Shockwave therapy in Vienna
Stubborn pain in a tendon often does not improve with rest alone. Shockwave therapy is a procedure without an incision and without medication, which I use in focused and radial form — wherever tendons and tendon insertions at the elbow, shoulder and hand are irritated.
In short
Shockwave therapy (ESWT) conducts high-energy pressure waves from outside the body through the skin into irritated tendon tissue. The mechanical stimulus is intended to promote blood flow and metabolism there and to set remodelling in motion in the tendon and the calcium deposit. I use it above all for calcific tendinitis, tennis and golfer's elbow, and irritated tendon insertions at the shoulder and elbow. Treatment is outpatient, without anaesthetic and in several sessions. Whether the procedure suits you, I decide after examination and ultrasound.
What is shockwave therapy?
Shockwaves are short, high-energy pressure waves — mechanical sound waves generated by a device outside the body. Via an applicator and a contact gel they pass through the skin into the tissue, where they reach tendons, tendon insertions and calcium deposits. The mechanical stimulus is intended to promote blood flow and metabolism and to trigger repair processes in tissue that can no longer get them going on its own.
Focused or radial — the difference
I use both forms. They differ in where their energy arrives:
- Focused shockwave — the energy is concentrated on a point at a particular depth and so reaches deeper structures, such as a calcium deposit in the rotator cuff. I determine the target point on ultrasound.
- Radial shockwave — the pressure wave spreads out spherically from the applicator head. Its energy is highest just under the skin and decreases with depth; this suits tendon insertions close to the surface and the surrounding muscles.
Which form I choose depends on the findings. Both can be combined within one series of treatments.
What it helps with
Shockwave therapy is not an all-purpose remedy. It is used where the problem lies in the tendon or at its attachment to the bone and the symptoms have persisted for some time:
- Calcific tendinitis (Tendinitis calcarea) — a calcium deposit in a tendon of the rotator cuff, which shows up well on ultrasound and can be targeted precisely.
- Tennis elbow and golfer's elbow (Epicondylitis lateralis and medialis) — an irritated tendon insertion on the outer or inner side of the elbow, usually after overuse at work or in sport.
- Irritated tendon insertions (insertional tendinopathy) at the shoulder and elbow, when rest and physiotherapy have not been enough.
The aim is to relieve the pain and to make the tendon better able to bear load again. Shockwave therapy rarely stands alone: depending on the findings I combine it with physiotherapy, ultrasound-guided injection, PRP therapy or magnetic field therapy. All conservative treatment options at a glance.
How a treatment proceeds
Before the first session
Before I use shockwave therapy, the findings have to be established. I ask about the course of your symptoms and the strain involved, and I examine you clinically. With the ultrasound available to me in the practice, I assess the tendon, bursa and calcium deposit in motion and determine the target point for the treatment. If that is not enough to classify the problem, I arrange an X-ray or an MRI outside the building.
The session itself
You sit or lie down, with your arm resting in a relaxed position. After applying the contact gel I place the applicator and look for the point that is tender to pressure; your feedback helps me with this. Then I increase the intensity step by step. The sensation is usually described as a tapping or throbbing, over irritated tissue also as a stabbing — it is not pleasant, but as a rule it is quite bearable.
Afterwards and over the course of treatment
You leave the practice without a dressing. Redness or a temporary increase in symptoms on the day of treatment is possible and settles by itself. Treatment is given in several sessions with intervals in between. An accompanying exercise programme is important — physiotherapy and exercise therapy are available in the building at the Orthozentrum Döbling.
Limits of the method
Shockwave therapy does not work equally well for everyone. It is well studied for calcific tendinitis and tennis elbow; for other conditions the evidence is thinner, and I tell you so openly. Where there is structural damage — a full-thickness tendon tear, a compressed nerve, advanced osteoarthritis — a different treatment is needed, sometimes an arthroscopic procedure.
Shockwave therapy is not used with a clotting disorder or while taking blood-thinning medication, with an acute infection or a tumour in the treatment area, or during pregnancy. I do not treat over growth plates in children and adolescents, or over the course of larger nerves and vessels.
My practice is a private practice, in Austria a Wahlarztordination. I do not bill any public health insurer directly; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. Whether shockwave therapy is an option for you, I decide together with you after examination and findings.
Frequently asked
Frequently asked questions about shockwave therapy
A device generates high-energy pressure waves outside the body and conducts them through the skin into the irritated tissue via an applicator. The mechanical stimulus is intended to promote blood flow and metabolism there. The aim is to relieve the symptoms and to make the tendon better able to bear load again.
The focused shockwave concentrates its energy on a point at a particular depth and reaches deeper structures, such as a calcium deposit in the rotator cuff; I determine the target point on ultrasound. The radial shockwave spreads out spherically and acts closer to the surface and over a wider area.
You will always feel it. Most people describe a tapping or throbbing sensation, and over irritated tissue also a stabbing one. It is not pleasant, but as a rule it is quite bearable. I increase the intensity step by step and am guided by your feedback; no anaesthetic is needed for it.
I do not fix that in advance. Shockwave therapy is applied in several sessions with intervals in between; what makes sense depends on the findings and on the course. After each session I assess how you are responding and discuss the next steps with you.
Calcific tendinitis is one of the conditions for which shockwave therapy has been well studied. The focused form can be aimed precisely at the calcium deposit under ultrasound. Whether it is suitable in the individual case depends on the position and condition of the deposit. Sometimes an injection or an arthroscopic procedure is the way forward.
It is not used with a clotting disorder or while taking blood-thinning medication, with an acute infection or a tumour in the treatment area, or during pregnancy. I do not treat over growth plates or over the course of larger nerves and vessels. Whether anything speaks against it, I clarify beforehand.
You leave the practice without a dressing; no immobilisation is planned afterwards. I advise against intense training loads on the day of treatment, because the treated tissue is irritated. How you then build up again is something I agree with you and the physiotherapists.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. What your insurance contributes depends on your policy.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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