STORZ MEDICAL DUOLITH SD1 Application Brochure

Transcription

DUOLITH® SD1
APPLICATION BROCHURE
MAN IS THE MEASURE OF ALL THINGS
PROTAGORAS
02 STORZ MEDICAL
Contents
Introduction
04
Key features at a glance 05
Physics and medicine 06
Focused and planar/defocused shock waves with F-SW and C-ACTOR® II handpiece 06
Radial shock waves (R-SW) 07
System functions and use
Touch screen
Loading and saving patient data and indications
How to use focused shock waves (F-SW)
How to use planar/defocused shock waves with C-ACTOR® II handpiece
How to use radial shock waves (R-SW)
Vibration therapy – V-ACTOR® handpiece
08
08
09
10
12
14
16
Indications
17
17
20
21
22
23
24
25
26
27
30
32
General treatment information
Plantar fasciitis/heel pain/heel spur
Calcific tendonitis/shoulder pain
Radial/ulnar humeral epicondylitis
Achillodynia
Patellar tendonitis (Jumper‘s knee)
Tibial stress syndrome (Shin splint)
Trochanteric tendonitis
Myofascial pain syndrome Shock wave acupuncture
Indications – Quick reference guide DUOLITH® SD1
Facts and figures
34
Technical specifications 34
Worldwide sales and service 35
STORZ MEDICAL 03
Introduction
Extracorporeal shock wave systems designed for interdisciplinary use, such as
the DUOLITH® SD1, allow medical specialists to gain access to the benefits
of non-invasive technology. With its
pioneering technological innovations,
STORZ MEDICAL is setting new standards in the treatment of pain in closeto-bone soft tissue of the postural and
locomotor systems. As a reliable partner
of doctors, we are committed to making
a vital contribution to medical progress
in the service of new therapy methods.
After having proved their efficacy in
the disintegration of kidney stones for
many decades, extracorporeal shock
04 STORZ MEDICAL
waves have also made their way into orthopaedics, surgery, rheumatology and rehabilitation during the last few years.
Users of the DUOLITH® SD1 who are making their first steps in ESWT will appreciate
this brochure as an indispensable guide to extracorporeal shock wave therapy. Apart
from explanations on the mode of action of shock waves, the brochure gives extensive handling and application advice. This information has been compiled in close
co-operation with experienced ESWT users. The second part of the brochure provides
examples of indications, including pictures and information on settings, to give new
users a clear and easy overview of how to use the DUOLITH® SD1. As with any other
new type of therapy, the treatment success will increase the more experience the
user gains with the operation and use of the DUOLITH® SD1.
Note
This application brochure is not intended to replace the unit‘s instruction manual.
Refer to the manual for more detailed information.
Key features at a glance
DUOLITH® SD1 – combined shock wave therapy
The DUOLITH® SD1 is the first combined shock wave therapy system designed for the
generation of radial shock waves (R-SW) and focused shock waves (F-SW). A planar/
defocused shock wave handpiece (C-ACTOR® II) is available as an option.
The extraordinary efficiency of this modern ESWT device derives from the powerful and individually selectable energy range. The DUOLITH® SD1 enables reliable
treatment of deep therapy regions. Its large focal zone ensures increased targeting
precision.
As a result, the DUOLITH® SD1 offers optimal therapy possibilities. What‘s more, it
is a good investment into the future: simple handpiece replacement and easy-toinstall retrofit options, such as software updates, foot pedal, etc., ensure that the
DUOLITH® SD1 always remains up to date to handle new applications or respond to
clinical and technological progress.
»Tower« version
These features make the DUOLITH SD1 a powerful technology tool that secures the
future of the medical surgery.
®
»Tower« version
»T-Top« version
Complete system with F-SW
and R-SW, optional C-ACTOR® II,
V-ACTOR®
Large monitor with
touch screen operation
Also available as pure
F-SW/C-ACTOR® II system
Two R-SW connectors
Two R-SW connectors
Designed for stationary use
Easy transport for use
in different surgeries
Built-in compressor
High-end system for the
most demanding applications
Complete system with F-SW
and R-SW, optional C-ACTOR® II,
V-ACTOR®
Available with low-noise
oil compressor or ENERGY II
compressor
»T-Top« version with ENERGY II compressor
STORZ MEDICAL 05
Physics and medicine
Focused and planar/defocused shock waves with F-SW and C-ACTOR® II handpiece
Shock waves used in medical technology are extremely short, powerful
pressure pulses with high pressure amplitudes and low tensile components.
There are different methods of shock
wave generation. By developing a shock
wave source with cylindrical geometry,
STORZ MEDICAL has managed not only
to circumvent the drawbacks of other
methods, but also to decisively improve
the principle of electromagnetic shock
wave generation. This ensures excellent shock wave dosing capability as
well as minimal variations during shock
wave application at low energy levels
or high pressures. The key features of
the STORZ MEDICAL cylindrical source
include minimal side effects, constant
energy application, superior dosing capability, long service life and low operating costs.
Focused shock waves are characterized by short wave lengths and are focused on
a focal zone outside the therapy head. They exert their efficacy in deep penetration
areas. Different stand-off distances can be used to vary the penetration depth and
adjust it to the tissue plane to be treated.
Scientific studies have confirmed the effectiveness of focused shock waves in the
treatment of calcific tendonitis, radial humeral epicondylitis, plantar fasciitis and
pseudarthrosis. Moreover, focused shock waves are increasingly used in the diagnosis and therapy of the myofascial trigger point syndrome. They help to localize
referred pain and enable a targeted treatment of deep trigger points. Nodular sarcomere adhesions are eliminated, and nociceptive afferents are inhibited.
