The objective of this study was to evaluate effects of extracorporeal shockwave therapy (ESWT) on spinal mechanical nociceptive threshold (MNT) and multifidus muscle cross-sectional area (CSA) in horses with thoracolumbar pain. We hypothesized that ESWT would increase MNT and multifidus CSA. Twelve horses with thoracolumbar pain were included. Prior to treatment, each thoracolumbar spine was radiographed to document existing pathology. Horses received 3 ESWT treatments, 2 weeks apart (days 0, 14, 28). Palpation scores were documented (days 0, 45, 65) and ultrasonographic CSA of left and right multifidus was recorded at T12, T14, T16, T18, L3 and L5 (days 0, 45, 65). MNT was measured at T12, T14, T16, T18, L3 and L5 every 7 days (day 0-56). Change in MNT in 10/12 horses was significant at each timepoint compared to day 0 (P<0.05). MNT increased at all timepoints at 6 sites in 2/12, at 5 sites in 3/12, at 4 sites in 4/12 and at 1 site in 1/12 (P<0.05). MNT average percent increase from day 0-56 was 64% for T12-T18 and 29% for L3-L5. There was no statistical difference in MNT from day 35-56 (P=0.25). A bimodal analgesic trend was observed following ESWT. Degree of radiographic change was not associated with response to treatment and no significant change in multifidus CSA was observed. In conclusion, 3 treatments of ESWT 2 weeks apart raised MNT over a 56-day period in horses with back pain, but did not influence change in CSA of the multifidus. / Master of Science / Back pain in the horse is a frequently diagnosed and treated cause of back stiffness, lameness, poor performance and/or avoidance behavior under saddle. Treatment is focused on reducing pain and inflammation and on strengthening and promoting proper muscle development to maintain long term results. Recently, rehabilitation of the deep spinal stabilizer multifidus muscle, particularly with regard to increased cross-sectional area (CSA), has become a focus of targeted physiotherapy. Assessment of the degree of pain is subjective due to individual interpretation and palpation technique. In an attempt to standardize quantification of pain, pressure algometry has become a validated, objective and repeatable measure of axial skeleton mechanical nociceptive threshold (MNT), which is defined as the minimum pressure required to induce a pain response. Although many treatment options for back pain exist, there is limited research documenting the efficacy of these treatments in horses. Extracorporeal shockwave therapy (ESWT), which consists of focused, high velocity acoustic waves, is one type of non-invasive, well-tolerated treatment for back pain. Despite its popularity, there is no research documenting the effects of ESWT on equine spinal MNT or multifidus muscle CSA. This is the first study to document the effects of ESWT on spinal MNT and multifidus muscle CSA in horses with back pain. We hope that the results of this study will help guide treatment decisions for horses with back pain.

INTRODUÇÃO E OBJETIVO: A disfunção erétil (DE) em pacientes transplantados renais é frequente. A modalidade de tratamento ideal não deve interferir com a função do enxerto. A terapia de onda de choque extracorpórea de baixa intensidade (TOCE) tem atraído interesse devido às suas propriedades angiogênicas e mostrou resultados interessantes quando usada para tratar pacientes com doença cardiovascular e em homens com DE. Nosso objetivo é estudar a eficácia e segurança da TOCE para o tratamento da DE de provável etiologia vascular em homens transplantados renais. MÉTODOS: Foram selecionados 20 homens (média de idade = 53,7 anos, 46 a 61 anos) que foram submetidos a transplante de rim há pelo menos 6 meses e com DE há pelo menos 6 meses. O estudo foi duplo-cego, realizado em um único centro, prospectivo, randomizado e placebo-controlado. Dez pacientes foram randomizados para o grupo de terapia placebo e 10 pacientes para o grupo TOCE .O protocolo da TOCE consistiu em 2 sessões de tratamento por semana durante 3 semanas. O tratamento placebo foi realizado utilizando o mesmo dispositivo, porém com substituição do probe eficaz por um sem emissão de energia, mas que proporcionava um som e uma sensação de pulso durante o tratamento. A avaliação pré-tratamento e do seguimento foi realizada com o Índice Internacional de Função Erétil-5 (IIEF-5) e Escore de Rigidez Peniana (EHS) após 1, 3 e 12 meses. Ultra-sonografia Doppler do pênis com fármaco ereção foi realizada antes da terapia e após o tratamento (3 meses). RESULTADOS: Não houve diferença entre estes dois grupos no escore basal do IIEF-5 e EHS. No início do estudo, 1 e 3 meses após o último tratamento, o IIEF-5 no grupo TOCE foi de 10,9 ± 5,1, 15,6 ± 6,1 e 17,2 ± 5,7, respectivamente. O IIEF-5 no grupo placebo foi de 14,9 ± 3, 16,6 ± 5,4 e 16,5 ± 5, respectivamente. O comportamento entre os 2 grupos ao longo do tempo foi significativamente estatistico (p=0,0177). A melhora do escore IIEF-5 foi superior a 5 pontos em 70% (variou de 1-14) dos pacientes no grupo TOCE e em 10% (variou de 0-10) dos pacientes no grupo placebo, 3 meses após o tratamento. A análise após 12 meses foi realizada exclusivamente no grupo TOCE. A alteração média no IIEF-5 após 12 meses foi de 4,8 no grupo TOCE. A média do IIEF-5 após 12 meses foi de 15,7 ± 6,45, mostrando estabilidade da melhora inicial. No início do estudo, 1 e 3 meses após o último tratamento, o EHS no grupo TOCE foi de 2 ± 1,05, 2,5 ± 0,85 e 2,6 ± 0,84, respectivamente. O EHS no grupo placedo foi de 2 ± 0,67, 2,4 ± 0,7 e 2,4 ± 0,7, respectivamente. Percebemos um comportamento semelhante nos dois grupos (p=0,724). No grupo TOCE, notamos um EHS médio um pouco maior após 3 meses. Os parâmetros da ultra-sonografia doppler peniana não diferiram entre os grupos e não apresentaram melhoras significativas. CONCLUSÕES: A TOCE é um tratamento não farmacológico com eficácia clínica em homens transplantados renais com DE. Além do seu potencial de reabilitação, é viável e eficaz. Não verificamos impacto nos parâmetros do doppler peniano apesar do efeito da neoangiogênese do método / INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) in kidney transplant patients is frequent. The ideal treatment modality should not interfere with the graft function. Low-intensity Extracorporeal Shock Wave Therapy Extracorporeal (Li-ESWT) has been of interest due to its angiogenic properties and has shown interesting results when used to treat patients with cardiovascular disease and non-transplanted men with ED. Our objective is to study the efficacy of Li-ESWT for the treatment of ED of probable vascular etiology in kidney transplanted men. METHODS: Twenty men (mean age = 53.7 years, range 46 to 61 years) that have been submitted to kidney transplant for at least 6 months and have been suffering from ED for at least 6 months were selected for the treatment. This was a double-blinded, single-center, prospective, randomized, placebo-controlled trial. Ten patients were randomized into the placebo therapy arm and 10 patients into the Li-ESWT arm. The Li-ESWT protocol consisted of a 2 treatment sessions per week for 3 weeks. The placebo treatment was performed using the same device replacing the effective probe for one that emits zero energy, but delivers a sound and pulse sensation during treatment. Initial and follow-up assessment was performed with International Index of Erectile Function Questionnaire-5 (IIEF-5) score and Erection Hardness Score (EHS) after 1, 3 and 12 months. Penile ultrasound Doppler with drug erection was performed before therapy and after treatment (3 months). RESULTS: There was no difference between these 2 groups in baseline IIEF-5 score and EHS. At baseline, 1 and 3 months after the last treatment, the IIEF-5 in the Li-ESWT group were 10.9 ± 5.1, 15.6 ± 6.1 and 17.2 ± 5.7, respectively. The IIEF-5 in the sham therapy group were 14.9 ± 3, 16.6 ± 5.4 and 16.5 ± 5, respectively. The interaction was significant (p = 0.0177), indicating significantly different behaviors between the groups over time. The IIEF-5 score improved to higher than 5 points in 70% (range, 1-14) of the patients in the Li-ESWT group and 10% (range, 0-10) of the patients in the placebo treatment group, 3 months after treatment. The analysis after 12 months was performed exclusively in the Li-ESWT group. The mean change in IIEF-5 after 12 months was 4.8 in the Li-ESWT group. The mean of the IIEF-5 score after 12 months was 15.7 ± 6.45, showing stability of the initial improvement. At baseline, 1 and 3 months after the last treatment, the EHSs in the Li-ESWT group were 2±1.05, 2.5±0.85, and 2.6±0.84, respectively. The EHSs in the sham treatment group were 2±0.67, 2.4±0.7, and 2.4±0.7, respectively. We noticed a similar behavior in both groups (P=0,724). In the Li-ESWT group, we noticed a slightly higher mean EHS after 3 months. Penile Doppler ultrasound parameters did not differ between groups and did not show significant improvements. CONCLUSIONS: Li-ESWT is a non pharmacological treatment with clinical efficacy in kidney transplant recipients with ED. Besides its restorative potential, this treatment is feasible and effective. Despite evidences suggesting neoagiogenesis, our protocol had no impact in penile Doppler parameters

Title Comparison between the effectiveness of extracorporeal shockwave therapy (ESWT) and the surgical approach in the treatment of the rotator cuff tendinopathy. Objective The main goal of this research work is comparing the effectiveness of extracorporeal shock wave therapy and the surgical intervention (arthroscopic approach) in the treatment of calcific rotator cuff tendinopathy depending on the outcome measures of the Constant-Murley Score (CMS), and the Visual Analogue Scale (VAS) from the recent scientific publications. Methodology This thesis is systemic (literature) review. The studies which recruited in this research were randomized controlled trials, prospective studies, and retrospective case series studies which written in English language form, and published between the year 2000 to the year 2018. The studies were retrieved from following databases: EMBASE, PubMed, CINAHL, Medline, SpringerLink, ProQuest using different integrations of the key words. The participants in the studies were from both genders and all ages. The type of the pathology which included in this research was chronic calcific rotator cuff tendinopathy. Regarding the intervention types both Radial, and Focused ESWT with low, medium, and high intensities and the arthroscopic interventions were the main types of...