Precision Occupational Medical Group, Inc., (POMG

Precision Occupational Medical Group, Inc., (POMG) is
California’s premier provider of quality EMG & NCS
services.
Established in 2003 at Cedars-Sinai Medical Center in Los
Angeles, Precision has expanded to more than 30 locations
throughout California.
With Precision, you're assured of the highest quality
diagnostic services from Board Certified providers with
unparalleled reliability.
Leadership
Dr. Sean Bamshad, M.D., is President and founder of
POMG. He is Board Certified in Physical Medicine and
Rehabilitation. Dr. Bamshad’s primary office is located at
Cedars-Sinai Medical Center in Los Angeles, California
with his business partner, Richard Riggs, M.D., Medical
Director and Chairman of the Department of Physical
Medicine and Rehabilitation at Cedars- Sinai.
Dr. Bamshad received his Doctor of Medicine degree at
Albert Einstein College of Medicine in New York, New
York.
He completed his Residency in Physical Medicine and
Rehabilitation at UCLA Medical Center, where he was
Chief Resident from 2001- 2002.
BEVERLY HILLS
9730 WILSHIRE BLVD, STE 110
BEVERLY HILLS, CA 90212
LAS VEGAS, NV
6950 W. DESERT INN RD, #110
LAS VEGAS, NV 89117
LOS ANGELES - SCSR
1801 S. LA CIENEGA BLVD. STE 203
LOS ANGELES, CA 90035
BURBANK
348 E. OLIVE AVE, STE. B
BURBANK, CA 91502
LAWNDALE
14516 HAWTHORNE BLVD
LAWNDALE, CA 90260
PALMDALE
38440 5TH STREET WEST
PALMDALE, CA 93551
FONTANA
7774 CHERRY AVE
FONTANA, CA 92336
LONG BEACH
701 E. 28 TH ST STE 117
LONG BEACH, CA 90806
PASADENA
2693 E. WASHINGTON BLVD
PASADENA, CA 91107
GARDEN GROVE
12556 VALLEY VIEW AVE
GARDEN GROVE, CA 92845
LOS ANGELES - CEDARS
8631 W 3RD ST STE 915E
LOS ANGELES, CA 90048
RIVERSIDE
6700 INDIANA AVE, #145
RIVERSIDE, CA 92504
GARDENA
1225 W 190TH ST #425
GARDENA, CA 90248
LOS ANGELES - WILSHIRE
6200 WILSHIRE BLVD., #910
LOS ANGELES, CA 90048
SANTA ANA/IRVINE
1805 E DYER RD #110
SANTA ANA, CA 92705
HENDERSON, NV
2875 ST. ROSE. PKWAY, #120
HENDERSON, NV 89052
SANTA FE SPRINGS
11627 TELEGRAPH RD STE 105
SANTA FE SPRINGS, CA 90670
INDIO
82013 DR. CARREON BLVD, #A-B
INDIO, CA 92201
SAN BERNARDINO
1850 S. WATERMAN, STE. E
SAN BERNARDINO, CA 92408
LAGUNA HILLS
23161 MILL CREEK DR., #110
LAGUNA HILLS, CA 92653
VAN NUYS
14557 FRIAR ST #B2
VAN NUYS, CA 91411
LA HABRA
860 LA HABRA BLV, STE 120
LA HABRA, CA 90631
Quality Care You Can Trust
P r e c i s i o n
M e d i c a l
WEST COVINA
1321 W. GARVEY NORTH
WEST COVINA, CA 91790
O c c u p a t i o n a l
G r o u p , I n c .
Shahriar Bamshad, M.D.
Medical Director
Board Certified Physical Medicine & Rehabilitation
Fellowship Interventional Pain Management
SERVICES
•
Board Certified Physicians in Neurology, Physiatry, and Electrodiagnostic Medicine
•
Electromyography (EMG) and Nerve Conduction Velocity (NCV) Testing
COMPETITIVE ADVANTAGE
•
Significant Cost Saving Strategies
•
Multiple Locations Throughout Southern California
•
Timely and Accurate Medical Reports
•
Prompt Patient Scheduling
Contracted with: Adin, AMR, Care IQ, Diagnostic Village, Genex (PDM),
Magnetic Imaging, MDIA, Medlink, Medfocus, MIS, MTI, Next Image,
One Call, One Source, Orchid, Tech Health And Most MPN’s
To Schedule an Appointment contact:
PHONE (855) EMG-NCV1 / (855) 364-6281; FAX (949) 955-0220; or Email Referrals@pomg.net
www.PrecisionEMG.com
Quality Care You Can Trust
P r e c i s i o n
M e d i c a l
O c c u p a t i o n a l
G r o u p , I n c .