Similarly to focused shock waves, planar/defocused shock waves are characterized by short wave lengths. However, they do not have a focal zone outside the
therapy head. Planar/defocused shock waves exert their efficacy at the body
surface and are preferably used in the diagnosis and therapy of the myofascial trigger point syndrome. They enable a targeted treatment of superficial trigger points and ensure elimination of nodular sarcomere adhesions and inhibition of nociceptive afferents. Planar/defocused shock waves are also used
in dermatology and can be applied in addition to focused shock waves in the
treatment of calcific tendonitis, radial humeral epicondylitis and plantar fasciitis.
Focused shock waves – F-SW handpiece
06 STORZ MEDICAL
Planar/defocused shock waves – C-ACTOR® II handpiece
Radial shock waves (R-SW)
Radial shock waves (R-SW) are introduced into the body by means of a freely moved
handpiece and cover the entire pain region. In physics radial shock waves are described under the term of radial pressure waves.
The radial therapy head of the DUOLITH® SD1 is a compressed air operated, ballistic shock wave generator. A projectile is accelerated by compressed air. The kinetic
energy stored in the motion and weight of the projectile is converted into acoustic
energy in the form of long-wave pressure pulses when the projectile strikes a transmitter. These acoustic pulses are transmitted to the target tissue by means of a
protective cap and gel.
0.5 µs
Radial shock waves propagate divergently after application and lose energy
as the penetration depth increases.
They are characterized by long wave
lengths and cannot be focused on deep
target areas. The penetration depth is
approximately 3 cm with the standard
transmitter R15. Their maximum energy
flux density is at the exit point from the
transmitter. Among other indications,
radial shock waves should preferably
be used in the treatment of patellar
tendonitis, tibial stress syndrome and
superficial trigger points.
500 µs
Time
Pressure rise: shock wave (left) and pressure wave (right)
Propagation of radial shock waves
with R-SW handpiece
STORZ MEDICAL 07
System functions and use
9
Touch screen
The DUOLITH SD1 is designed for maximum ease of use. Modern touch screen
technology makes buttons obsolete. The
menu-driven user interface guarantees
reliable acquisition of F-SW and R-SW
parameters. During patient treatment,
all essential parameters always remain
under control. The energy level, frequency, shock counter and number of
applied shock waves are displayed in
a clearly structured manner, and treatment data can be saved directly in the
system.
®
1
10
2
11
3
12
4
13
5
14
6
7
8
9
Selection of operating mode
Touch screen of DUOLITH® SD1 »T-Top«
Touch screen of DUOLITH® SD1 »Tower«
08 STORZ MEDICAL
1 Mode selector key – R-SW (radial shock waves) or
F-SW (focused shock waves)
2 Active mode display: active mode is highlighted in white
3 Selected energy level display
4 Display of selected shock number per session
5 Shock frequency display
6 Applied shock number display
7 Display of applied energy in F-SW mode
8 Patient report or indication
9 Increase/ Reduction of values 3 to 5
10 Menu access key
11 Language selection key (direct selection/display)
12 Energy level selector key
13 Shock number selector key
14 Frequency selector key
Loading and saving patient data and indications
Procedure
1
2
3
4
Press »Configuration« to load
existing configurations.
The »Configuration« screen appears
with indications and patient reports
(indications are marked with a *).
Select the desired configuration
and press »Load« to confirm.
Press »Menu exit« to return to the
start screen. Pre-configured settings
are displayed on the screen.
The DUOLITH® SD1 allows you to load
pre-configured indications and save patient data.
Indications
F-SW
R-SW
Plantar fasciitis 1
Plantar fasciitis 2
Calcific tendonitis 1
Calcific tendonitis 2
Epicondylitis 1
Epicondylitis 2
Achillodynia 1
Achillodynia 2
Patellar tendonitis 1
Patellar tendonitis 2
Tibial stress syndrome 1
Tibial stress syndrome 2
Trochanteric tendonitis 1
Trochanteric tendonitis 2
Myofascial trigger points 1 (F-SW)
Myofascial trigger points 1 (R-SW)
»Configuration« screen with list of indications
List of pre-configured indications
STORZ MEDICAL 09
How to use focused shock waves (F-SW)
Procedure
F-SW mode screen
10 STORZ MEDICAL
1 Connect the F-SW handpiece.
2 Switch on the main switch on the rear
panel beside the power connector.
3 The screen turns on with a white
display or shows the STORZ
MEDICAL logo (depending on
software version).
4 Wait until the automatic degassing
process is finished (3 – 5 min.). All
functions except for F-SW triggering
can be selected.
5 Follow the request to press the
shock wave release button on the F-SW handpiece to perform a test.
6 Select the »Mode«: F-SW.
7 Enable the menu by pressing the
blinking display.
8 In F-SW mode: apply silicone oil or
coupling gel to the handpiece
membrane and fit the correct
stand-off (I/II) for the desired
penetration depth.
9 Select the »Energy«, »Shocks«
and »Frequency« parameters with
the up or down arrow.
10 Remove the handpiece from the
holder and apply coupling gel.
11 Press the shock wave release
button on the handpiece to start
treatment.
12 Adjust the energy level and shock
wave frequency with the arrows,
if necessary.
button on the handpiece to stop
shock wave application.
Penetration depth of:
Without stand-off
Focal area
35 – 65 mm
50 mm
Therapeutic
efficacy
0 – 125 mm
Stand-off I
Focal area
15 – 45 mm
30 mm
Therapeutic
efficacy
0 – 105 mm
Stand-off II
Focal area
0 – 30 mm
15 mm
Use of stand-offs
The handpiece can be used for different penetration depths with different
stand-offs:
without stand-off
with stand-off I
with stand-off II
Silicone oil (preferable because inadvertent trapping of air bubbles
is avoided) or coupling gel must be
applied between the handpiece and
stand-off to ensure reliable coupling.
