Sonorex has developed a philosophy and program of orthopedic extracorporeal shock wave treatment which it believes maximizes the advantages of this new technology while reducing clinical risks and enhancing cost effectiveness. Shaped by management’s many years of clinical and administrative experience in the urological application of both high and low energy shock waves for kidney stones, and heavily influenced by our German orthopedic colleagues’ experience with shock wave treatment techniques, the Sonorex approach may be briefly summarized.

Key concepts of therapy:

1. Selection of proper energy level for shock wave treatment. Although both high and low energy may be used, Sonorex believes that the use of low energy has significant advantages over high energy shock wave applications in the most cases of near bone pain. These include:

   a) ability to treat patients without the necessity of regional or general anesthesia

   b) reduces the clinical risk of tissue injury or bleeding into the skin, joint, or other tissues near the area being treated

   c) allows highly individulized treatment at the exact site of pathology by allowing the use of precise clinical focusing rather than depending upon imaging with ultrasound, flouroscopy, or x-ray that may not adequately identify the exact site of the problem. ( Imaging devices cannot "see pain".)

   Within the low energy range of energy treatment levels, the ability to adjust this level to each patient’s tolerance adds to the concept of individualized treatment and safety. Although the use of low energy may require more treatment sessions (usually three) than higher energy (one to two) the reduced cost of eliminating the anesthesia and imaging expense allows the treatment to be more cost effective. Patients who have bone fractures or pseudoarthroses (nonunion) should be treated with high energy and imaging device focusing.

2. Proper patient selection. Only patients who have well localized painful areas should be treated. These painful areas should be able to be localized by digital pressure with the index finger. Patients with large or poorly localized areas of near bone pain should not be treated. With proper patient selection, 70 to 90 per cent of those treated should get significant improvement.