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MASTERPULS® »Elite« LINE APPLICATION BROCHURE

02 STORZ MEDICAL

MAN IS THE MEASURE OF ALL THINGSPROTAGORAS

STORZ MEDICAL 03

Contents

Non-invasive therapy 04Physics of radial shock wave technology 05

System design 06 MASTERPULS® MP50 »Elite« and MASTERPULS® MP100 »Elite« – System functions and use 07MASTERPULS® MP200 »Elite« – System functions and use 08Loading and saving patient data and indications 09Overview transmitters 10Handpiece and transmitter handling 11V-ACTOR® – Vibration therapy 12

Treatment 13Application energy 14Indications 15Plantar fasciitis/heel pain/heel spur 16Calcific tendonitis/shoulder pain 17Radial/ulnar humeral epicondylitis 18Achillodynia 19Patellar tendonitis (Jumper‘s knee) 20Tibial stress syndrome (Shin split) 21Trochanter tendonitis 22Acupuncture shock wave therapy (AkuST) 23Myofascial pain syndrome 25

Quick reference guide MASTERPULS® MP50 »Elite« 28Quick reference guide MASTERPULS® MP100 »Elite« 29Quick reference guide MASTERPULS® MP200 »Elite« 30Global presence 31

04 STORZ MEDICAL

Non-invasive therapy

Our objective

Better therapies through new technologies. Established in 1987, STORZ MEDICAL AG is a Swiss member company of the KARL STORZ Group. The objective pursued by our physicists and engineers is to conduct ongoing research into shock wave tech-nology and to develop new system concepts. Our products have proved their effi-cacy all over the world in the fields of urology, orthopaedics, rehabilitation, gastro-enterology, cardiology and dermatology. New compact systems have recently been developed so that other medical disciplines can also gain access to the benefits of non-invasive shock wave technology.

With its pioneering technological innovations, STORZ MEDICAL is setting new stand-ards in aesthetic medicine and in the treatment of pain in close-to-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.

STORZ MEDICAL 05

Physics of radial shock wave technology

Radial shock waves (R-SW) are introduced into the body by means of a freely moved handpiece and cover the entire pain region. Radial shock waves are often referred to as radial pressure waves, which is the correct definition in physical terms.

The radial therapy head of the MASTERPULS® is a compressed air operated, ballis-tic 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 shock pulses when the projectile strikes a transmit-ter. These acoustic pulses are transmitted to the target tissue by means of a protec-tive cap and gel.

Radial shock waves propagate diver-gently 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. Penetration depth is ap-proximately 3 cm with the standard transmitter R15. Their maximum energy flux density is at the exit point from the transmitter.

Time

500 µs

Pressure rise: radial pressure wave Radial shock waves – R-SW handpiece

06 STORZ MEDICAL

System design

The MASTERPULS® MP200 »Elite«, MASTERPULS® MP100 »Elite« and MASTER-PULS® MP50 »Elite« offer excellent therapeutic possibilities. What‘s more, they are a good investment into the future: simple transmitter replacement, easy-to-install retrofit options and software updates and other convincing features ensure that the MASTERPULS® »Elite« systems always remain up to date to handle new applications or respond to clinical and technological progress.

This information has been compiled in close cooperation with experienced users of radial shock waves. The treatment success achieved with the MASTERPULS® will obviously increase the more experience the user gains with the operation and use of the system.

MASTERPULS® MP200 »Elite« –The high frequency shock wave therapy solution

LCD display: pressure, frequency, applied shock number

Energy level control via touch screen: 1.0 – 5.0 bar

Frequency setting via touch screen: 1 – 21 Hz

»Silent« air compressor, oil compressor at choice

Visual treatment guide

Two handpiece connectors

Optional: V-ACTOR® 35 Hz »Vibration-Therapy«

MASTERPULS® MP50 »Elite« –The most compact shock wave therapy system

LED displays: pressure, frequency, applied shock number

Energy level control knob for extended pressure/frequency range: 8 Hz/4.0 bar, 11 Hz/3.4 bar, 15 Hz/2.8 bar

Frequency setting buttons: 1 – 15 Hz

»Silent« air compressor included

Mobile use

Transportation case/bag

MASTERPULS® MP100 »Elite« –The classic shock wave therapy method

LED displays: pressure, frequency, applied shock number

Energy level control knob: 1.0 – 4.0 bar

Frequency setting buttons: 1 – 15 Hz

»Silent« power air compressor included

Mobile use

Precision pressure adjustment

Transportation case/bag

Note

This application brochure is not in-tended to replace the unit‘s instruction manual. Refer to the manual for more detailed information.

