanisms. Lots of studies mention tendon rupture. In the Fridman paper (J Am Podiatr Med Assoc 98(6): 466-468) cases are reported but not only on the treatment group. I can see no overt evidence of increase risk of tendon rupture AS a DIRECT result of the shockwave intervention (certainly not in radial mode). There are cases of rupture in many tendinopathy studies - and as others have pointed out, this relates to the pathology, the concomitant issues that the patients have - overweight, diabetes etc - but if there is a direct relationship between radial shockwave and increased risk to tendon rupture, I have missed it.

lochingai197
lochingai197

Is the risk of tendon rupture due to ESWT or the pathology?

The case reports I read about tendon tear after ESWT were mainly chronic calcified Achilles Tendinopathy.

If it is a general risk of ESWT, we may need that informed consent. But if it is due to the pathology, then we should have the guideline for the clinician to give precaution instead.

L.Laakso335
L.Laakso335

I agree. An important question nevertheless, in a time when risk is being considered almost as highly as benefit.

Dr Sandy Rennie
Dr Sandy Rennie

I would agree with Professor Watson. With radial ESWT I believe it is important to inform the patient of the risks (somewhat painful, feeling of strong tapping/pins & needles) and the benefits (potential reduction in the tendinopathy symptoms) of the treatment. However I have not read anywhere that tendon rupture with low doses is a risk. Cheers, Sandy

Prof Tim Watson
Prof Tim Watson

are you using radial or focused shockwave in your treatments? The reported risk of tendon rupture is - as I read the evidence - very low if the treatment doses are appropriate and treatment protocol follows best evidence. Personal opinion is that written consent is no more necessary for this intervention than any other bout would be interested to know what others think. Tim

1-8 of 8

Reply to this discussion

You cannot edit posts or make replies: