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Pain following Shockwave Biceps tendon

I have a therapist using Shockwave for her patient's Bicep tendonitis. Patient tolerates the treatment well, pain reduces for 24 hours and then for the next 48 hours is in a lot of pain. She has not been increasing her activity or doing anything out of the ordinary. Any advice would be appreciated!

Hannah Humphries

1 year ago

Back to General Electrotherapy

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Cliff Eaton
Cliff Eaton

Hi Niki I feel I need to clarify my comments I asked whether the treatment was for superior or distal biceps tendon. I have seen clinicians treating the whole of the anterior deltoid including the area around the subacromial bursa, using RPW, This may well 'upset' the subacromial bursa. I do not feel it is right to 'generalise' and expect there to be an increase in pain symptoms post RPWT. If an analgesic effect is what your desired clinical outcome is then the treatment needs to promote a noxious stimulus. Discussing this with clinicians around the world there appears to be a general consensus of not going higher than a 7/10 on a VAS. In response you body will release Substance P and CGRP, which in turn will promote local vasodilation. This increased local blood flow diminishes the effects of vasoneuroactive substances such as: histamine and prostaglandins. This outcome has been likened to the effects of dry needling (Shah et al., 2008). In my clinical experience, which is supported in the literature patients have an analgesic effect lasting days rather than an increase in pain symptoms. See Anaesth. Pain Med. 2016 1-6(4). So much so that I need to educate my patients about their optimal loading, home exercise programme. As it does not hurt it does not mean it is healed. Therefore do not over do it. I am sure you know what I mean Cliff

Niki Giada
Niki Giada

Honestly, I know that a rise up of pain following an RSWT treatment is normal...

Cliff Eaton
Cliff Eaton

Han I presume this is RPW? can you provide us with the parameters used including transmitter. Also whether it is proximal or distal as they are different tendon types and consideration if there is potential for Bursal involvement (Enthesis Organ, Benjamin et al., 2015) Cliff

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