MASTERPULS® MP50 »Elite« andMASTERPULS® MP100 »Elite« – System functions and use

STORZ MEDICAL 07

MASTERPULS® MP50 »Elite« andMASTERPULS® MP100 »Elite« – System functions and use

Procedure

1 Connect the R-SW handpiece.2 Switch on the main switch on the rear panel beside the power connector.3 Adjust the energy level with the pressure knob, start treatment at a pressure of 1.5 – 2.0 bar.4 Adjust the frequency by pressing the frequency keys, start treatment at a pressure of 8 Hz.5 To start treatment, press the shock wave release button on the handpiece. 6 To stop shock wave application, press the shock wave release button.7 To reset counter, press the counter reset key.

Please refer to the MASTERPULS® oper-ating manuals for detailed information on the system design and operation.

Settings

1 Display of selected energy level2 Display of selected shock number3 Display of pulse frequency4 Adjusting knob pressure5 Counter reset key6 Adjusting frequency keys

1

2

3

4

5

6

1

2

3

4

5

6

MASTERPULS® MP50 »Elite«

MASTERPULS® MP100 »Elite«

08 STORZ MEDICAL

MASTERPULS® MP200 »Elite« System functions and use

Settings

1 Mode selector key2 Display of selected energy level3 Display of selected shock number per session4 Display of pulse frequency5 Display of applied shock number6 Patient report or indication key7 Keys for increase / reduction of values 1 to 38 Menu access key9 Language selection key (direct selection/display)10 Energy level selector key11 Shock number selector key12 Frequency selector key

2

3

4

5

6

89

10

11

10

7

71

Procedure

1 Connect the R-SW/V-ACTOR® 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 Confirm the displayed setting by pressing the blinking display.5 Select the »Operating mode«.6 Select the »Energy«, »Shocks« and »Frequency« parameters with the up or down arrow. Start treatment at a pressure of 1.5 – 2.0 bar and a frequency of 10 Hz.7 Remove the handpiece from the holder and apply coupling gel.8 Press the shock wave release button on the handpiece to start treatment. 9 Adjust the energy level and frequency with the arrows, if necessary.10 Press the shock wave release button to stop shock wave application.

Touch screen

The MASTERPULS® MP200 »Elite« is designed for maximum ease of use. Modern touch screen technology makes buttons obsolete. The menu-driven user interface guarantees reliable ac-quisition of R-SW parameters. During patient treatment, all essential param-eters always remain under control. The energy level, frequency, shock counter and number of applied shock waves are displayed in a clearly structured man-ner, and treatment data can be saved directly in the system.

Loading and saving patient data and indications

Procedure

1 Press »Configuration« to load existing configurations. 2 The »Configuration« screen appears with indications and patient reports (indications are marked with a *).3 Select the desired configuration and press »Load« to confirm.4 Press »Menu exit« to return to the start screen. Pre-configured settings are displayed on the screen.

The MASTERPULS® MP200 »Elite«allows you to load pre-configured indications and save patient data.

»Configuration« screen with list of indications List of pre-configured indications

STORZ MEDICAL 09

Indications Pain Points Muscles

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

Shin splint 1

Shin splint 2

Trochanteric tendonitis 1

Trochanteric tendonitis 2

Myofascial trigger points 1

Myofascial trigger points 2

Acupuncture (AkuST)

10 STORZ MEDICAL

Overview transmitters

Transmitter Data Indications Geometry of waves/Penetration depth

Energy density at max. pressure

A6, Ø 6 mm, AkuSt transmitter,radial shock waves

Shock wave acupuncture Radial

0 – 40 mm

0.32 mJ/mm2

C15, Ø 15 mm,CERAma-x®,ESWT transmitter, radial shock waves

Gel free shock wave therapy for all tendinopathies

Radial

0 – 40 mm

0.45 mJ/mm2

R15, Ø 15 mm,ESWT transmitter, radial shock waves

Radial shock wave therapy, all tendinopathies

Radial

0 – 40 mm

0.38 mJ/mm2

DI15, Ø 15 mm, Deep Impact® transmitter, »Energy Beam«

Deep-seated diseases, trigger, chronical diseases, high energy requirements, ideal combination with D20-S/D35-S transmitter for muscular problems

0 – 60 mm

0.63 mJ/mm2

F15, Ø 15 mm, »Focus-Lens« transmitter, energy focus area

Close to surface pain areas, masticatory muscles, neck, individual triggers

0 – 20 mm

0.16 mJ/mm2

D20-S, Ø 20 mm,D-ACTOR® transmitter, radial shock waves and vibration pulses, max. pressure up to 5 bar

Myofascial trigger therapy, muscle- and connective tissue, dis-solution of fibrosis (e. g. carpal tunnel syndrome), treatment of deep-seated muscles (e. g. piriformis muscle, gluteus minimus muscle)

Cylindric

0 – 50 mm

0.48 mJ/mm2

D35-S, Ø 35 mm,D-ACTOR® transmitter, radial shock waves and vibration pulses, max. pressure up to 5 bar

Myofascial trigger therapy, muscle- and connective tissue back muscles, skin elasticity, trigger-diagnose, dissolution of fibrosis (e. g. carpal tunnel syndrome), treatment of deep-seated muscles ( e. g. piriformis muscle, gluteus minimus muscle)

Cylindric

0 – 50 mm

0.46 mJ/mm2

Handpiece and transmitter handling

Radial shock wave handpiece

The handpiece is placed over the pre-viously diagnosed pain region. To start and stop shock wave application, the trigger button provided on the hand-piece must be briefly pressed.

Hygiene caps

Hygiene caps can be employed to en-sure hygienic coupling to the patient‘s skin. Hygiene caps can be used with the A6, R15, DI15 and F15 transmitters.

Different ways of holding the R-SW handpiece

Like a penThe handpiece is held behind the trans-mitter screw cap. This way of holding the handpiece is recommended for tac-tile treatment.

Like a bar The handpiece is grasped with the en-tire hand behind the transmitter screw cap. This way of holding the handpiece is recommended for the treatment of pain regions covering relatively large areas.

Like a pistolThis way of holding the handpiece is recommended for the treatment of pain confined to specific points.

Transmitters

The MASTERPULS® handpiece can be used with various transmitters. Each trans-mitter has its own characteristic effect (see page 10). The transmitters employed produce either shock waves or vibration waves or both.

The R15, DI15 and F15 transmitters produce shock waves. These transmitters are generally used for the localization and treatment of insertional tendonitis, painful spots and trigger points.

The D20-S and D35-S transmitters produce both shock waves and vibration pulses. These transmitters are used for the smoothing and treatment of muscles and con-nective tissue over large surface areas.

In general, treatment should be started by using the R15, DI15 or F15 transmit-ters on painful spots and trigger points. Afterwards, the surrounding muscle tissue should be smoothed with the D20-S or D35-S transmitters

STORZ MEDICAL 11

12 STORZ MEDICAL

V-ACTOR® – Vibration therapy

The ideal complement to radial shock wave therapy

The V-ACTOR® generates stimulating vibrations as a non-pharmacological method to reduce muscular strain and eliminate muscle triggers or disorders of tendon inser-tions caused by muscle triggers. Vibration therapy increases the blood circulation in the extracellular matrix of connective tissue and stimulates metabolic activities.

»Physiological intrinsic oscillations play a key role in muscular perfusion and lymphatic drainage.«(Professor V. T. Nazarov, 1988)

Only with MASTERPULS® MP200 »Elite«

Vibration: 1 – 35 Hz

Vibration head stroke: 1 – 4 mm

Available vibration head diameters: 25 or 40 mm

STORZ MEDICAL 13

Treatment

Anaesthesia

Anaesthesia for sensitive patients:In general, shock wave therapy can be performed without local anaesthesia. An-aesthesia would reduce the possibility of pain localization during treatment and has been found to adversely affect the therapy result. In most cases, shock wave therapy is well tolerated by patients if the energy level is gradually increased and the frequency and handpiece press-on force are adjusted to the patient‘s sensitivity to pain.

If anaesthesia is necessary in exceptional cases, infiltrate a local anaesthetic into the pain region. Make sure to inject the anaesthetic outside the shock wave application points!

Tip: cool the application area before you apply shock waves. This will substantially reduce the patient‘s pain sensation.

Generally speaking, one has to bear in mind that shock wave therapy is experienced differently from patient to patient. Some people do not experience any discomfort at all, while others may feel slight pain. Close co-operation with the patient is required to achieve optimum therapy results. The painful spots are localized by palpation fol-lowing the patient‘s indications of pain. In many cases, deep pain regions or areas of diffuse pain can be localized more rapidly by means of shock waves.

Treatment is started at the point of maximum pain. Shock waves are applied to the target tissue by moving the handpiece in a slow circular motion over the entire pain region. A total number of 300 to 400 shocks per painful spot should not be exceeded.

During the entire duration of the therapy session, a constant dialogue with the pa-tient is required to ensure precise localization of the painful spot(s). Once the pri-mary point of pain has been eliminated by the analgesic effect of the shock waves, other painful spots appear that were previously covered up by the principal pain. The painful spot begins to migrate.

