Superficial nonunions




Name Tissue Type of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome


Nonunion refers to the failure of bone fractures to achieve cortical continuity on radiographic studies.

The prevalence of nonunion of all fracture types ranges from 2.5% to 46% and the complication places substantial economic burdens on health systems. Surgical fracture stabilization using bone grafts and internal/external fixation has remained the gold standard for treating fracture nonunions.

However, these procedures often lead to serious complications including deep infections, persistent wound drainage, hematoma formation, sensory loss, persisting pain and nonunions. Hence, there remains a need for efficient therapies that will bring better results more quickly and without major complications. Over the past decades, focused extracorporeal shock wave therapy (fESWT) has emerged as an efficient, non-invasive and cost-effective alternative to surgery in the treatment of fracture nonunions.

A total of 40 studies (as of Juli 31, 2017) have shown an overall success rate of approximately 76% after six months when treating fracture nonunions with fESWT, without major complications. Among these 40 studies were one randomized controlled trial with a success rate of 71% after six months, two cohort studies comparing fESWT with surgery, with success rates of 91% and 79% after six months, and 36 case series without control group, with success rates between 39% and 100% after six months


Kertzman et al., J Orthop Surg Res 2017: in press.

Radial extracorporeal shock wave therapy is efficient and safe in the treatment of fracture nonunions of superficial bones: a retrospective case series


Silk et al., Foot Ankle Int 2012;33:1128-1132.

Low-energy extracorporeal shock wave therapy to treat lesser metatarsal fracture nonunion: case report.



Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2 to 3 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 2,000 to 3,000 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15mm
Skin pressure Light to moderate

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