Therapeutic
efficacy
0 – 90 mm
Application energy
Frequency setting
Shock wave application has an analgesic effect, which makes the therapy as pleasant as possible for your patients:
The highest possible frequency is automatically selected for each individual
energy level. Although low frequency
settings are generally selected only at
high energy levels, the user may prefer a lower frequency at a low energy
level (to increase patient tolerance). In
this case, select »Setup« in the first submenu to disable the »Auto frequency«
mode.
Begin with an initial energy level of approx. 0.1 mJ/mm2. Energies up to
0.35 mJ/mm2 will generally be sufficient. Higher energy levels are only required
for specific applications (e.g. pseudarthrosis).
When the patient reports abatement of pain, you can gradually increase
the energy level. Select the application energy according to the
patient‘s sensitivity to pain.
Acute indications should be treated by selecting a low initial energy level.
Higher energy levels can be used to start treatment of chronic indications.
STORZ MEDICAL 11
How to use planar/defocused shock waves
with C-ACTOR® II handpiece
Procedure
C-ACTOR® II mode screen
12 STORZ MEDICAL
1 Connect the C-ACTOR® II handpiece
with stand-off II.
2 Switch on the main switch on
the rear panel beside the power
connector.
3 The screen turns on with a white
software version).
4 Wait until the automatic degassing
process is finished (3 – 5 min.). All
functions except for C-ACTOR® II triggering can be selected.
5 Follow the request to press the
shock wave release button on the C-ACTOR® II handpiece to perform
a test.
6 Select the »Mode«: C-ACTOR®.
7 Enable the menu by pressing the
blinking display.
8 Select the »Energy«, »Shocks«
and »Frequency« parameters with
the up or down arrow.
9 Remove the handpiece from the
button on the handpiece to start
treatment.
11 Adjust the energy level and shock
wave frequency with the arrows,
if necessary.
button on the handpiece to stop
shock wave application.
Application energy
Begin with an initial energy level of approx. 0.09 mJ/mm2.
When the patient reports abatement of pain, you can gradually increase the
energy level. Select the application energy according to the patient‘s sensitivity
to pain.
Energies up to 0.25 mJ/mm2 will generally be sufficient.
Frequency setting
The highest possible frequency is automatically selected for each individual energy
level. Although low frequency settings are generally selected only at high energy
levels, the user may prefer a lower frequency at a low energy level (to increase
patient tolerance). In this case, select »Setup« in the first submenu to disable the
»Auto frequency« mode.
Change between F-SW and C-ACTOR® II handpiece
The handpieces (F-SW/C-ACTOR® II) can be changed during the treatment without
any time delay (without switching the unit off).
Nevertheless, the following has to be considered:
Both handpieces must have been previously used with the system
(initial water filling and degassing).
Both handpieces must have been previously used on the treatment day
(short automatic degassing process, required only once a day).
STORZ MEDICAL 13
How to use radial shock waves (R-SW)
Procedure
1
2
3
4
5
6
7
8
9
Switch on the main switch on the rear
panel beside the power connector.
The screen turns on with a white
software version).
Select the »Mode«: R-SW.
Confirm the displayed setting
by pressing the blinking display.
Select the »Energy«, »Shocks« and
»Frequency« parameters with the up or down arrow. Start treatment at a pressure of 1.5 – 2 bar and
a frequency of 5 Hz.
Remove the handpiece from the
Press the shock wave release button
on the handpiece to start treatment.
Adjust the energy level with the
arrows, if necessary.
Press the shock wave release button
to stop shock wave application.
Different ways of holding the R-SW handpiece
Like a pen
14 STORZ MEDICAL
Like a bar
Like a pistol
Application energy
Begin with an initial energy level of approx. 1.5 – 2 bar. Energies up to 3 bar will
generally be sufficient.
When the patient reports abatement of pain, you can gradually increase the
energy level with the arrows.
Select the application energy according to the patient‘s sensitivity to pain
(bio-feedback).
Shock wave coupling cushion
A shock wave coupling cushion can be used with the 6 mm and 15 mm transmitters
to ensure hygienic coupling to the patient‘s skin. Silicone oil or coupling gel must be
applied between the cushion and transmitter.
Optional transmitters
A6: AkuST transmitter, Ø 6 mm, acupuncture
C15: CERAma-x®, ESWT transmitter, Ø 15 mm, pain therapy
R15: RSWT transmitter, Ø 15 mm, pain therapy
DI15: Deep Impact® transmitter, Ø 15 mm, »Energy Beam«
F15: »Focus-Lens« transmitter, Ø 15 mm, energy focus area
D20-S:D-ACTOR® I transmitter, Ø 20 mm, trigger points, muscle activation
D35-S:D-ACTOR® II transmitter, Ø 35 mm, muscle and connective tissue activation, muscle smoothing
See »transmitter chart« for the different applications and contact your dealer for information on the complete range of available
transmitters!
STORZ MEDICAL 15
Vibration therapy – V-ACTOR® handpiece
The ideal complement to shock wave therapy
»Physiological intrinsic oscillations play
a key role in muscular perfusion and
lymphatic drainage.«
(Professor V. T. Nazarov, 1988)
Vibration:
1 – 35 Hz
Vibration head stroke:
1 – 4 mm
Available vibration head diameters:
25 or 40 mm
16 STORZ MEDICAL
The V-ACTOR® generates stimulating vibrations as a non-pharmacological method
to reduce muscular strain and eliminate muscle triggers or disorders of tendon insertions caused by muscle triggers. Vibration therapy increases the blood circulation
in the extracellular matrix of connective tissue and stimulates metabolic activities.
Indications
General
Die Applikationsenergie
treatment information
Die Stosswellenbehandlung bewirkt einen analgetischen Effekt der die Behandlung
Generally
für Ihren Patienten
speaking,möglichst
one has toangenehm
bear in mind
gestaltet:
that shock wave therapy is experienced
differently
• Beginnenfrom
Sie mit
patient
einer to
Anfangsenergie
patient. Somevon
people
ca. 1.5
find
- 2itbar,
rather
Energien
pleasant,
bis 3 whereas
bar sind
others
in der Regel
may feel
ausreichend
slight pain.
