***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM This review article focuses on a possible pain-alleviating effect of shock-wave application in persistent lateral epicondylopathy of the elbow and compares the effects with data on other non-operative and operative procedures . METHODS Patients who suffered from chronic tennis elbow for more than 12 months and were therefore referred for a surgical procedure were assigned at r and om to two groups of low-energy shock-wave therapy . Group I received a total of 3000 ( 3 x 1000 ) impulses of 0.08 mJ/mm(2 ) , while group II ( control group ) received a total of 30 ( 3 x 10 ) impulses of 0.08 mJ/mm(2 ) . Follow-up examinations were carried out after 3 , 6 , and 24 and 52 weeks . RESULTS There was a significant improvement of pain and function in group I , with a good or excellent outcome in 52 % of cases compared to 6 % in group II at the last evaluation . CONCLUSION Extracorporeal shock-wave application has a dose-dependent pain-relieving effect on chronic tendopathy of the lateral elbow Summary . Fifty patients who suffered from persistent tennis elbow for more than 12 months , and were referred for surgical treatment , were assigned at r and om to 2 groups of low-energy extracorporal shock wave therapy . Group I received a total of 3000 impulses of 0.08 mJ/mm2 ; group II ( controls ) 30 impulses of 0.08 mJ/mm2 . Follow up was after 3 and 12 weeks . We found no significant differences between the 2 groups before treatment , there was but significant relief of pain and improvement of function in group I with good or excellent outcome in 56 % at the last evaluation . Résumé . Le but de cette étude est d’évaluer les effects des ondes de choc de basse énergie sur les douleurs persistantes de l’épiconcyle afin de préciser leur utilisation en orthopédie . On a divisé 50 patients en deux groupes selon le nombre des ondes de choc appliquées . Le groupe n ° I qui a re*u trois fois 100 impulsions à 0.08 mJ/mm2 montrait significativement des meilleurs résultats après trois et douze semaines que le groupe n ° II qui a re*u trois fois 10 impulsions à 0.08 mJ/mm2 . Globalement nous avons trouvés des résultats bons et excellents chez 56 % des patients du groupe n ° I comparé avec 20 % chez des patients du groupe n ° II Technological change in general orthopaedics and its multiple subspecialisations is continual . These changes are regulated , to varying degrees , by delegated authorities within appropriately m and ated concepts . One relatively recent technology , since approximately 1990 , has been the revision of treating relatively deep seated urolithiasis , whether in the renal parenchyma or the ureter , to more superficial musculoskeletal indications . Although originally conceived to dissipate calcifications in rotator cuff tendinopathy and to alter osseous biology , the technology rapidly spread to other common disorders that affect the musculoskeletal system . Unfortunately many of these applications were not tested through appropriate r and omised clinical trials or practical clinical trials , which could adequately assess clinical efficacy and significant modification of the natural history of a given musculoskeletal disorder . Such studies are obviously in dem and by clinicians and healthcare provider organisations to justify the application of both a given treatment modality and the efficiency of a new drug or device to accomplish an end result that is personally satisfactory to the patient and doctor and economically justifiable to the healthcare insurer/provider . The application of laser therapy on soft tissue is used for pain relief , anti-inflammation action and biostimulation . The efficiency of High Energy Laser Therapy has not yet been studied on Achilles tendinopathy . The aim of the study is to evaluate the effectiveness of a flow of Cold air and High Energy Laser Therapy ( CHELT ) versus Extracorporeal Shock Waves Therapy ( ESWT ) in the treatment of Achilles tendinopathy . In this prospect i ve , clinical trial , 60 subjects affected by insertional Achilles tendinopathy were enrolled and r and omized to CHELT ( 30 subjects ) or to ESWT ( 30 subjects ) . In CHELT group the patients received ten daily sessions of 1,200 J and 12 W of laser therapy ( wavelength of 1,084 , 810 and 980 nm ) added to a flow of cold air at −30 ° C . In the ESWT group , the patients received three sessions at 3- to 4-day intervals of 1,600 impulses with an energy flux density ( EFD ) of 0.05–0.07 mJ/mm2 . Both groups of participants performed stretching and eccentric exercises over a 2-month period . The