Coupling

Treatment efficacy is conditional upon good coupling! Always apply a suffi-cient amount of gel to ensure optimal shock transmission into the tissue.

Make sure that the entire transmitter surface is in contact with the patient‘s skin. (Do not tilt the transmitter and check that not only the edge of the transmitter is in contact with the pa-tient‘s body!) If you use a hygiene cap, apply sufficient gel to the cap to ensure reliable coupling with the transmitter.

The more painful spots are localized and eliminated in the course of the treatment session, the better the ther-apy result.

During the entire therapy period, only light training should be done and any strain on the treated body regions should be avoided. In most cases, 3 to 5 treatment sessions at 7 to 10 days in-tervals are necessary. An initial therapy success is achieved after 3 sessions, ad-ditional improvements are noted after 3 months.

14 STORZ MEDICAL

Shock wave application has an analgesic effect. Use this effect to minimize any discomfort the patient may experience:

Begin with an initial energy level of approx. 1.8 to 2.0 bar.

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 3.5 bar will generally be sufficient for standard indications.

The denser the target tissue and the deeper the pain region, the higher the applica-tion energy can be selected.

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.

Application energy

STORZ MEDICAL 15

The MASTERPULS® MP200 »Elite«, MP100 »Elite« and MP50 »Elite« systems can be used for the following indications, among others:

Plantar fasciitis/heel pain/heel spur Calcific tendonitis/supraspinatus tendon Radial/ulnar humeral epicondylitis Achillodynia Patellar tendonitis (Jumper‘s knee) Tibial edge syndrome (Shin splint)

Trochanteric tendonitis Acupuncture shock wave therapy (AkuST) Myofascial pain syndrome

Indications

Treatment with the MASTERPULS® systems is not permitted in the following cases:

Note

Please keep track of the latest medical publications and new information pub-lished by the manufacturer for details on additional indications approved af-ter the date of printing of this brochure.

We recommend that the user and the patient should wear suitable hearing protection. Please offer always the pa-tient hearing protection.

Generally speaking, shock waves must not be applied to target areas located above air filled tissue (lungs), large nerves, vessels, the spinal column or head.

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 biologi-cal systems, whereas a high dose may cause damage.

Coagulation disorders (haemophilia) Use of anticoagulants, especially Marcumar Thrombosis Tumour diseases, carcinoma patients Pregnancy Children in growth (growth plates) Cortisone therapy up to 6 weeks before first ESWT treatment

Treatment with the MASTERPULS® systems may cause the following side effects:

Swelling, reddening, haematomas Petechiae Pain Skin lesions after previous cortisone therapy

Side effects generally abate after 2 to 5 days. Make sure that the above side effects have disappeared before starting the next therapy session.

16 STORZ MEDICAL

Plantar fasciitis/heel pain/heel spur

MASTERPULS® MP200 »Elite«Number of

sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points

(acute and chronic pain)3 – 5

2.0 – 3.0 3000 – 3500 12 – 15 R15, DI15

2. Muscles

(acute and chronic pain)1.8 – 3.0 2000 – 3000 15 – 21 D20-S

Additional recommendations

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 intervall 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


2.0 – 3.0 3000 – 3500 12 – 15 R15, DI15

2. Muscles

(acute and chronic pain)1.8 – 3.0 2000 – 3000 15 D20-S




D20-S, treatment interval 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


2.0 – 3.0 3000 – 3500 12 – 14 R15, DI15

2. Muscles

(acute and chronic pain)1.8 – 3.0 2000 – 3000 14 D20-S




D20-S, treatment interval 1 week

STORZ MEDICAL 17

Calcific tendonitis/shoulder pain


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points (Supraspinatus

tendon/chronic pain)3 – 5

1.8 – 4.0 1500 – 3000 12 – 15 R15, DI15

2. Muscles

(Surrounding muscles)1.8 – 3.0 2000 – 3000 15 – 21 D20-S


Preliminary ultrasound/X-ray examination for localization (marking of therapy region), smoothing of

surrounding muscles with V-ACTOR®, treatment interval 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter



1.8 – 4.0 1500 – 3000 12 – 15 R15, DI15

2. Muscles

(Surrounding muscles)1.8 – 3.0 2000 – 3000 15 D20-S



surrounding muscles with D20-S, treatment interval 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter



1.8 – 4.0 1500 – 3000 8 R15, DI15

2. Muscles




surrounding muscles with D20-S, treatment interval 1 week

18 STORZ MEDICAL

Radial/ulnar humeral epicondylitis


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points

(Tendon insertion)5 – 8

2.0 – 3.0 1800 – 2000 12 – 15 R15

2. Muscles (Adjacent upper

arm and forearm muscles)1.8 – 2.6 2000 – 3000 15 – 21 D20-S


Bio-feedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with

V-ACTOR®, treatment interval 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


2.0 – 3.0 1800 – 2000 12 – 15 R15


arm and forearm muscles)1.8 – 2.6 2000 – 3000 15 D20-S


Biofeedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with

D-20-S, treatment interval 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


2.0 – 3.0 1800 – 2000 12 – 14 R15


arm and forearm muscles)1.8 – 2.6 2000 – 3000 15 D20-S


Biofeedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with

D-20-S, treatment interval 1 week

STORZ MEDICAL 19

Achillodynia


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points (Achilles

tendon/directly to tendon)3 – 5

2.0 – 3.0 1000 – 1500 12 – 15 R15

2. Muscles

(Surrounding muscles)1.8 – 3.0 2000 – 3000 15 – 21 D20-S


Trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, smoothing of surrounding

muscles with V-ACTOR®, treatment interval 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter



2.0 – 3.0 1000 – 1500 12 – 15 R15

2. Muscles



Trigger point therapy of calf muscles and intrinsic foot muscles and smoothing of surrounding muscles

with D20-S, treatment interval 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter



2.0 – 3.0 1000 – 1500 12 – 14 R15

2. Muscles



Trigger point therapy of calf muscles and intrinsic foot muscles and smoothing of surrounding muscles


20 STORZ MEDICAL

Patellar tendonitis (Jumper‘s knee)


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


1.8 – 2.2 1500 – 2000 10 – 12 R15

2. Muscles (Quadriceps,

Musc. tensor fasciae latae)1.8 – 2.2 2000 – 3000 15 – 21 R15, D20-S


In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding

muscles with V-ACTOR®, treatment interval 10 – 14 days


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


1.8 – 2.2 1500 – 2000 10 – 12 R15


Musc. tensor fasciae latae)1.8 – 2.2 2000 – 3000 15 R15, D20-S



muscles with D20-S, treatment interval 10 – 14 days


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


1.8 – 2.2 1500 – 2000 10 – 12 R15


Musc. tensor fasciae latae)1.8 – 2.2 2000 – 3000 15 R15, D20-S



muscles with D20-S, treatment interval 10 – 14 days

STORZ MEDICAL 21

Tibial stress syndrome (Shin splint)


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points (Medial, inner

edge of shin bone)3 – 5

1.8 – 2.8 2000 – 3000 15 R15

2. Muscles

(Surrounding muscles)1.8 – 2.8 2000 – 3000 15 – 21 R15, D20-S


Treatment of surrounding muscles with R15/D20-S, smoothing of surrounding muscles as well as

instrinsic foot muscles with V-ACTOR®, treatment interval 8 – 10 days


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter



1.8 – 2.8 2000 – 3000 12 – 15 R15

2. Muscles

(Surrounding muscles)1.8 – 2.8 2000 – 3000 15 R15, D20-S


Treatment/Smoothing of surrounding muscles as well as instrinsic foot muscles with R15/D20-S,

treatment interval 8 - 10 days


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter



1.8 – 2.8 2000 – 3000 12 – 15 R15

2. Muscles

(Surrounding muscles)1.8 – 2.8 2000 – 3000 15 R15, D20-S


Treatment/Smoothing of surrounding muscles as well as instrinsic foot muscles with R15/D20-S,

treatment interval 8 - 10 days

22 STORZ MEDICAL

Trochanteric tendonitis


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


2.8 – 3.5 2000 – 3000 15 – 21 R15, DI15

2. Muscles

(Surrounding muscles)2.0 – 3.5 2000 – 4000 21 D20-S, D35-S


Localization of painful spots and additional trigger points of associated muscles by palpation and

shock wave stimulation, stretching, biofeedback, referred pain, smoothing of surrounding muscles

with V-ACTOR®, treatment interval 1 week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


2.8 – 3.5 2000 – 3000 12 – 15 R15, DI15

2. Muscles







sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Pain Points


2.8 – 3.4 2000 – 3000 8 – 11 R15, DI15

2. Muscles






STORZ MEDICAL 23

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 struc-tures 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 shock wave therapy (AkuST)

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 pres-sure receptors in the tissue, shock waves applied by means of the MASTERPULS®

provide an additional method of stimu-lation. Local and distant points are selected according to the principles of Chinese medicine.