• Berichtet Ihr Patient von einem Nachlassen des Schmerzes, können Sie die Energie
Close
durch co-operation
die Pfeiltastenwith
langsam
the patient
steigern
is required to achieve optimum therapy results.
The
• Orientieren
painful spots
Sie sich
are an
localized
der Schmerzempfindlichkeit
by palpation following
desthe
Patienten
patient‘s
(Biofeedback).
indications of
pain. Deep pain regions can also be localized directly by means of the shock waves.
Combined therapy with focused shock waves and radial shock waves is performed in
two
Die Frequenzeinstellung
steps (e.g. Achillodynia 1 (F-SW), Achillodynia 2 (R-SW)). Treatment is started at
the
Beginnen
point of
Siemaximum
die Behandlung
pain. Shock
mit 5waves
Hz. Da
aredie
applied
Schmerzempfindung
to the target tissue
bei by
jedem
moving
Pathe
tienten
handpiece
anders in
ist,a sollten
slow circular
Sie während
motionder
over
Behandlung
the entire pain
durch
region.
Umschalten
Duringder
theFrequentire
duration
enz testen,
of welche
the therapy
Einstellung
session,Ihra Patient
constant
besser
dialogue
verträgt.
with the patient is required to
ensure precise localization of the painful spot(s).
Stosswellen-Koppelkissen
Once
Ist eine
thehygienische
primary point
Patientenankoppelung
of pain has been eliminated
gewünscht,
by erfolgt
the analgesic
die Anwendung
effect of the
mit
dem Druckwellen-Koppelkissen
6 mm
mm- Applikator.
shock
waves, other painful spots für
appear
thatbzw.15
were previously
covered Koppelöl
up by the muss
prinzwischen
undspot
Applikator
aufgetragen
werden.
cipal
pain.Membran
The painful
begins to
migrate. The
more painful spots are localized
and eliminated in the course of the treatment session, the better the therapy result.
In most cases, 3 to 5 treatment sessions at 10 to 14 days intervals are necessary.
Coupling
Treatment efficacy is conditional upon good coupling! Always apply a sufficient
amount of gel to ensure optimal shock transmission into the tissue. Make sure that
the entire surface of the transmitter or handpiece membrane is in contact with the
patient‘s skin. Hold the handpiece in such a way that it is positioned at right angles
to the skin surface. When working in F-SW mode, apply silicone oil or coupling gel
between the handpiece and stand-off.
STORZ MEDICAL 17
Indications
Anaesthesia
In general, local anaesthesia is not required. Anaesthesia would reduce the possibility of pain localization and bio-feedback during treatment. There is scientific
evidence that local anaesthesia decreases the effectiveness of shock waves. This is
presumably caused by the inhibition of biochemical processes. In most cases, shock
wave therapy is well tolerated by patients if the application energy is gradually increased and the frequency is adjusted to the patient‘s sensitivity to pain.
Tip: cool the application area before you apply shock waves. This will substantially
reduce the patient‘s pain sensation.
Fields of application of F-SW, C-ACTOR® and R-SW
Patient
Limited sports activities and physical
strain are recommended during the entire duration of the therapy.
Indications
All indications listed in this brochure
are pre-configured in the DUOLITH®
SD1 software and can be loaded by the
user (see page 09).
Orthopaedics/surgery:
e.g. heel spur, myofascial trigger points, shoulder pain or achillodynia
Urology:
e.g. Peyronie‘s disease, prostatitis
Dermatology/aesthetics:
e.g. wound healing, scar smoothing, skin burns, skin tightening
Neurology:
e.g. spasms
Note
Please keep track of the latest medical publications and new information published
by the manufacturer for details on additional indications approved after the date of
printing of this brochure.
We recommend that the user and the patient should wear suitable hearing protection. Please offer always the patient hearing protection.
18 STORZ MEDICAL
Treatment
with the DUOLITH® SD1
is
not permitted in the following cases:
für Ihren Patienten möglichst angenehm gestaltet:
• Beginnen Sie mit einer Anfangsenergie von ca. 1.5 - 2 bar, Energien bis 3 bar sind
coagulation disorders (haemophilia)
in der Regel ausreichend
use of anticoagulants, especially Marcumar
thrombosis
durch die Pfeiltasten langsam steigern
tumour diseases, carcinoma patients
• Orientieren Sie sich an der Schmerzempfindlichkeit des Patienten (Biofeedback).
pregnancy
children in growth (growth plates)
cortisone therapy up to 6 weeks before first ESWT treatment
Generally speaking, shock waves must not be applied to target areas located above
Beginnen Sie die Behandlung mit 5 Hz. Da die Schmerzempfindung bei jedem Paair filled tissue (lungs), large nerves, vessels, the spinal column or head.
tienten anders ist, sollten Sie während der Behandlung durch Umschalten der Frequenz testen, welche Einstellung Ihr Patient besser verträgt.
Treatment
with the DUOLITH® SD1
Ist einecause
hygienische
gewünscht, erfolgt die Anwendung mit
may
the Patientenankoppelung
following side effects:
dem Druckwellen-Koppelkissen für 6 mm bzw.15 mm- Applikator. Koppelöl muss
zwischen
swelling,
reddening,
haematomas
Membran
und Applikator
aufgetragen werden.
petechiae
pain
skin lesions after previous cortisone therapy
These side effects should be avoided by using low energy levels and pressures. Bear
in mind that a low shock wave dose has a beneficial effect on biological systems,
whereas a high dose may cause damage.
Side effects generally abate after 2 to 5 days. Make sure that the above side effects
have disappeared before starting the next therapy session.