visual analogue scale ( VAS ) , the Ankle – Hindfoot Scale , and the Roles and Maudsley Score were measured before treatment ( T0 ) , and at end of the treatment session ( T1 ) and 2 ( T2 ) and 6 months ( T3 ) after treatment during the follow-up examinations . In both groups , we found a statistically significant improvement of the VAS at T1 , T2 and T3 ( p < 0.01 ) . The difference between the two groups was statistically significant in favour of the CHELT group ( p < 0.001 ) . At 2 months , the CHELT group was statistically better for Ankle – Hindfoot Scale and the Roles and Maudsley Score ( p < 0.05 ) and at 6 months only for the Roles and Maudsley Score ( p < 0.001 ) . High Energy Laser Therapy gave quicker and better pain relief . It also gave the patient a full functional recovery and greater satisfaction OBJECTIVES To evaluate the therapeutic effect of extracorporeal shock wave therapy ( ESWT ) in shoulders with chronic calcific tendinitis , to compare the functional outcomes of ESWT and transcutaneous electric nerve stimulation ( TENS ) therapy , and to investigate which types of calcium deposit effectively respond to ESWT . DESIGN R and omized controlled trial . SETTING Outpatient clinics of the departments of physical medicine and rehabilitation and of orthopedics and traumatology of a veterans hospital in Taiwan . PARTICIPANTS Sixty patients with continuous shoulder pain for 6 months or more and with radiographically and sonographically verified calcific tendinitis . Patients were r and omly allocated to receive ESWT ( 33 shoulders ) or TENS treatment ( 30 shoulders ) . INTERVENTIONS ESWT was performed with 2000 shock waves at 2Hz and energy level between.26 and .32mJ/mm(2 ) per session . Treatment was given in 2 sessions , 14 days apart . TENS therapy was given 3 times a week for 4 weeks . MAIN OUTCOME MEASURES Mean Constant score , visual analog scale ( VAS ) , manual muscle test , and changes of sonographic size and shape of calcium deposits were calculated for 4 time points : at baseline , 2 weeks , 4 weeks , 12 weeks posttherapy . RESULTS In both groups , Constant score and VAS improved significantly at 2- , 4- , and 12-week follow-ups ( P<.05 ) , and the size of calcium deposits decreased significantly at the 4- and 12-week follow-ups . Moreover , the arc-shaped calcific plaques of the rotator cuff were markedly meliorated with ESWT . CONCLUSIONS ESWT is more effective in the treatment of chronic calcific tendinitis of the shoulder than is TENS therapy , especially for arc-type calcific plaque BACKGROUND Extracorporeal shockwave therapy ( ESWT ) is recommended as an alternative treatment for lateral epicondylitis ( LE ) . An influence on the blood perfusion is considered to be one possible effect . Infrared thermography is used in this trial to measure effects of ESWT on the thermal regulation in the target area . METHODS 33 patients with chronic LE were examined in a prospect i ve , placebo-controlled single blind study with an independent observer . 3 x 2000 impulses of an energy flux density ED+ 0.22 mJ/mm2 were applied under local anaesthesia as verum-ESWT . Placebo-ESWT was performed under the same conditions . One elbow was treated , the other served as control . Before and after each shockwave application and after 12 weeks skin temperature was measured on both elbows at three predefined points by infrared thermography . RESULTS While a significant decrease in the skin temperature was found on the treated and sham-treated sides opposed to the contralateral side , there was no difference between the real shockwave treatment and placebo therapy . Responder and Non-responder to the treatment could not be distinguished during the therapy . DISCUSSION Infrared thermography was proved to be a valuable additional technical instrument for diagnosis of LE , but is not an appropriate instrument to predict the clinical outcome in patients treated with ESWT . A noted reduction of skin temperature on the treated side is not due to specific effects of the shockwaves . It is unlikely that ESWT as applied has an influence on thermal regulation in the target area . These findings are supported by negative results of experimental and clinical trials BACKGROUND Plantar fasciitis is a common foot disorder that may be resistant to nonoperative treatment . This study evaluated the use of electrohydraulic high-energy shock waves in patients who failed to respond to a minimum of six months of antecedent nonoperative treatment . METHODS A r and omized , placebo-controlled , multiply blinded , crossover study was conducted . Phase 1 consisted