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.

acupuncture indications such as ischial-gia, tinnitus, vertigo, dry cough, consti-pation, irritable bladder, prostatitis, per-fusion disorders, lymphatic edema etc.

Therapy concept

When the MASTERPULS® is used for a well selected combination of acupuncture points, complex disorders and pain syndromes can now be treated with extracor-poreal 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.

Extension of Traditional Chinese Medicine according to Dr. Everke

Benefits of shock wave acupuncture over needle acupuncture

Indications for shock wave acupuncture

24 STORZ MEDICAL


Indications asthma cervical syndrome coxarthrosis heel spur gonarthrosis lumbar spine syndrome lumbago irritable bladder tennis arm


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

1. Acupuncture Points 6 – 12 1.0 – 2.010 – 50

(per point)1 – 10 A6


Acupuncture: Qualified training in acupuncture and acupuncture shock wave therapy (AkuST) is

required for therapeutic application, treatment interval 1 – 2 sessions/week


sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter







sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter






STORZ MEDICAL 25

Myofascial pain syndrome

Trigger points are groupings of microscopic muscular nodules (sarcomeres) that form into a palpable trigger node within a hardened muscle band. Active trigger points are sensitive and painful, causing radiating sensations and reflex pain when palpated with the fingers or with the handpiece. Latent trigger points only cause pain during palpation.

Types of trigger points

In order to ensure reliable trigger point diagnosis, one has to distinguish between distant and structural trigger points. Trigger point shock wave therapy can only be started after the trigger points have been precisely localized inside the muscle. Moreover, it is essential to find out whether the thickened or hardened muscle band is located in the pain region or whether pain is felt in an entirely different area distal from the trigger points. As trigger points cannot be diagnosed by means of imaging systems, manual examination is required for trigger point localization. Deep trig-ger points can also be diagnosed by shock wave application to the affected tissue.

Trigger point shock wave therapy elimi-nates end-plate dysfunction or contrac-tion nodes and stimulates metabolism in the affected muscle fibers.

Pressure exerted on the trigger points in conjunction with shock wave applica-tion will cause exactly the kind of pain reported by the patient

Treatment concept for trigger point shock wave therapy

Shock waves are radially applied to the pain-producing trigger area within the af-fected muscle region. Treatment can be performed in one or several sessions.

Localization of trigger points: manually or with shock waves Apply gel »Deep Impact« transmitter (DI15): recommended for

precisely localized or deep trigger points Other transmitters: R15, D20-S/D35-S for smoothing the

surrounding muscles Application: 8000 – 10000 shocks; 1.0 – 4.0 bar; 10 – 21 Hz Smoothing and activation of the surrounding muscles with the V-ACTOR®

(only with the MASTERPULS® MP200 »Elite«) Re-treatment after 3 – 6 days 4 – 8 sessions Note: A sound knowledge of trigger point therapy and trigger point shock

wave therapy is required if the MASTERPULS® MP50 »Elite«/MP100 »Elite«/ MP200 »Elite« is used for the above applications.

Indications for trigger point shock wave therapy

Patients suffering from intervertebral disk disease, ischialgia, spinal disorders, neck/shoulder pain, tensed-up muscles, tendon and joint disorders or headache, who have undergone conventional or alternative therapies without any suc-cess, are the major target group for trig-ger point shock wave therapy.

26 STORZ MEDICAL

Number of

sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

Upper and lower Cervical-Syndrome (Trapezius muscle)

Trigger point treatment 1. Pain Points 4 – 8

1.2 – 3.0300 – 1000

(per point)10 – 15 R15, D20-S

Smoothing muscles over large area 2. Muscles 1.2 – 2.8 500 – 4000 10 – 21 R15, D20-S


Eventual preliminary ultrasound examination, localization with biofeedback, marking of

pain region, muscle smoothing/massaging of large area, after RSWT sessions with D20-S or

V-ACTOR® (2 – 3 minutes, 30 – 35 Hz), treatment interval: 1 – 2 sessions per week

Periarticular shoulder pain (Deltoid muscle)


1.2 – 3.0300 – 1000

(per point)10 – 15 R15, D20-S






Tendomyosis in the extensor and flexor region of the forearm (Forearm muscles)


1.2 – 2.6300 – 1000

(per point)10 – 15 R15, D20-S






Glutealgia (Gluteal muscles)

Trigger point treatment 1. Pain Points

4 – 8

1.2 – 4.0300 – 1000

(per point)10 – 15

R15, DI15,

D20-S, D35-S

Smoothing muscles over large area 2. Muscles 1.2 – 3.8 500 – 4000 10 – 21 R15, D20-S,