STORZ MEDICAL 19
Plantar fasciitis/heel spur/heel pain
Preparation
Preliminary ultrasound examination; MRT in case of chronic conditions
to exclude calcaneal edema
Patient placement in a lying position with roll under foot joints
Gel application
Localization of painful spot with bio-feedback
Treatment interval 10 – 14 days
Direct therapy start after completion of preparations
Application
Number of sessions
1–3
F-SW
Energy level: Pulses/session: Frequency:
Stand-off: 0.20 – 0.30 mJ/mm2
1800 – 2000
4 Hz
I or II
R-SW
Energy level: Pulses/session: Frequency: Transmitter: Therapy region:
1.8 – 3.0 bar
3000 – 3500
15 – 21 Hz
R15, D20-S*
smoothing of calf muscles
and foot sole
Pre-configured indications in DUOLITH® SD1 software
Plantar fasciitis 1 (F-SW)
Plantar fasciitis 2 (R-SW)
* See page 15
20 STORZ MEDICAL
Preparation
für Ihren
Preliminary
Patienten
examination
möglichstfor
angenehm
localization
gestaltet:
by ultrasound, X-ray or CT
• Beginnen
MarkingSie
of therapy
mit einerregion
Anfangsenergie von ca. 1.5 - 2 bar, Energien bis 3 bar sind
in der
GelRegel
application
ausreichend
• Berichtet
Treatment
Ihr interval
Patient von
10 –einem
14 days
Nachlassen des Schmerzes, können Sie die Energie
Application
Number of sessions
3Die
– 5Frequenzeinstellung
Beginnen Sie die Behandlung mit 5 Hz. Da die Schmerzempfindung bei jedem PaF-SW
tienten anders ist, sollten Sie während der Behandlung durch Umschalten der FrequEnergy
level:welche
0.18 – 0.32
enz testen,
Einstellung
IhrmJ/mm
Patient2 besser verträgt.
Pulses/session: 1500 – 1800
Frequency:
4 – 6 Hz
Stand-off:
I or II
Ist eine hygienische
R-SW
zwischen Membran und Applikator aufgetragen werden.
Energy level: 1.8 – 3.0 bar
Frequency: 15 – 21 Hz
Transmitter: D20-S*
Therapy region:
upper arm and cervical muscles,
smoothing of surrounding muscles
Calcific tendonitis 1 (F-SW)
Calcific tendonitis 2 (R-SW)
* See page 15
STORZ MEDICAL 21
Preparation
Patient placement in a supine position
Gel application
Localization of painful spot with F-SW and bio-feedback
Treatment preferably in F-SW mode
Application
Number of sessions
3–5
F-SW
Stand-off: Therapy region: 0.15 – 0.35 mJ/mm2
1500 – 1800
4 – 6 Hz
I or II
painful spots in epicondyle
R-SW
Energy level: Pulses/session: Frequency: Transmitter: Therapy region:
1.8 – 3.0 bar
2000 – 3000
15 – 21 Hz
R15, D20-S*
forearm extensors and/or forearm flexors
Epicondylitis 1 (F-SW)
Epicondylitis 2 (R-SW)
*See page 15
22 STORZ MEDICAL
Achillodynia
Preparation
für Ihren
Patient
Patienten
placement
möglichst
in a prone
angenehm
positiongestaltet:
• Beginnen
Roll under
Siefoot
mit joints
einer Anfangsenergie von ca. 1.5 - 2 bar, Energien bis 3 bar sind
in der
GelRegel
application
ausreichend
• Berichtet
Localization
Ihr Patient
of painful
von spots
einemalong
Nachlassen
the Achilles
des Schmerzes,
tendon können Sie die Energie
durch
in F-SW
die Pfeiltasten
mode, constant
langsam
dialogue
steigernwith the patient
• Orientieren
TreatmentSie
interval
sich an
8 days
der Schmerzempfindlichkeit des Patienten (Biofeedback).
Application
Number
Beginnenof
Siesessions
die Behandlung mit 5 Hz. Da die Schmerzempfindung bei jedem Pa4tienten
– 6 anders ist, sollten Sie während der Behandlung durch Umschalten der Frequenz testen, welche Einstellung Ihr Patient besser verträgt.
F-SW
Energy
level: 0.20 – 0.30 mJ/mm2
Pulses/session:
500 – 800
Frequency:
4 Hz
für 6 mm bzw.15 mm- Applikator. Koppelöl muss
Stand-off:
I or Applikator
II
zwischen Membran
und
aufgetragen werden.
Therapy region:
dorsal, lateral, medial
R-SW
Energy level: Pulses/session:
Frequency: Transmitter: Therapy region: 1.8 – 2.6 bar
2000 – 3000
15 – 21 Hz
R15, D20-S*
smoothing of surrounding
calf muscles and foot sole
Achillodynia 1 (F-SW)
Achillodynia 2 (R-SW)
* See page 15
STORZ MEDICAL 23
Patellar tendonitis (Jumper‘s knee)
Preparation
Patient placement in a supine position
Knee roll under popliteal fossa
Stretched leg
Gel application
Localization of pain region at patellar apex in F-SW mode
Lifting of apex by applying pressure and push force from a cranial direction
Application
Number of sessions
3–5
F-SW
1500 – 2000
4 – 6 Hz
II
tendon insertion
R-SW
Energy level: Pulses/session: Frequency: Transmitter: Therapy region: 1.8 – 2.2 bar
2000 – 3000
15 – 21 Hz
R15, D20-S*
quadriceps muscle, tensor fasciae latae muscle,
iliotibial band
Patellar tendonitis 1 (R-SW)
Patellar tendonitis 2 (F-SW)
*See page 15
24 STORZ MEDICAL
Preparation
für Ihren
Patient
Patienten
placement
möglichst
in a supine
angenehm
positiongestaltet:
• Beginnen
Localization
Sie mit
of painful
einer Anfangsenergie
spots along thevon
tibia
ca. 1.5 - 2 bar, Energien bis 3 bar sind
in der
GelRegel
application
ausreichend
• Berichtet
Treatment
Ihr interval
Patient von
1 week
einem Nachlassen des Schmerzes, können Sie die Energie
Application
Number of sessions
3Die
– 4Frequenzeinstellung
Beginnen Sie die Behandlung mit 5 Hz. Da die Schmerzempfindung bei jedem PaF-SW
II)
tienten(C-ACTOR
anders ist,® sollten
Sie während der Behandlung durch Umschalten der FrequEnergy
level:welche
0.18 – 0.25
enz testen,
Einstellung
IhrmJ/mm
Patient2 besser verträgt.
