Extracorporeal Shock Wave Therapy ,體外沖擊波疼痛治療系統,SONOTHERA,SONOTHERA體外沖擊波疼痛治療系統是韓國HANIL-TM公司研發的一款雙彈道多功能型沖擊波疼痛治療系統，該產品是目前全球擁有最多治療模式的體外沖擊波骨科治療儀， SONOTHERA 的【激波針灸技術】在全球首創開創了無創針灸技術新紀元！是全球唯一具有【激波針灸技術】的沖擊波治療系統。,SONOTHERA 醫學機理,聲學邊界的能量釋放Energy release at acoustic boundaries空化作用Cavitation 增加細胞壁的通透性Increase of cell wall permeability刺激微循環（血液、淋巴）Stimulation of Microcirculation (Blood, Lymph) 釋放P物質Release of Substance P 減少非髓鞘神經Reduction of unmyelinated nerves釋放一氧化氮（血管舒張，細胞新陳代謝增加，血管新生，抗炎作用）Release of Nitric oxide (vasodilation, increased cell metabolism, neoangogenesis, anti-inflammatory effect)抗菌作用Antibacterial effect 刺激生長因子（血管、骨骼、膠原蛋白新生）Stimulation of Growth factors (neogenesis of vessels, bone, collagen)刺激干細胞Stimulation of Stem cells,絕對禁忌癥ABSOLUTE CONTRAINDICATIONS,妊娠Pregnancy血栓癥thrombosis血凝固紊亂（血友病）coagulation disorders (haemophilia)腫瘤疾病tumour diseases 急性炎癥acute inflammation目標治療區膿腫pus focus in the target area,相對禁忌癥RELATIVE CONTRAINDICATIONS,抗凝血劑使用者，特別是苯丙香豆素（維生素K拮抗劑） use of anticoagulants, especially marcumar (vitamin k antagonist)有多發性神經病的糖尿病 polyneuropathy in case of diabetes mellitus可的松治療結束六周后才能使用體外沖擊波治療 cortisone therapy up to 6 weeks before first ESWT treatment風濕性疾病 rheumatic disease,腫脹swelling變紅reddening血腫haematomas瘀點petechiae灼傷般疼痛感pain like sunburn治療初期病情惡化first worsening,副作用SIDE EFFECTS,沖擊波治療的益處Benefits of Shock Wave Treatment,幾次治療后，疼痛即得到緩解/減輕 pain relief/ reduction after a few treating sessions 治療依從性好 the compliance is very good 治療后病人能直接感受到第一療效 the patients can feel first effects directly after the treatment 能治療復雜癥狀及相關適應癥 treatment of complex symptoms/ indications possible,沖擊波治療的益處Benefits of Shock Wave Treatment,治療結締組織 treatment of connective tissue活化淋巴系統 activation of lymphatic system大面積治療 treatment of large areas possible作用于神經系統（門控制、疼痛記憶） effects on the nervous system (gate control, pain memory?),經典適應癥CLASSIC INDICATIONS,經典適應癥 Classic Indications,Calcific tendonitis/ shoulder pain鈣化性肌腱炎/肩痛,Achillodynia 跟腱痛,Plantar fasciitis 足底筋膜炎,Ulnar humeral epicondylitis肱骨內上踝炎,Tibial stress syndrome脛骨壓力癥候群,Radial humeral epicondylitis肱骨外上髁炎,Trochanteric tendonitis轉子肌腱炎,Patellar tendonitis髕腱炎,治療方法 PROTOCOL,查找主要痛點和其他痛點look for the main and other pain points 與病人密切交談close dialogue with the patient 生物反饋biofeedback 2000次發散式沖擊波 radial shocks 2000 多數學派的治療方法protocol of the most studies 傳統派old school新派：聯合療法，治療扳機點 new: combined therapy, trigger points,治療方法PROTOCOL,治療間隔：5-7天 interval5 7days治療次數：3-5次 sessions3 5最晚在第5次治療后進入休息期 break latest after 5th session,鈣化肌腱炎/肩痛Calcific tendonitis/Shoulder pain,前期超聲或X線定位/決定治療區域與深度Preliminary ultrasound orx-ray localization/ determination of penetration depth and treatment area在皮膚上標記出治療區域Marking of therapeutic window on the skin在90%的例子中，旋轉套的岡上肌腱感染，需要治療。In approx. 