D35-S




V-ACTOR® (2 – 3 minutes, 30 – 35 Hz), treatment interval: 12 sessions per week


STORZ MEDICAL 27

Number of

sessions

Energy

(bar)

Pulses/

session

Frequency

(Hz)

Transmitter

Shortenings in the femoral extensor and flexor muscles (Femoral muscles)

Trigger point treatment 1. Pain Points

4 – 8

1.2 – 4.0300 – 1000


R15, DI15,

D20-S, D35-S


D35-S





Tibial anterior syndrome

Trigger point treatment 1. Pain Points 1.4 – 2.6300 – 1000


R15, D20-S,

D35-S


D35-S





Caution: Do not apply more than 300 – 500 pulses (trigger shock wave therapy 300 – 1000 pulses) at one point of treatment. Move handpiece during pulse application.

28 STORZ MEDICAL

Quick reference guide MASTERPULS® MP50 »Elite«

Number of sessions Energy (bar) Pulses/session Frequency (Hz) Transmitter


Heel (acute and chronic pain) 1. Pain Points3 – 5

2.0 – 3.0 3000 – 3500 12 – 14 R15, DI15

Calf muscles 2. Muscles 1.8 – 3.0 2000 – 3000 14 D20-S

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 D20-S, treatment intervall 1 week


Supraspinatus tendon (chronic pain) 1. Pain Points3 – 5

1.8 – 4.0 1500 – 3000 8 R15, DI15

Surrounding muscles 2. Muscles 1.8 – 3.0 2000 – 3000 14 D20-S

Preliminary ultrasound/X-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with D20-S, treatment interval 1 week


Tendon insertion 1. Pain Points5 – 8

2.0 – 3.0 1800 – 2000 12 – 14 R15

Adjacent upper arm and forearm muscles 2. Muscles 1.8 – 2.6 2000 – 3000 15 D20-S

Biofeedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with D-20-S, treatment interval 1 week

Achillodynia

Achilles (tendon/directly to tendon) 1. Pain Points3 – 5

2.0 – 3.0 1000 – 1500 12 – 14 R15


Trigger point therapy of calf muscles and intrinsic foot muscles and smoothing of surrounding muscles with D20-S, treatment interval 1 week



1.8 – 2.2 1500 – 2000 10 – 12 R15

Quadriceps, Musc. tensor fasciae latae 2. Muscles 1.8 – 2.2 2000 – 3000 15 R15, D20-S

In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with D20-S, treatment interval 10 – 14 days


Medial, inner edge of shin bone 1. Pain Points3 – 5

1.8 – 2.8 2000 – 3000 12 – 15 R15

Surrounding muscles 2. Muscles 1.8 – 2.8 2000 – 3000 15 R15, D20-S

Treatment/Smoothing of surrounding muscles as well as instrinsic foot muscles with R15/D20-S, treatment interval 8 – 10 days



2.8 – 3.4 2000 – 3000 8 – 11 R15, DI15

Surrounding muscles 2. Muscles 2.0 – 3.4 2000 – 4000 11 D20-S, D35-S

Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, biofeedback, referred pain, smoothing of surrounding muscles with D20-S, treatment interval 1 week


Trigger point treatment 1. Pain Points4 – 8

1.0 – 4.0300 – 1000

(per trigger point)8 R15, DI15, D20-S

Smoothing muscles over large area 2. Muscles 1.0 – 3.0 500 – 4000 14 D20-S, D35-S

Palpation of the trigger points, no local anaesthetic, diagnosis in case of resistance to therapy, detailed knowledge of TrST (Trigger shock wave therapy) required, participation in seminars recommended, treatment interval 1 – 2 sessions/week


Acupuncture 1. Points 6 – 12 1.0 – 2.0 10 – 50 (per point) 1 – 10 A6

Acupuncture: Qualified training in acupuncture and acupuncture shock wave therapy (AkuST) is required for therapeutic application, treatment interval 1 – 2 sessions/week

Caution: Do not apply more than 300 – 500 pulses (trigger shock wave therapy 300 – 1000 pulses) at one point of treatment, Timeline for improvements: 1. First improvements after 3 sessions, 2. Further noticeable improvements after 3 months

STORZ MEDICAL 29





2.0 – 3.0 3000 – 3500 12 – 15 R15, DI15

Calf muscles 2. Muscles 1.8 – 3.0 2000 – 3000 15 D20-S

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 D20-S, treatment intervall 1 week



1.8 – 4.0 1500 – 3000 12 – 15 R15, DI15


Preliminary ultrasound/X-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with D20-S, treatment interval 1 week