Frequency:
4 – 6 Hz
Stand-off:
II
Ist eine hygienische Patientenankoppelung
Therapy
region:
tibia
für 6 mm bzw.15 mm- Applikator. Koppelöl muss
R-SW
Energy level: 1.8 – 2.8 bar
Frequency: 15 – 21 Hz
Transmitter: R15, D20-S*
Therapy region: smoothing of surrounding muscles
Tibial stress syndrome 1 (F-SW)
Tibial stress syndrome 2 (R-SW)
* See page 15
STORZ MEDICAL 25
Preparation
Patient placement in a lateral position
Localization of painful spots and/or painful region in F-SW mode
Gel application
Treatment interval 1 week
Application
Number of sessions
3–5
Treatment of trigger points in gluteal region
F-SW
1500 – 2000
4 – 5 Hz
0
trochanter
R-SW
Energy level: Pulses/session: Frequency: Transmitter: Therapy region: 2.0 – 3.0 bar
2000 – 3000
15 – 21 Hz
D20-S, D35-S*
Application over large surface area, stretching, localization of
additional trigger points in associated muscles by palpation
and shock wave stimulation, stretching, depending on position, considering bio-feeback and referred pain
Trochanteric tendonitis 1 (R-SW)
Trochanteric tendonitis 2 (F-SW)
*See page 15
26 STORZ MEDICAL
Myofascial pain syndrome
Trigger
point shock wave therapy
Trigger
für Ihrenpoints
Patienten
are groupings
möglichstofangenehm
microscopic
gestaltet:
nodules which are caused by contracted
muscle
• Beginnen
fibresSieand
mitform
einerinto
Anfangsenergie
a palpable trigger
von ca.node
1.5 - within
2 bar, Energien
a muscle.bisThese
3 barsmall
sind
nodular
in der Regel
thickenings
ausreichend
frequently lead to the formation of taut bands.
Active
durch die
muscular
Pfeiltasten
trigger
langsam
pointssteigern
cause the typical referred pain described by Travell
and
• Orientieren
Simons. This
Sie referred
sich an der
painSchmerzempfindlichkeit
is recognized by the patient
des Patienten
as familiar.
(Biofeedback).
Latent trigger
points only cause pain during palpation and stretching.
Localization
of trigger points
Beginnen Sie die Behandlung mit 5 Hz. Da die Schmerzempfindung bei jedem PaManual
examinations,
palpation
and der
stretching
tests durch
are the
main methods
emtienten anders
ist, sollten
Sie während
Behandlung
Umschalten
der Frequployed
in the
diagnosis
and localization
of trigger
points. Trigger points cannot
enz testen,
welche
Einstellung
Ihr Patient besser
verträgt.
be diagnosed by means of imaging systems such as ultrasound devices. Focused
shock
waves are an ideal diagnostic tool for the precise localization of trigger points
through
bio-feedback.
As soon as the applied
shock waves
reach
trigger point,
gewünscht,
erfolgt
diethe
Anwendung
mit
patients
will recognize the precise
of the pain
are suffering
from.muss
This
fürposition
6 mm bzw.15
mm-they
Applikator.
Koppelöl
procedure
is extremely
the diagnosis
of trigger points located deep in
zwischen Membran
undimportant
Applikatorinaufgetragen
werden.
the tissue.
Therapy can be performed after completion of diagnosis and localization. Treatment
is started in F-SW mode and then continued in R-SW mode.
Therapy concept
Shock waves are applied to the pain-producing trigger area within the affected muscle region in one or several therapy sessions. In general, 6 to 10 sessions are necessary at about 5 days intervals. Each trigger point requires 100 to 400 shock waves.
The muscles are then stretched and smoothed with about 2000 radial shock waves.
In case of therapy resistance, the diagnosis needs to be verified.
Indications
Patients suffering from neck/shoulder
pain and back pain or from tendon and
joint disorders are the major target group
for trigger point shock wave therapy.
Even tension headache may be caused
by trigger points. A differential medical
diagnosis of all disorders is of crucial importance before starting the therapy.
Note
A sound knowledge of trigger point
therapy is required for the use of the
DUOLITH® SD1 in the field of trigger
point shock wave therapy.
STORZ MEDICAL 27
Preparation
Patient placement depends on symptoms
Localization of trigger points by palpation and R-SW/F-SW
Localization of painful spots and/or pain region in F-SW mode
No local anaesthesia
Gel application
Application
Number of sessions
4–8
F-SW
Energy level: Pulses: Frequency:
Stand-off: 0.05 – 0.35 mJ/mm2
200 – 500/trigger point
4 Hz
0, I or II
R-SW
Energy level: Pulses: Frequency: Transmitter: Therapy region: 1.0 – 4.0 bar
300 – 1000/trigger point, 500 – 4000/muscle area
10 – 21 Hz
R15, DI15, D20-S, D35-S*
muscle smoothing over large surface area
Sound knowledge of TrST required
Seminar attendance required
Diagnosis in case of therapy resistance
Myofascial trigger points 1 (F-SW)
*See page 15
28 STORZ MEDICAL
für Ihren Patienten möglichst angenehm gestaltet:
• Beginnen Sie mit einer Anfangsenergie von ca. 1.5 - 2 bar, Energien bis 3 bar sind
in der Regel ausreichend
• OrientierenofSie
sich an
der Schmerzempfindlichkeit des Patienten (Biofeedback).
