Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome.
BACKGROUND
Medial tibial stress syndrome (MTSS) is a pain syndrome along the tibial origin of the tibialis posterior or soleus muscle. Extracorporeal shock wave therapy (SWT) is effective in numerous types of insertional pain syndromes.


OBJECTIVE
Shock wave therapy is an effective treatment for chronic MTSS.


METHODS
Cohort study; Level of evidence, 3.


METHODS
Forty-seven consecutive subjects with chronic recalcitrant MTSS underwent a standardized home training program, and received repetitive low-energy radial SWT (2000 shocks; 2.5 bars of pressure, which is equal to 0.1 mJ/mm(2); total energy flux density, 200 mJ/mm(2); no local anesthesia) (treatment group). Forty-seven subjects with chronic recalcitrant MTSS were not treated with SWT, but underwent a standardized home training program only (control group). Evaluation was by change in numeric rating scale. Degree of recovery was measured on a 6-point Likert scale (subjects with a rating of completely recovered or much improved were rated as treatment success).


RESULTS
One month, 4 months, and 15 months from baseline, success rates for the control and treatment groups according to the Likert scale were 13% and 30% (P < .001), 30% and 64% (P < .001), and 37% and 76% (P < .001), respectively. One month, 4 months, and 15 months from baseline, the mean numeric rating scale for the control and treatment groups were 7.3 and 5.8 (P < .001), 6.9 and 3.8 (P < .001), and 5.3 and 2.7 (P < .001), respectively. At 15 months from baseline, 40 of the 47 subjects in the treatment group had been able to return to their preferred sport at their preinjury level, as had 22 of the 47 control subjects.


CONCLUSIONS
Radial SWT as applied was an effective treatment for MTSS.
OrthoTrauma Evaluation Center, Oppenheimer Street 70, D-55130 Mainz, Germany. profrompe@web.de
Jan D
JD
Rompe
Angelo
A
Cacchio
John P
JP
Furia
Nicola
N
Maffulli
D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000628:therapy; D016022:Case-Control Studies; D002908:Chronic Disease; D015331:Cohort Studies; D012090:Cumulative Trauma Disorders / Q000628:therapy*; D005260:Female; D015775:Fractures, Stress / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D011795:Surveys and Questionnaires; D013977:Tibia / Q000293:injuries*; D013978:Tibial Fractures / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D055815:Young Adult