For scheduling: Call (855)EMG-NCV1 / (855) 364-6281,
Fax directly to 949-955-0220 • Or Email to Referral@pomg.net
Referral Source (Facility Name):___________________________________
Referral Coordinator:_____________________ Date:__________________
FAX and/or EMAIL (To send appt letter and report):
_________________________________________________________________
Dr. Name: _______________________ Dr. Phone: _____________________
Patient Name:__________________________ Date of Birth: ____________
Diagnosis(es):____________________________________________________
EMG/NCV and Neurodiagnostic Testing+Consult
EMG/NCV
RIGHT
CONSULT
LEFT
BILATERAL
UPPER EXTREMITIE(S)
LOWER EXTREMITIE(S)
(Please Circle one)
AME • QME • PANEL QME • Work Comp • PI • PPO • Medicare • Cash
Follow-up Appointment Date:
Comments:
M.D. Signature________________________________________ Date ________________
THANK YOU FOR YOUR REFERRALS.
MARKETER:________________________________
CURRICULUM VITAE
Shahriar Sean Bamshad, M.D.
Diplomate, American Board of
Physical Medicine and Rehabilitation
Precision Occupational Medical Group, Inc.
1805 E Dyer Rd. #110
Santa Ana, Ca. 92705
Office: (855) EMG-NCV1 / (855)364-6281
Fax: (949) 955-0220
smsean2000@yahoo.com
PERSONAL INFORMATION
Citizenship:
Martial Status:
Language Spoken:
Interests:
United States
Single
English, Farsi
Antiquity history, and literature
WORK HISTORY
PRIVATE PRACTICE
2003 - Present
Shahriar Bamshad M.D., Inc.
Cedars-Sinai Medical Office Towers
8631 W. 3rd Street Suite 915E
Los Angeles, CA 90048
(310) 423-3063
2/04 – Present
Precision Occupational Medical Group, Inc.
President and CEO
1805 E. Dyer Rd #110
Santa Ana, CA 92705
HOSPITAL PRIVILEGE
Cedars Sinai Medical Center
EDUCATION
Doctor of Medicine
Albert Einstein College of Medicine
New York, New York
June 1998
SHAHRIAR SEAN BAMSHAD, M.D.
Bachelor of Arts
Classical Civilization
UCLA
Los Angeles, California
June 1993
BOARD CERTIFICATION
Diplomate, American Board of Physical Medicine and Rehabilitation
May 2003
POSTGRADUATE TRAINING
Fellowship
Interventional Pain Management
Department of PM&R
UCLA/West Los Angeles VA
Los Angeles, California
2002-2003
Reference: Dr. Quynh Pham
Program Director
(310) 268-3337
Residency
Physical Medicine and Rehabilitation
(Chief resident 2001-2002 Academic Year)
UCLA/West Los Angeles VA
Los Angeles, California
1999-2002
Reference: Dr. Quynh Pham
Director of Residency Training Program
(310) 268-3337
Internship
Internal Medicine
UCLA/West Los Angeles VA
Los Angeles, California
1998-1999
Reference: Dr. Jane Weinreb
Director of Residency Training Program
(310) 268-3034
LICENSURE
California State Medical License Number
Drug Enforcement Agency Registration Number
A70123
BB9027601
Exp.2/28/14
Exp. 7/31/13
SHAHRIAR SEAN BAMSHAD, M.D.
VOLUNTEER WORK
Team Physician
Culver City High School Football Team
Fall 1999
AWARDS AND HONOR
Dean’s Scholar for Academic Excellence- six terms (UCLA)
Outstanding Achievement award, Mosholu Woodlawn South Community Coalition;
worked to improve the health/housing conditions for low-socioeconomic groups in
the Bronx, New York.
RESEARCH
Role of Anxiety and Depression in Functional Outcome Following Interventional Spine
Procedure: Bamshad, S., Fish, D., Pham, Q.; presented March 28, 2003 at the 2003
Annual Meeting of the Association of Academic Physiatrists.