90% of the casesthe supraspinatus tendon of the rotator cuff is affected and has to be treated,鈣化肌腱炎/肩痛Calcific tendonitis/Shoulder pain,鈣化肌腱炎/肩痛Calcific tendonitis/Shoulder pain,鈣化肌腱炎/肩痛 Calcific tendonitis/Shoulder pain,鈣化肌腱炎/肩痛Calcific tendonitis/Shoulder pain,Treatment interval: 5 - 7day 治療間隔：5 -7天,病人仰臥位 R-SW應用 于腹外側位Supine patient positioning R-SW application in ventrolateral position,鈣化性肌腱炎/肩痛Calcific tendonitis/Shoulder pain 僅使用發散性沖擊波療法Only with radial shock wave therapy,Tenderness in the region of thelateral epicondyle確定上踝側 位區柔軟度Greatest tension is elicited withthe elbow in extension, forearmin pronation, and wrist in flexion肘部外展、前臂轉至手掌向下、腕關節彎曲，造成最大張力狀態Preliminary ultrasound/x-ray for localization ofepicondyle 前期上踝超聲或x線定位Marking of therapy region 標記治療區域,肱骨外上踝炎Radial humeral epicondylitis,肱骨內上髁炎Radial humeral epicondylitis DD,Treatment interval: 5 - 7 days 治療間隔： 5 - 7天,病人仰臥位 肘部彎曲大約130度，手掌向下。R-SW（R15）應用于腱附著端。接著使用D20-S治療鄰近的上臂與前臂的肌肉。,肱骨外上髁炎Radial humeral epicondylitis 僅使用發散性沖擊波療法Only with radial shock wave therapy,病人仰臥位-肘關節外展。用V-ACTOR按摩鄰近肌肉。Supine patient positioning Extension of elbow joint. Smoothing of surrounding muscles with the V-ACTOR.,肱骨外上髁炎Radial humeral epicondylitis,ESWT New Treatment Guide,Preliminary ultrasound/x-ray for localization of epicondyle 前期上髁超聲或x線定位Marking of therapy region 標記治療區域,肱骨內上髁炎Ulnar humeral epicondylitis,Treatment interval: 5 - 7 days 治療間隔：5 - 7 天,Supine patient positioning Flexion of elbow joint approx. 30 to 40 degree, supination position. R-SW (R15) application at the tendon insertion. 病人仰臥位 肘關節彎曲大約30-40度，手心向上。R-SW(R15)應用于腱附著端。,Supine patient positioning Extension of elbow joint, supination position. Smoothing of forearm muscles with D20-S.病人仰臥位 肘關節外展，手心向上。用D20-S按摩前臂肌肉。,肱骨內上髁炎Ulnar humeral epicondylitis僅使用發散性沖擊波療法Only radial shock wave therapy,肱骨內上髁炎Ulnar humeral epicondylitis,病人仰臥位-肘關節外展。用V-ACTOR按摩鄰近肌肉。Supine patient positioning Extension of elbow joint. Smoothing of surrounding muscles with the V-ACTOR。,Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超聲或X線定位，確定治療深度Marking of therapy region 標記治療區域,轉子肌腱炎Trochanteric Tendonitis,轉子肌腱炎Trochanteric Tendonitis DD,Treatment interval: 5 - 7 days 治療間隔： 5 - 7天,Lateral patient positioning Smoothing of associated muscles with D35.病人側臥位 用D35按摩相關肌肉。,Lateral patient positioning R-SW application (DI15) on the tip of the trochanter, M. piriformis and associated muscles.病人側臥位 R-SW（DI15）應用于轉子尖、梨狀肌及相關肌肉。,轉子肌腱炎 Trochanteric Tendonitis 僅使用發散式沖擊波療法Only radial shock wave therapy,Patellar tendonitis (Jumpers Knee) 髕骨肌腱炎（跳躍膝）,Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超聲或x線定位，確定治療深度Marking of therapy region 標記治療區域,髕骨肌腱炎（跳躍膝）Patellar tendonitis (Jumpers Knee),Treatment interval: 5 - 7 days 治療間隔：5 - 7 天,Supine patient positioning with the knee on a half roll. Fixation of patellar zone with a cuff. R-SW (R15) application at the patella (tip, basis) and tibial tendon insertion.病人仰臥位，膝蓋置于半圓柱形物上。用一條繃帶固定髕骨區。R-SW(R15)應用于髕骨（尖部、底部）及脛骨腱附著端。,Supine patient positioning with the knee on a half roll. Fixation of paellar zone with a cuff. Smoothing of adjacent muscles with D20.病人仰臥位，膝蓋置于半圓柱形物上。用一條繃帶固定髕骨區。用D20按摩相鄰肌肉。,髕骨肌腱炎Patellar tendonitis (Jumpers Knee) 僅使用發散式沖擊波療法Only radial shock wave therapy,Preliminary ultrasound/ x-ray 前期超聲/X線定位 Marking of therapy region 標記治療區域,脛骨壓力綜合征（脛骨疲勞性骨膜炎）Tibial stress syndrome (Shin splint),Treatment interval: 5 - 7 days 治療,Supine patient positioning with knee on a half roll. R-SW application.病人仰臥位，膝蓋置于半圓柱形物上。使用R-SW。