Use of extracorporeal shock wave therapy for wounds and musculoskeletal treatment: a systematic review

The aim of this systematic review was to assess the healing performance of extracorporeal shock wave therapy (ESWT) on integumentary wounds and musculoskeletal tissue injury.

Using PubMed and Google Scholar, a systematic search was conducted in June 2021 on randomised controlled trials (RCTs) that assessed treatment efficacy of ESWT on wounds or musculoskeletal tissue injuries. Reviewed studies were stratified by target tissue and energy density level, and assessed for risk of bias. Outcome measures reported in more than one reviewed study on the same target tissue were pooled and graded for quality of evidence.

A total of 296 records were considered and 14 eligible studies reviewed. Experimental design varied across studies, with ESWT applied at energy densities ranging from 0.08-0.58mJ/mm². The performance of ESWT matched or exceeded that of placebo-controlled treatments and/or standard of care in all reviewed studies. In addition, 12 studies-including all studies on wounds-reported significantly faster tissue healing and/or greater pain reduction with ESWT compared with the comparator treatment(s). Evidence from pooled analyses favoured ESWT and ranged from very low to moderate in quality.

The findings of this systematic review suggested that ESWT supported wound healing and is a promising treatment method for musculoskeletal tissue injuries. An implementation of standardised, tissue-specific ESWT protocols will benefit future evidence-based investigations that compare findings between studies on the same targeted tissue. Additional results from well-designed, appropriately powered RCTs will aid decision-making and further inform the clinical evidence of the tissue healing benefits provided by ESWT.