human
***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: We carried out a prospect i ve , r and omised controlled trial on two groups of 40 patients with painful calcific tendonitis and a mean age of 48.4 years ( 32.5 to 67.3 ) . All were to undergo arthroscopic removal of the calcific deposit within six months after r and omisation . The 40 patients in group I received ultrasound-guided needling followed by high-energy shock-wave therapy and the 40 in group II had shock-wave therapy alone . In both groups one treatment consisting of 2500 impulses of shock waves with an energy flux density of 0.36 mJ/mm(2 ) was applied . The clinical and radiological outcome was assessed using the 100-point Constant shoulder scoring system and st and ardised radiographs . The mean follow-up was 4.1 months and no patient was lost to follow-up . Both groups had significant improvement in their Constant shoulder score . Radiographs showed disappearance of the calcific deposit in 60.0 % of the shoulders in group I and in 32.5 % of group II ( p < 0.05 ) . Significantly better clinical and radiological results were obtained in group I than in group II . Arthroscopic removal of the deposit was avoided in 32 patients of group I and in 22 of group II . No severe side-effects were recorded . Ultrasound-guided needling in combination with high-energy shock-wave therapy is more effective than shock-wave therapy alone in patients with symptomatic calcific tendonitis , giving significantly higher rates of elimination of the calcium deposits , better clinical results and reduction in the need for surgery 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 In a prospect i ve study of 435 patients with chronic proximal plantar fasciitis , 283 ( 65 % ) had an inferior calcaneal bone spur of variable size evident prior to treatment with electrohydraulic high-energy extracorporeal shock waves ( ESW ) .  This included 308 patients who received extracorporeal shock wave treatments and 127 placebo ( sham control ) patients .  At both initial ( 3 months ) and final ( 12 months ) evaluations after receiving ESW , no patient who received shock wave applications had significant disappearance or change in the radiographic appearance of the heel spur . Clinical outcome after ESW was satisfactory in 168 patients ( 82 % ) with a radiographically demonstrable inferior heel spur and in 81 patients ( 79 % ) without such a heel spur . The results showed no correlation between the presence or absence of the heel spur and the eventual treatment outcome Plantar heel pain , a chronic and disabling foot alignment , occurs in the adult population . Extracorporal shock wave therapy ( ESWT ) offers a nonsurgical option in addition to stretching exercises , heel cups , NSAI , and corticosteroid injections . This study aim ed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes . The study involved 108 patients with heel pain and radiologically diagnosed heel spurs . All patients underwent ESWT once a week for 5 weeks at the clinic . Each patient received 2,000 impulses of shock waves , starting with 0.05 mJ/mm2 ( 1.8 bar ) and increasing to 0.4 mJ/mm2 ( 4.0 bar ) . St and ard radiographies of the affected heels were obtained before and after the therapy . Clinical results demonstrated excellent ( no pain ) in 66.7 % of the cases , good ( 50 % of pain reduced ) in 15.7 % of the cases , and unsatisfactory ( no reduction in pain ) in 17.6 % . After five ESWT treatments , no patients who received shock wave applications had significant spur reductions , but 19 patients ( 17.6 % ) had a decrease in the angle of the spur , 23 patients ( 21.3 % ) had a decrease in the dimensions of the spur , and one patient had a broken spur . Therefore , results showed no correlation between clinical outcome and radiologic changes . The present study supports the finding that even with no radiologic change after ESWT therapy , the therapy produces significant effects in reducing patients ’ complaints about heel spurs Objectives : Extracorporeal shockwave therapy ( ESWT ) and corticosteroid injection ( CSI ) are treatment options for plantar fasciitis . Their clinical outcome comparison remains a debate . Also , the thickness changes of the plantar fascia on objective evaluation under the medium energy ESWT and CSI therapy are elusive . Methods : A total of 97 patients with chronic plantar fasciitis were enrolled in the r and omized prospect i ve trial . Forty-seven patients received extracorporeal shock wave therapy ( ESWT )  , and fifty patients received corticosteroid injection ( CSI ) . The thickness of the plantar fascia was evaluated respectively before ESWT and CSI , and at the 4th and 12th week after ESWT and CSI by ultrasonography .  