Physical mechanisms of shock wave therapy in orthopedics

描述（由申请人提供）：体外冲击波治疗（ESWT）代表了足底筋膜炎、外侧上髁炎、肩肌腱炎、骨不连和其他骨科领域的潜在重要治疗方式。对于保守治疗效果不佳的患者，ESWT也是手术的替代选择。然而，对其作用机制尚未达成共识，对肌肉骨骼结构如何影响能量传播也没有任何了解。本提案探讨冲击波（SW）在肌肉骨骼结构中传播的基本效应。空化和剪切的具体作用将被量化并用于优化ESWT方案。具体建议骨科医生如何最好地利用当前的技术将是本研究的主要目标。我们有三个具体目标。首先是量化SW通过肌肉骨骼结构的传播。我们将使用最先进的有限体积技术来预测肌肉骨骼结构如何阻碍和偏转声能传播。建模工作将导致剪切应力和空化行为的预测。我们的另外两个目标是实验量化空化波和横波。这些研究将用于验证建模工作，并作为指导建模工作的载体。空化将使用声学探测器（被动空化探测器，b型超声）进行测量。横波测量将使用偏振光学和透明骨模型。这一努力与公众健康有关，因为目前冲击波疗法被用于治疗各种疾病，如脚后跟疼痛、肘部疼痛、肩部疼痛和髋关节疼痛。然而，目前还没有研究表明冲击波是如何导致身体自我修复的。通过了解冲击波与骨骼和组织相互作用的基础科学，我们将能够为医生提供如何优化治疗这些疾病的建议。

DESCRIPTION (provided by applicant): Extracorporeal shock wave therapy (ESWT) represents a potentially important treatment modality for plantar fasciitis, lateral epicondylitis, shoulder tendonitis, non-unions, and other areas in orthopedics. ESWT is also an alternative to surgery for patients who do not respond well to conservative treatments. However, there is no consensus on the mechanism of action, nor is there any understanding of how musculoskeletal structures affect energy propagation. This proposal examines the basic effects of shock wave (SW) propagation through musculoskeletal structures. The specific roles of cavitation and shear will be quantified and used to optimize ESWT protocols. Specific recommendations to orthopedic physicians on how best to use current technology will be a major goal of this research. We have three specific aims. The first is to quantify SW propagation through musculoskeletal structures. We will use state-of-the-art finite volume techniques to predict how musculoskeletal structures impede and deflect acoustic energy propagation. The modeling effort will lead to predictions of shear stress and cavitation behavior. Our other two aims are to experimentally quantify cavitation and shear waves. These studies will be used to validate the modeling effort, and to serve as vectors for directing the modeling effort. Cavitation will be measured using acoustic detectors (passive cavitation detectors, B-mode ultrasound). Shear waves will be measured using polarization optics and transparent bone models. This effort is relevant to the public health because currently, shock wave therapy is being used to treat a variety of conditions, such as heel pain, elbow pain, shoulder pain, and hip pain. However, there is no research into how the shock waves actually cause the body to repair itself. By understanding the basic science of shock wave interaction with bones and tissues, we will be able to provide recommendations to physicians on how to optimize their treatments of these conditions.