Localization
trigger
points
Smoothing in lying position with R-SW – D35-S
in lumbar region with F-SW and stand-off II
Beginnen Sie die Behandlung mit 5 Hz. Da die Schmerzempfindung bei jedem Patienten anders ist, sollten Sie während der Behandlung durch Umschalten der Frequenz testen, welche Einstellung Ihr Patient besser verträgt.
Ist eine hygienische Patientenankoppelung gewünscht, erfolgt die Anwendung mit
Localization of trigger point
in lumbar region with R-SW
Treatment of quadriceps muscle with R-SW – D35-S
Localization and treatment of trigger points with F-SW
(without stand-off) in piriform muscle syndrome therapy
Treatment and smoothing
of gluteus muscles with R-SW – D20-S
STORZ MEDICAL 29
Shock wave acupuncture
Extension of Traditional
Chinese Medicine according
to Dr. Everke
Acupuncture is one of the oldest forms
of medical treatment. Based on the
concepts of oriental medicine, acupuncture stimulates precisely identified sensitive points on the body surface to improve the most varied disorders. So far,
this has been done by means of needle,
heat, cold and, recently, electrical stimuli such as laser stimulation.
Since many acupuncture points are
characterized by groupings of pressure
receptors in the tissue, shock waves applied by means of the DUOLITH® SD1
provide an additional method of stimulation. Local and distant points are
selected according to the principles of
Chinese medicine.
Note
Qualified training in acupuncture and
acupuncture shock wave therapy is
required for therapeutic application of
shock waves in the field of shock wave
acupuncture.
30 STORZ MEDICAL
Benefits of shock wave acupuncture
over needle acupuncture
Shock wave acupuncture is a non-invasive therapy method that requires extremely
short treatment times of only few seconds per point and provides increased efficacy as high-intensity shock waves reach the entire target region at the same time.
Blood circulation in the affected area is decisively improved and lymphatic drainage
is accelerated. Provided that the specified contraindications are excluded from shock
wave therapy, this treatment method causes virtually no pain or side effects.
Therapy concept
When the DUOLITH® SD1 is used for a well selected combination of acupuncture
points, complex disorders and pain syndromes can now be treated with extracorporeal shock waves for the first time. Shock wave acupuncture therapy stimulates distant points, master points and local acupuncture points in order to make their effects
additive.
Indications for shock wave acupuncture
The indications for shock wave acupuncture are basically the same as for classical
acupuncture. Shock wave acupuncture has shown to be particularly beneficial in the
treatment of osteoarthritis. This is due to the fact that the well-targeted stimulation
of local and distant points in the presence of contracted muscle and tendon structures provides instant alleviation of pain.
However, shock wave therapy – perhaps combined with classical acupuncture – is
also a valuable addition to the treatment options currently available for standard
acupuncture indications such as ischialgia, tinnitus, vertigo, dry cough, constipation,
irritable bladder, prostatitis, perfusion disorders, lymphatic edema etc.
Acupuncture therapy
Indications
für Ihren
asthma
Patienten möglichst angenehm gestaltet:
• Beginnen
cervical syndrome
Sie mit einer Anfangsenergie von ca. 1.5 - 2 bar, Energien bis 3 bar sind
in der
coxarthrosis
Regel ausreichend
• Berichtet
heel spur
Ihr Patient von einem Nachlassen des Schmerzes, können Sie die Energie
durch
gonarthrosis
die Pfeiltasten langsam steigern
• Orientieren
lumbar spine
Sie syndrome
sich an der Schmerzempfindlichkeit des Patienten (Biofeedback).
lumbago
irritable bladder
tennis arm
Beginnen Sie die Behandlung mit 5 Hz. Da die Schmerzempfindung bei jedem PaPreparation
tienten anders ist, sollten Sie während der Behandlung durch Umschalten der Frequenz testen, welche Einstellung Ihr Patient besser verträgt.
Patient placement depends on symptoms
Localization of acupuncture points
Ist eine
Gel application
hygienische Patientenankoppelung gewünscht, erfolgt die Anwendung mit
dem
Next
session after 2 – 3 daysfür 6 mm bzw.15 mm- Applikator. Koppelöl muss
Druckwellen-Koppelkissen
Application
Number of sessions
6 – 12
R-SW
Energy level:
Pulses: Frequency: Transmitter: 1 – 2 bar
10 – 50/acupuncture point
1 – 5 Hz
A6*
A sound knowledge of acupuncture therapy is required.
