title: Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system.
abstract: Application of extracorporeal shockwaves (ESW) to the musculoskeletal system may induce long-term analgesia in the treatment of chronic tendinopathies of the shoulder, heel and elbow. However, the molecular and cellular mechanisms behind this phenomenon are largely unknown. Here we tested the hypothesis that long-term analgesia caused by ESW is due to selective loss of nerve fibers in peripheral nerves. To test this hypothesis in vivo, high-energy ESW were applied to the ventral side of the right distal femur of rabbits. After 6 weeks, the femoral and sciatic nerves were investigated at the light and electron microscopic level. Application of ESW resulted in a selective, substantial loss of unmyelinated nerve fibers within the femoral nerve of the treated hind limb, whereas the sciatic nerve of the treated hind limb remained unaffected. These data might indicate that alleviation of chronic pain by selective partial denervation may play an important role in the effects of clinical ESW application to the musculoskeletal system.
authors.affiliation: Department of Orthopaedic Surgery, University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hausdorf
authors.forename: M A M
authors.initials: MA
authors.lastname: Lemmens
authors.forename: K D W
authors.initials: KD
authors.lastname: Heck
authors.forename: N
authors.initials: N
authors.lastname: Grolms
authors.forename: H
authors.initials: H
authors.lastname: Korr
authors.forename: S
authors.initials: S
authors.lastname: Kertschanska
authors.forename: H W M
authors.initials: HW
authors.lastname: Steinbusch
authors.forename: C
authors.initials: C
authors.lastname: Schmitz
authors.forename: M
authors.initials: M
authors.lastname: Maier
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D004195:Disease Models, Animal; D004597:Electroshock / Q000009:adverse effects*; D005260:Female; D005269:Femur / Q000473:pathology / Q000528:radiation effects; D046529:Microscopy, Electron, Transmission / Q000379:methods; D009141:Musculoskeletal System / Q000528:radiation effects*; D036421:Nerve Fibers, Unmyelinated / Q000473:pathology* / Q000648:ultrastructure; D010523:Peripheral Nervous System Diseases / Q000209:etiology* / Q000473:pathology*; D011817:Rabbits; D012584:Sciatic Nerve / Q000473:pathology / Q000528:radiation effects