,脛骨壓力綜合征（脛骨疲勞性骨膜炎） Tibial stress syndrome (Shin splint)僅使用發散式沖擊波療法Only radial shock wave therapy,跟腱痛Achillodynia,Preliminary ultrasound / x-ray 前期超聲/x線定位Marking of therapy region 標記治療區域,跟腱痛Achillodynia,跟腱痛Achillodynia,足底筋膜炎Plantar fasciitis,Preliminary ultrasound/ x-ray 前期超聲/x線定位Localization of pain points withbio-feedback 根據人體生物反饋定位痛點Marking of therapy region 標記治療區域,足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur,足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur,足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur,Abdominal patient position with foot on a half roll. R-SW (DI15) application. Localization of patients with bio-feedback.病人腹臥們，腳置于半圓柱形物上。使用R-SW(DI15)。利用生物反饋進行痛點定位。,Treatment interval: 5 - 7 days 治療間隔： 5 - 7天,足底筋膜炎Plantar fasciitis 僅使用發散式沖擊波療法Only radial shock wave therapy,研究Studies,2000次沖擊波，治療3次，一周一次2000, 3 sessions, 1/ week,跟骨骨刺Heel Spur,肱骨外上髁炎HER,發散式沖擊波，2000次，治療3次，1周1次RSW, 2000, 3 sessions, 1/ week,肩袖鈣化性肌腱炎Calcific Tendinitis of Rotator Cuff,RSW, 5 sessions, 1/ week,RSW, 2000, 3 sessions, 1/ week 發散式沖擊波，2000次，治療3次，1周1次,鈣化性肌腱炎，聚焦式沖擊波Tendinosis Calcarea, FSW,夾擠綜合癥，聚焦式沖擊波Impingement Syndrome, FSW,Sports-Induced Diseases,發散式沖擊波，治療5次，1周1次RSW, 5 sessions, 1/ week,肌筋膜疼痛綜合癥Myofascial pain syndrome,扳機點治療Trigger point treatment,肌筋膜疼痛綜合征Myofascial pain syndrome可用RSWT成功治愈的骨科適應癥 Orthopaedic indications which can be treated successfully with RSWT,上位及低位頸部綜合征Upper and lower Cervical-Syndrome肩周痛Periarticular shoulder pain前臂屈伸肌腱炎Tendomyosis in the extensor and flexor region of the forearm 上踝病變Epicondylopathy背痛Dorsalgia (Back pain)臀肌痛Glutealgia,肌筋膜疼痛綜合征Myofascial pain syndrome可用RSWT成功治愈的骨科適應癥 Orthopaedic indications which can be treated successfully with RSWT,內收肌疼痛Pain in the adductor muscles 股屈伸肌痙攣Shortenings in the femoral flexor and extensor muscles 小腿筋膜間室綜合征Peroneal compartment syndrome脛前綜合征Tibial anterior syndrome 脛骨壓力綜合征（脛骨疲勞性骨膜綜合征）Tibial stress syndrome (Shin splint)伴有/不伴有跟腱痛的小腿肌肉萎縮Shortening of the calf muscle with and without Achillodynia 跖骨痛Metatarsalgia,肌筋膜疼痛綜合征Myofascial pain syndrome,治療長度Length of treatment,取決于肌肉刺激的持續范圍和時間Depending on the extent and duration of the muscle irritation早期疼痛可經過1-2次治療成功治愈。Early stage complaints can be treated successfully with 1 - 2 treatments sessions 多數案例中，痛點的緩解/解除需要4-8次治療（一周12次治療）In most cases several treatment sessions (4 - 8) are required to release/eliminate the pain points (1 -2 treatments / week).建議盡早采用扳機點治療It is recommended to start trigger point treatment at the most possible early stage,肌筋膜疼痛綜合征Myofascial pain syndrome 沖擊波治療的優點Benefits of shock wave therapy,促進組織再生Strong regenerative effect on the tissue可深入組織治療，而不傷皮膚Penetrate deep inside the tissue without harming the skin 因此沖擊波操作方便，易于重復治療。可被大多數患者接受。Therefore shock wave therapy can be easily repeated and is well tolerated by most patients.,超聲波掃描術Sonography 給病人提供最安全的治療方案 Gives the patients the most possible treatment safety 可識別不可采用ESWT治療的結構改變（例如腫瘤） Structural modifications which must not be treated with RSWT (e.g. tumors) will be recognized,肌筋膜疼痛綜合征Myofascial pain syndrome 沖擊波治療前的診斷Diagnostics before shock wave therapy,上位及低位頸部綜合征Upper and lower Cervical-Syndrome 臂痛、背痛、頭痛with brachialgia, dorsalgia and cephalgia,Trapezius muscle 斜方肌,Recommended treatment: radial. 使用發散式治療,上位及低位頸部綜合征Upper and lower Cervical-