Pain level and clinical outcomes were recorded using visual analogue scale ( VAS ) and 100-points scoring systems . Correlation analysis was performed between the thickness change and clinical outcome . Results : Under ultrasonography , we observed more increase of plantar fascia thickness of ESWT group than CSI group at 4th week ( p=0.048 ) . VAS of plantar fasciitis patients receiving ESWT was lower than those who received corticosteroid injection ( 0.001 and p<0.001 , at 4th and 12th week ) . On the assessment of 100-points scoring systems , the pain level of patients with ESWT was lower than those with CSI at the 12th week ( p<0.001 ) . On the other h and , the increase of plantar fascia thickness at 4th week was positively correlated with the decrease of VAS score at 12th week follow-up ( R=0.302 , P=0.039 ) . Conclusions : At 4th week after treatment , the thickness of plantar fascia increased . Then it decreased gradually , but not to the baseline at 12th week . On the pain level outcome at 12th week , extracorporeal shockwave therapy ( ESWT ) was more efficient than corticosteroid injection ( CSI ) on chronic plantar fasciitis . The more change of plantar fascia after ESWT , the more efficient on clinical outcome ABSTRACT We determined and compared the effectiveness of low‐level laser therapy ( LLLT ) , therapeutic ultrasound ( US ) therapy , and extracorporeal shock wave therapy ( ESWT ) using magnetic resonance imaging ( MRI ) . We performed a r and omized , prospect i ve , comparative clinical study . A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided r and omly into 3 treatment groups : group 1 underwent 15 sessions of LLLT ( 8 J/cm2 ; 830 nm ) ; group 2 underwent 15 sessions of continuous US ( 1 mHz ; 2 W/cm2 ) ; and group 3 underwent 3 sessions of ESWT ( 2000 shocks ) . All patients were assessed using the visual analog scale ( VAS ) , heel tenderness index ( HTI ) , American Orthopaedic Foot and Ankle Society ( AOFAS ) ankle‐hindfoot scale , Roles – Maudsley score , and MRI before and 1 month after treatment . The primary efficacy success criterion was the percentage of decrease in heel pain of > 60 % from baseline at 1 month after treatment for ≥2 of the 3 heel pain ( VAS ) measurements . Significant improvement was measured using the mean VAS , AOFAS scale , and HTI scores for all 3 groups . The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups . The treatment success rate was 70.6 % in the LLLT group , 65 % in the ESWT group , and 23.5 % in the US group . LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion ( p = .006 and p = .012 , respectively ) , with no significant difference between the LLLT and ESWT groups ( p > .05 ) . The treatment of chronic plantar fasciitis with LLLT and ESWT result ed in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes . & NA ; Level of Clinical Evidence : BACKGROUND To evaluate the efficacy of extracorporeal shockwaves therapy ( ESWT ) in patients with chronic painful shoulder . METHODS EXPERIMENTAL DESIGN a prospect i ve design was used with a short term follow-up . SETTING data were collected at the Service of Physioterapy in Villa Stuart Clinic-Rome . PATIENTS 72 patients of both sexes with an average age of 38 years ( range 18 to 69 ) affected by chronic painful shoulder , whose symptoms lasted more than 6 months . INTERVENTIONS all patients received on average , 2,000 impulses of ESWT at level 5 energy ( 0.21 mJ/mm2 ) according to Dornier Epos equipment one session per week for 8 weeks . MEASURES all cases underwent an instrumental examination with X-ray conventional imaging and clinical assessment of pain ( visual analogue scale ) and functional limitation of the shoulder , two weeks before the treatment and at one month follow-up . RESULTS 53 % of patient scored excellent results , 14 % good , 13 % fair and 20 % poor . In the group of calcifying tendinitis we had a reduction in 37 % and no changes in 63 % . CONCLUSIONS Even with a limited number of cases our early results show the efficacy and safety of ESWT in the treatment of chronic painful shoulder resistant to other conservative approaches In a prospect i ve r and omised trial of calcifying tendinitis of the rotator cuff , we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy , via an electromagnetic generator under fluoroscopic guidance .  Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff , with calcification measuring 10 mm or more in maximum dimension . The primary outcome measure was the change in the Constant and Murley Score .  A total of 80 patients were enrolled ( 40 in each group ) , and were re-evaluated at a mean of 110 ( 41 to 255 ) days after treatment when the increase in Constant and Murley score was significantly greater ( t-test , p = 0.026 ) in the high-energy treatment group than in the low-energy group . The improvement from the baseline level was significant in the high-energy group , with a mean gain of 12.5 ( -20.7 to 47.5 ) points ( p < 0.0001 ) . The improvement was not significant in the low-energy group . Total or subtotal resorption of the calcification occurred in six patients ( 15 % ) in the high-energy group and in two patients ( 5 % ) in the low-energy group . High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up , but the calcific deposit remains unchanged in size in the majority of patients Myositis ossificans ( MO ) is a fairly common evolution in sports activity and can be due to direct trauma or to repeated micro-injuries . The traditional therapeutic approach relies on a variety of treatments , such as physical therapy but evidence of their proven clinical efficacy is lacking . The latest therapeutic option is surgical removal but this is a demolitive procedure and is frequently associated with a significant loss of functional integrity . There are few articles in literature about the treatment of post-traumatic MO , and none on extracorporeal shock wave therapy ( ESWT ) . We illustrate a case series of 24 sportsmen treated with three sessions of electro-hydraulic shockwave therapy and an associated rehabilitation program .  Only a partial reduction of the ossification was observed in the X-ray images but all the patients showed signs of functional improvement immediately after therapy . Two months after the therapy , a normal range of motion and no signs of weak 
    Output:
    
agent
***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: We carried out a prospect i ve , r and omised controlled trial on two groups of 40 patients with painful calcific tendonitis and a mean age of 48.4 years ( 32.5 to 67.3 ) . All were to undergo arthroscopic removal of the calcific deposit within six months after r and omisation . The 40 patients in group I received ultrasound-guided needling followed by high-energy shock-wave therapy and the 40 in group II had shock-wave therapy alone . In both groups one treatment consisting of 2500 impulses of shock waves with an energy flux density of 0.36 mJ/mm(2 ) was applied . The clinical and radiological outcome was assessed using the 100-point Constant shoulder scoring system and st and ardised radiographs . The mean follow-up was 4.1 months and no patient was lost to follow-up . Both groups had significant improvement in their Constant shoulder score . Radiographs showed disappearance of the calcific deposit in 60.0 % of the shoulders in group I and in 32.5 % of group II ( p < 0.05 ) . Significantly better clinical and radiological results were obtained in group I than in group II . Arthroscopic removal of the deposit was avoided in 32 patients of group I and in 22 of group II . No severe side-effects were recorded . Ultrasound-guided needling in combination with high-energy shock-wave therapy is more effective than shock-wave therapy alone in patients with symptomatic calcific tendonitis , giving significantly higher rates of elimination of the calcium deposits , better clinical results and reduction in the need for surgery 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 In a prospect i ve study of 435 patients with chronic proximal plantar fasciitis , 283 ( 65 % ) had an inferior calcaneal bone spur of variable size evident prior to treatment with electrohydraulic high-energy extracorporeal shock waves ( ESW ) .  This included 308 patients who received extracorporeal shock wave treatments and 127 placebo ( sham control ) patients .  