of twenty patients who were nonr and omized to treatment with extracorporeal shock waves  to assess the phase-2 study protocol . In phase 2 , 293 patients were r and omized and an additional seventy-one patients were nonr and omized . Following ankle-block anesthesia , each patient received 100 grade d shocks starting at 0.12 to 0.22 mJ/mm(2 ) , followed by 1400 shocks at 0.22 mJ/mm(2 ) with use of a high-energy electrohydraulic shock-wave device . Patients in the placebo group received minimal subcutaneous anesthetic injections and nontransmitted shock waves by the same protocol . Three months later , patients were given the opportunity to continue without further treatment or have an additional treatment . This allowed a patient in the active treatment arm to receive a second treatment and a patient who received the placebo to cross over to the active treatment arm . Patients were followed at least one year after the final treatment . RESULTS Treatment was successful in seventeen of the twenty phase-1 patients at three months . This improved to nineteen ( 95 % ) of twenty patients at one year and was maintained at five years . In phase 2 , three months after treatment , sixty-seven ( 47 % ) of the 144 actively treated patients had a completely successful result compared with forty-two ( 30 % ) of the 141 placebo-treated patients ( p = 0.008 ) . At one year , sixty-five of the sixty-seven actively treated , r and omized patients maintained a successful result . Thirty-six ( 71 % ) of the remaining fifty-one nonr and omized patients had a successful result at three months . For all 289 patients who had one or more actual treatments , 222 ( 76.8 % ) had a good or excellent result . No patient was made worse by the procedure . CONCLUSIONS The application of electrohydraulic high-energy shock waves to the heel is a safe and effective noninvasive method to treat chronic plantar fasciitis , lasting up to and beyond one year Background : Recent literature shows evidence for effective treatment for plantar fasciitis using either focused or radial shock waves . Up to now no research has been available which compares these different procedures . We hypothesized ( H0 Hypothesis ) that for plantar fasciitis , outcomes following focused or radial shock wave treatment were equal . Material s and Methods : For this pilot study , 39 patients suffering from recalcitrant plantar fasciitis were r and omized in two groups . Treatment was performed in three sessions . Once a week 2000 impulses of radial ( 0.17 mJ/mm 2 ) or focused ( 0.20 mJ/mm 2 ) shock waves were applied . Efficacy was determined by multivariate analysis of eight single variables including changes in Foot Functional Index , neuromuscular performance ( Single leg drop and long jump , postural stability , isokinetic testing ) , and by a composite score from baseline to 12 weeks followup . Multivariate Wilcoxon tests ( Wei-Lachin procedure ) and formal meta-analytic procedure with adjustment for subgroups was performed to determine the adjusted effect sizes with their corresponding confidence intervals . Results : The overall result ( “ Crude Pooling ” ) shows “ small ” superiority of the focused extracorporeal shock wave therapy ( MW = 0.55 , LB-CI = 0.4644 ) . Adjusted for age the focused treatment exhibited “ more than small ” superiority ( MW = 0.59 , LB-CI > 0.5 ) and this result is statistically significant ( LB-CI = 0.5067 , benchmark for e quality = 0.5 ) . Conclusion : This study provides some evidence for focused extracorporeal shock wave treatment being superior to radial extracorporeal shock wave therapy for recalcitrant plantar fasciitis . Level of Evidence : I , Prospect i ve R and omized Background There is conflicting evidence regarding extracorporeal shock wave treatment for chronic tennis elbow . Hypothesis Treatment with repetitive low-energy extracorporeal shock wave treatment is superior to repetitive placebo extracorporeal shock wave treatment . Methods Seventy-eight patients enrolled in a placebo-controlled trial . All patients were tennis players with recalcitrant MRIconfirmed tennis elbow of at least 12 months ’ duration . Patients were r and omly assigned to receive either active low-energy extracorporeal shock wave treatment given week 
    Output:
    
An optimum treatment protocol for ESWT appears to be three treatment sessions at 1-week intervals , with 2000 impulses per session and the highest energy flux density the patient can tolerate .
GROWING POINTS There is no scientific evidence in favour of either radial ESWT or focused ESWT with respect to treatment outcome .