2.0 – 3.0 1800 – 2000 12 – 15 R15

Adjacent upper arm and forearm muscles 2. Muscles 1.8 – 2.6 2000 – 3000 15 D20-S

Biofeedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with D-20-S, treatment interval 1 week

Achillodynia


2.0 – 3.0 1000 – 1500 12 – 15 R15


Trigger point therapy of calf muscles and intrinsic foot muscles and smoothing of surrounding muscles with D20-S, treatment interval 1 week



1.8 – 2.2 1500 – 2000 10 – 12 R15

Quadriceps, Musc. tensor fasciae latae 2. Muscles 1.8 – 2.2 2000 – 3000 15 R15, D20-S

In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with D20-S, treatment interval 10 – 14 days



1.8 – 2.8 2000 – 3000 12 – 15 R15

Surrounding muscles 2. Muscles 1.8 – 2.8 2000 – 3000 15 R15, D20-S

Treatment/Smoothing of surrounding muscles as well as instrinsic foot muscles with R15/D20-S, treatment interval 8 – 10 days



2.8 – 3.5 2000 – 3000 12 – 15 R15, DI15


Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, biofeedback, referred pain, smoothing of surrounding muscles with D20-S, treatment interval 1 week



1.0 – 4.0300 – 1000

(per trigger point)10 – 15 R15, DI15, D20-S

Smoothing muscles over large area 2. Muscles 1.0 – 3.0 500 – 4000 10 – 15 D20-S, D35-S






30 STORZ MEDICAL





2.0 – 3.0 3000 – 3500 12 – 15 R15, DI15

Calf muscles 2. Muscles 1.8 – 3.0 2000 – 3000 15 – 21 D20-S

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 intervall 1 week



1.8 – 4.0 1500 – 3000 12 – 15 R15, DI15

Surrounding muscles 2. Muscles 1.8 – 3.0 2000 – 3000 15 – 21 D20-S

Preliminary ultrasound/X-ray examination for localization (marking of therapy region), smoothing of surrounding muscles with V-ACTOR®, treatment interval 1 week



2.0 – 3.0 1800 – 2000 12 – 15 R15

Adjacent upper arm and forearm muscles 2. Muscles 1.8 – 2.6 2000 – 3000 15 – 21 D20-S

Bio-feedback for localization of pain, smoothing of adjacent upper arm and forearm muscles with V-ACTOR®, treatment interval 1 week

Achillodynia


2.0 – 3.0 1000 – 1500 12 – 15 R15

Surrounding muscles 2. Muscles 1.8 – 3.0 2000 – 3000 15 – 21 D20-S

Trigger point therapy of calf muscles and intrinsic foot muscles with D20-S, smoothing of surrounding muscles with V-ACTOR®, treatment interval 1 week



1.8 – 2.2 1500 – 2000 10 – 12 R15

Quadriceps, Musc. tensor fasciae latae 2. Muscles 1.8 – 2.2 2000 – 3000 15 – 21 R15, D20-S

In extended position, lift the apex by pressing and pushing from cranial, smoothing of surrounding muscles with V-ACTOR®, treatment interval 10 – 14 days



1.8 – 2.8 2000 – 3000 15 R15

Surrounding muscles 2. Muscles 1.8 – 2.8 2000 – 3000 15 – 21 R15, D20-S

Treatment of surrounding muscles with R15/D20-S, smoothing of surrounding muscles as well as intrinsic foot muscles with V-ACTOR®, treatment interval 8 – 10 days



2.8 – 3.5 2000 – 3000 15 – 21 R15, DI15


Localization of painful spots and additional trigger points of associated muscles by palpation and shock wave stimulation, stretching, bio-feedback, referred pain, smoothing of surrounding muscles with V-ACTOR®, treatment interval 1 week



1.0 – 4.0300 – 1000

(per trigger point)10 – 15 R15, DI15, D20-S

Smoothing muscles over large area 2. Muscles 1.0 – 3.0 500 – 4000 15 – 21 D20-S, D35-S






STORZ MEDICAL 31

Global presence

Worldwide services

Based in Tägerwilen/Switzerland, the company operates around the globe through its branch offices and partners, making sure that qualified service personnel is al-ways near at hand.

Creating synergies

The customer is the focus of everything we do!Complex technology is only as good as the skills of the people who use it. Our trai-ning 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.

Quality

Our products are designed to satisfy all requirements in terms of quality, safety, ease of use and service life.

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HUMANE TECHNOLOGY – TECHNOLOGY FOR PEOPLE

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

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