At both initial ( 3 months ) and final ( 12 months ) evaluations after receiving ESW , no patient who received shock wave applications had significant disappearance or change in the radiographic appearance of the heel spur . Clinical outcome after ESW was satisfactory in 168 patients ( 82 % ) with a radiographically demonstrable inferior heel spur and in 81 patients ( 79 % ) without such a heel spur . The results showed no correlation between the presence or absence of the heel spur and the eventual treatment outcome Plantar heel pain , a chronic and disabling foot alignment , occurs in the adult population . Extracorporal shock wave therapy ( ESWT ) offers a nonsurgical option in addition to stretching exercises , heel cups , NSAI , and corticosteroid injections . This study aim ed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes . The study involved 108 patients with heel pain and radiologically diagnosed heel spurs . All patients underwent ESWT once a week for 5 weeks at the clinic . Each patient received 2,000 impulses of shock waves , starting with 0.05 mJ/mm2 ( 1.8 bar ) and increasing to 0.4 mJ/mm2 ( 4.0 bar ) . St and ard radiographies of the affected heels were obtained before and after the therapy . Clinical results demonstrated excellent ( no pain ) in 66.7 % of the cases , good ( 50 % of pain reduced ) in 15.7 % of the cases , and unsatisfactory ( no reduction in pain ) in 17.6 % . After five ESWT treatments , no patients who received shock wave applications had significant spur reductions , but 19 patients ( 17.6 % ) had a decrease in the angle of the spur , 23 patients ( 21.3 % ) had a decrease in the dimensions of the spur , and one patient had a broken spur . Therefore , results showed no correlation between clinical outcome and radiologic changes . The present study supports the finding that even with no radiologic change after ESWT therapy , the therapy produces significant effects in reducing patients ’ complaints about heel spurs Objectives : Extracorporeal shockwave therapy ( ESWT ) and corticosteroid injection ( CSI ) are treatment options for plantar fasciitis . Their clinical outcome comparison remains a debate . Also , the thickness changes of the plantar fascia on objective evaluation under the medium energy ESWT and CSI therapy are elusive . Methods : A total of 97 patients with chronic plantar fasciitis were enrolled in the r and omized prospect i ve trial . Forty-seven patients received extracorporeal shock wave therapy ( ESWT )  , and fifty patients received corticosteroid injection ( CSI ) . The thickness of the plantar fascia was evaluated respectively before ESWT and CSI , and at the 4th and 12th week after ESWT and CSI by ultrasonography .  Pain level and clinical outcomes were recorded using visual analogue scale ( VAS ) and 100-points scoring systems . Correlation analysis was performed between the thickness change and clinical outcome . Results : Under ultrasonography , we observed more increase of plantar fascia thickness of ESWT group than CSI group at 4th week ( p=0.048 ) . VAS of plantar fasciitis patients receiving ESWT was lower than those who received corticosteroid injection ( 0.001 and p<0.001 , at 4th and 12th week ) . On the assessment of 100-points scoring systems , the pain level of patients with ESWT was lower than those with CSI at the 12th week ( p<0.001 ) . On the other h and , the increase of plantar fascia thickness at 4th week was positively correlated with the decrease of VAS score at 12th week follow-up ( R=0.302 , P=0.039 ) . Conclusions : At 4th week after treatment , the thickness of plantar fascia increased . Then it decreased gradually , but not to the baseline at 12th week . On the pain level outcome at 12th week , extracorporeal shockwave therapy ( ESWT ) was more efficient than corticosteroid injection ( CSI ) on chronic plantar fasciitis . The more change of plantar fascia after ESWT , the more efficient on clinical outcome ABSTRACT We determined and compared the effectiveness of low‐level laser therapy ( LLLT ) , therapeutic ultrasound ( US ) therapy , and extracorporeal shock wave therapy ( ESWT ) using magnetic resonance imaging ( MRI ) . We performed a r and omized , prospect i ve , comparative clinical study . A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided r and omly into 3 treatment groups : group 1 underwent 15 sessions of LLLT ( 8 J/cm2 ; 830 nm ) ; group 2 underwent 15 sessions of continuous US ( 1 mHz ; 2 W/cm2 ) ; and group 3 underwent 3 sessions of ESWT ( 2000 shocks ) . All patients were assessed using the visual analog scale ( VAS ) , heel tenderness index ( HTI ) , American