Summary

Shockwave therapy has been shown to aid wound healing and therefore return to play in an elite athlete

Abstract

Introduction

Extra Corporeal Shockwave Therapy (ESWT) has been reported to successfully resolve complex wounds. Focussed linear shockwave are emitted to a large area of tissue surface within the -6db range to encourage increase in angiogenic factors such as VEGF, PCNA, Enos and EGF with consequent reduction in wound size and healing time to full resolution of condition.

Methods

The patient in this case study was an elite professional Rugby league player with long term history of bilateral Achilles tendinopathy which had been managed conservatively prior to attending a warm weather a club training camp. During training the player felt a pop within the mid portion of the right Achilles tendon. An ultrasound scan diagnosed an inflamed right achilles tendon and ruptured Plantaris tendon at its insertion. The decision was made to perform bilateral Plantaris excision due to historical problems upon both sides although only the right tendon was symptomatic at time of diagnosis and review.
Surgery was performed on the 25th January 2016 with right tendon completely healed within 6 weeks. However, the left Plantaris wound site was still open due to 2 to 3 episodes of bacterial infection impeding healing. Regular review with club General Practitioner and 2 attempts to re-suture the wound proved unsuccessful due to the thin dermal layer surrounding the wound site.
The player was taken to see a consultant cosmetic/plastic surgeon for advice and treatment. Topical daktakort cream and dressings were recommended with the wound to be cleaned with sterile water twice daily, prior to applying cream. Little improvement was observed in wound healing in spite of full compliance with this regime.
Consideration was made by the club to use linear focussed shockwave therapy with the first treatment performed 2 months following surgery. Piezowave 2 Lithotripter using an FBL 10X5G2 linear transducer using a zero mm depth transmission gel pad was used. 4 treatment sessions over a 3 week period were performed employing a treatment protocol of 2000 shockwaves at energy flux density of 0.16mJ/mJ/mm2 at 5Hz transmission rate. At every treatment session the wound was cleaned, sterile gel was applied to the wound and covered with a Tegaderm dressing to restrict bacterial cross infection. Once the treatment was completed the wound was cleaned and dressed with a tegaderm and a dose of fusidic acid.

Results

Within 3 weeks, four ESWT sessions were performed with the player playing competitive rugby 4 weeks post ESWT as the wind had healed.

Discussion And Conclusion

ESWT should be considered as a viable option for patients with chronic wound healing problems. This can assist healing in professional athletes and facilitate a return to play.