*See page 15
STORZ MEDICAL 31
Indications – Quick reference guide DUOLITH® SD1
F-SW
Sessions
R-SW
Energy
(mJ/mm2)
Pulses/
session
0.20 – 0.30
1800 – 2000
4
---
---
---
Frequency Stand(Hz)
off
Energy
(bar)
Pulses/
session
Frequency Transmitter
(Hz)
I or lI
---
---
---
---
---
1.8 – 3.0
3000 – 3500
15 – 21
R15, D20-S
Plantar fasciitis/heel spur/heel pain
Heel
1. Pain Points
(acute and chronic pain)
1–3
Calf muscles
2. Muscles
Note
Preliminary ultrasound examination, trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, localization with
bio-feedback, smoothing of calf muscles and intrinsic foot muscles with V-ACTOR®, treatment interval 10 – 14 days
Supraspinatus tendon,
chronic pain
1. Pain Points
Surrounding muscles
2. Muscles
Note
Preliminary ultrasound/X-ray examination for localization (marking of therapy region), treatment of dorsal musculature with D20-S,
smoothing of dorsal musculature with V-ACTOR®, treatment interval 10 – 14 days
3–5
0.18 – 0.32
1500 – 1800
4–6
I or lI
---
---
---
---
---
---
---
---
1.8 – 3.0
2000 – 3000
15 – 21
D20-S
Tendon insertion
(painful spot)
1. Pain Points
Surrounding upper arm
and forearm muscles
2. Muscles
Note
0.15 – 0.35
1500 – 1800
4–6
I or lI
---
---
---
---
---
---
---
---
1.8 – 3.0
2000 – 3000
15 – 21
R15, D20-S
3–5
Preferably F-SW, bio-feedback for localization of focus of pain, smoothing of surrounding muscles with V-ACTOR®, treatment
interval 10 – 14 days
Achillodynia
Achilles tendon
(directly to tendon)
1. Pain Points
Surrounding muscles
2. Muscles
Note
Smoothing of surrounding calf muscles and of intrinsic foot muscles with D20-S and V-ACTOR , treatment interval 8 days
4–6
0.20 – 0.30
500 – 800
4
I or lI
---
---
---
---
---
---
---
---
1.8 – 2.6
2000 – 3000
15 – 21
R15, D20-S
®
Patellar tendonitis (Jumper’s knee)
Tendon insertion
1. Pain Points
Quadriceps, M. tensor
fasciae latae
2. Muscles
Note
In stretched position, lifting of apex applying pressure and push force from cranial direction, treatment interval 10 – 14 days
32 STORZ MEDICAL
3–5
0.15 – 0.30
1500 – 2000
4–6
ll
---
---
---
---
---
---
---
---
1.8 – 2.2
2000 – 3000
15 – 21
R15, D20-S
F-SW
Sessions
R-SW
Energy
(mJ/mm2)
Pulses/
session
0.18 – 0.25
1200 – 1500
4–6
---
---
---
Frequency Stand(Hz)
off
Energy
(bar)
Pulses/
session
Frequency Transmitter
(Hz)
ll
---
---
---
---
---
1.8 – 2.8
3000
15 – 21
R15, D20-S
Medial, inner edge of
shin bone
1. Pain Points
Surrounding muscles
2. Muscles
Note
Treatment of the lower regions of the tibia with R-SW or alternatively with planar/defocused shock wave, smoothing of surrounding
muscles with V-ACTOR®, treatment interval 1 week
3–4
Tendon insertion
1. Pain Points
Surrounding muscles
2. Muscles
Note
Localization of painful spots and additional trigger points in associated muscles by palpation and shock wave stimulation,
stretching, bio-feedback, referred pain, smoothing of surrounding muscles with V-ACTOR®, treatment interval 1 week
3–5
0.15 – 0.30
1500 – 2000
4–5
0
---
---
---
---
---
---
---
---
2.0 – 3.0
2000 – 3000
15 – 21
D20-S, D35-S
Trigger point treatment
(F-SW or R-SW )
1. Pain Points
200 – 500
(per trigger
point)
4
0,I or II
1.0 – 4.0
300 – 1000
(per trigger
point)
10 – 15
R15, DI15,
D20-S
---
---
---
---
1.0 – 3.8
500 – 4000
10 – 21
D20-S, D35-S
4–8
Smoothing muscles over
2. Muscles
large area, stretching
Note
0.05 – 0.35
Palpation of trigger points, no local anaesthesia, sound knowledge of TrST (trigger point shock wave therapy) required, seminar
attendance recommended, smoothing muscles over large area with V-ACTOR®, treatment interval 1 – 2 sessions/week
Caution: Do not apply more than 200 – 500 pulses at one point of treatment.
Timeline for improvements:
1. First improvements after 3 sessions
2. Further noticeable improvements after 3 months
Transmitters:
R15: RSWT transmitter, Ø 15 mm
DI15: Deep Impact® transmitter, Ø 15 mm
D20-S:D-ACTOR® I transmitter, Ø 20 mm
D35-S:D-ACTOR® II transmitter, Ø 35 mm
STORZ MEDICAL 33
Technical specifications
DUOLITH® SD1 »Tower«
H x W x D (without monitor): 80 x 45 x 55 cm
Weight: approx. 63 kg
F-SW handpiece: 770 g
R-SW handpiece: 445 g
Trigger button on both handpieces
Built-in compressor for R-SW and V-ACTOR®
Tiltable LCD colour display »Touch screen«
USB/LAN port
Mobile use in surgeries and clinics
Patented STORZ MEDICAL cylindrical source
Patented »Radial D-ACTOR®« technology
DUOLITH® SD1 »T-Top«
34 STORZ MEDICAL
H x W x D: 16.5 x 45 x 52 cm
Weight: approx. 23 kg
F-SW handpiece: 770 g
R-SW handpiece: 445 g
Trigger button on both handpieces
LCD colour display »Touch screen«
USB/LAN port
External compressor for R-SW and V-ACTOR®
Mobile
Patented STORZ MEDICAL cylindrical source
Patented »Radial D-ACTOR®« technology
Worldwide services
Worldwide services
Medical specialists all over the world benefit from our experience using systems
developed by STORZ MEDICAL AG.
Based in Tägerwilen/Switzerland, the company operates around the globe through
its branch offices and partners, making sure that qualified service personnel is
always near at hand.
Creating synergies
Complex technology is only as good as the skills of the people who use it. Our training concepts are geared to the interaction between doctors, systems and patients.
We provide on-the-spot training to our medical partners to ensure efficient use and
operation of our systems right from the very start.
Rely on us to support you in the development of new application methods. After all,
it is your know-how and ideas that pave the way for the continuous development of
leading-edge technology.
STORZ MEDICAL 35
STORZ MEDICAL AG · Lohstampfestrasse 8 · 8274 Tägerwilen · Switzerland
Tel. +41 (0)71 677 45 45 · fax +41 (0)71 677 45 05 · www.storzmedical.com
SM 18 299-01 E 0910/SIH
Subject to change without notice.
HUMANE TECHNOLOGY – TECHNOLOGY FOR PEOPLE

STORZ MEDICAL DUOLITH SD1 Application Brochure

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