Orthopaedic Foot and Ankle Society ( AOFAS ) ankle‐hindfoot scale , Roles – Maudsley score , and MRI before and 1 month after treatment . The primary efficacy success criterion was the percentage of decrease in heel pain of > 60 % from baseline at 1 month after treatment for ≥2 of the 3 heel pain ( VAS ) measurements . Significant improvement was measured using the mean VAS , AOFAS scale , and HTI scores for all 3 groups . The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups . The treatment success rate was 70.6 % in the LLLT group , 65 % in the ESWT group , and 23.5 % in the US group . LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion ( p = .006 and p = .012 , respectively ) , with no significant difference between the LLLT and ESWT groups ( p > .05 ) . The treatment of chronic plantar fasciitis with LLLT and ESWT result ed in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes . & NA ; Level of Clinical Evidence : BACKGROUND To evaluate the efficacy of extracorporeal shockwaves therapy ( ESWT ) in patients with chronic painful shoulder . METHODS EXPERIMENTAL DESIGN a prospect i ve design was used with a short term follow-up . SETTING data were collected at the Service of Physioterapy in Villa Stuart Clinic-Rome . PATIENTS 72 patients of both sexes with an average age of 38 years ( range 18 to 69 ) affected by chronic painful shoulder , whose symptoms lasted more than 6 months . INTERVENTIONS all patients received on average , 2,000 impulses of ESWT at level 5 energy ( 0.21 mJ/mm2 ) according to Dornier Epos equipment one session per week for 8 weeks . MEASURES all cases underwent an instrumental examination with X-ray conventional imaging and clinical assessment of pain ( visual analogue scale ) and functional limitation of the shoulder , two weeks before the treatment and at one month follow-up . RESULTS 53 % of patient scored excellent results , 14 % good , 13 % fair and 20 % poor . In the group of calcifying tendinitis we had a reduction in 37 % and no changes in 63 % . CONCLUSIONS Even with a limited number of cases our early results show the efficacy and safety of ESWT in the treatment of chronic painful shoulder resistant to other conservative approaches In a prospect i ve r and omised trial of calcifying tendinitis of the rotator cuff , we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy , via an electromagnetic generator under fluoroscopic guidance .  Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff , with calcification measuring 10 mm or more in maximum dimension . The primary outcome measure was the change in the Constant and Murley Score .  A total of 80 patients were enrolled ( 40 in each group ) , and were re-evaluated at a mean of 110 ( 41 to 255 ) days after treatment when the increase in Constant and Murley score was significantly greater ( t-test , p = 0.026 ) in the high-energy treatment group than in the low-energy group . The improvement from the baseline level was significant in the high-energy group , with a mean gain of 12.5 ( -20.7 to 47.5 ) points ( p < 0.0001 ) . The improvement was not significant in the low-energy group . Total or subtotal resorption of the calcification occurred in six patients ( 15 % ) in the high-energy group and in two patients ( 5 % ) in the low-energy group . High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up , but the calcific deposit remains unchanged in size in the majority of patients Myositis ossificans ( MO ) is a fairly common evolution in sports activity and can be due to direct trauma or to repeated micro-injuries . The traditional therapeutic approach relies on a variety of treatments , such as physical therapy but evidence of their proven clinical efficacy is lacking . The latest therapeutic option is surgical removal but this is a demolitive procedure and is frequently associated with a significant loss of functional integrity . There are few articles in literature about the treatment of post-traumatic MO , and none on extracorporeal shock wave therapy ( ESWT ) . We illustrate a case series of 24 sportsmen treated with three sessions of electro-hydraulic shockwave therapy and an associated rehabilitation program .  Only a partial reduction of the ossification was observed in the X-ray images but all the patients showed signs of functional improvement immediately after therapy . Two months after the therapy , a normal range of motion and no signs of weak 
    Output:
    