EMG as a Predictor of Chronic Pain Management, Bamshad, S., Saber, M., Chissian, S.;
Presented at the 2002 UCLA/GLAHS VA Research Day
LEADERSHIP
Chief Resident
UCLA/WLA VA PM&R Residency
2001-2002
Vice President
UCLA Classics Society
1992-1993
CERTIFICATE
Medical Review Officer
July 2004
Attention: EMG/NCV scheduling coordinator
Please schedule this authorized EMG/NCV study with
Precision Occupational Medical Group. Precision is
contracted with your company to perform EMG/NCV
studies and is my preferred provider. Precision’s
identifying information is listed below:
Dr. Shahriar S. Bamshad, M.D.
Tax I.D.: 20-0535031
Precision Occupational Medical Group, Inc.
Corporate Office:
1805 East Dyer Road, Suite #110
Santa Ana, CA. 92705
Office: (949) 955-0022
Fax: (949) 955-0220
Thank you
(INSERT DOCTOR’S OFFICE NAME)
(INSERT ADDRESS)
(INSERT PHONE)
(INSERT FAX)
DATE:____________
TO: ONE CALL MEDICAL
ATTN: JUSTIN EPSTEIN
FAX: 973-257-9512
Mr. Epstein:
Please note that from this date forth, all One Call EMG/NCV patient
referrals from our facility are requested to be scheduled with our preferred
provider, Precision Occupational Medical Group, Inc. (tax id # 20-0535031).
Sincerely,
(INSERT ONE)
Office Manager, Doctor, or Referral Coordinator
SAMPLE EMG/NCV REPORT - NORMAL STUDY
John Smith, M.D.
Diplomate, American Board of Physical Medicine and Rehabilitation
Diplomate, American Board of Electrodiagnostic Medicine
Precision Occupational Medical Group
1805 E. Dyer Road #110
Santa Ana, CA 92705
Phone: (949) 955-0022 Fax: (949) 955-0220
2/9/2010 12:50:20 PM
Patient: XXXX, Regina
DOB:
4/17/1966
Physician: Smith
ID#:
XXXX_REGINA_10020
SEX:
Female
Ref. Phys: Jones
________________________________________________________________________________
Patient Complaints:
Right hand numbness
Patient History:
The patient is referred by Dr. Jones for an electrodiagnostic evaluation of the right upper extremity.
The patient suffered a work related injury while working at an office. The patient reports pain and
numbness in the right hand.
Physical Exam:
GEN: No acute distress, well nourished, well developed
HEENT: Normal cephalic, PERRLA, EOMI
EXT: No clubbing cyanosis or edema
MUSCULOSKELETAL: No asymmetry, mass or tenderness to palpation. Strength is 5/5 in bilateral
upper and lower extremities
SPINE: There is no tenderness to palpation to the cervical or lumbar paraspinal muscles
NEURO: Patient is alert, awake and oriented x 3, muscle tone is normal without clonus.
DTR's are symmetrical and normal in bilateral upper and lower extremities. Sensation to light touch is
normal
Phalen's is negative
Tinel's is negative
ELECTRODIAGNOSTIC STUDY:
Nerve conduction study of the right upper extremity was done today with the surface skin measure at
32 degrees Celcius and above near the site of the recording electrodes.
Informed consent was obtained. Needle electromyography was performed with a monopolar
disposable needle electrode on selected muscles as shown below. Nerve conductions were
performed using standard surface conduction techniques. The patient tolerated the procedure
without complications.
Patient:
XXXX, Regina
Test Date:
2/9/2010
p.
2
Impression:
There is no electrodiagnostic evidence of a neuropathic or a myopathic process in right upper
extremity at this time. Also, no electrodiagnostic evidence of a neuropathy or a plexopathy in
the right upper extremity based on the nerve conduction studies. Conventional nerve
conduction studies and EMG cannot test the small sensory pain fibers which, when irritated
secondary to compression or tendon inflammation etc., could be a source of pain and
paresthesias from within the sensory nerves, nerve roots, subcutaneous structures, and/or
bony structures, etc.
In compliance with labor code section 4628 and the rules of practice and procedure, specifically 10978 and
10606, the following is supplied.
I declare under penalty of perjury, that all opinions in this report are mine. I performed the evaluation and
cognitive services at Precision Occupational Medical Group 1805 E. Dyer Road #110, Santa Ana, CA 92705
and that, except as otherwise stated herein, the evaluation was performed and the time spent performing the
evaluation was in compliance with the guidelines, if any, established by the Industrial Medical Council or the
Administrative director pursuant to paragraph (5) of subdivision (j) of the section 139.2 or section 5307.6 of the
California Labor Code.
I have complied with the Labor Code section 139.3 and I have offered or received any commissions or
inducements for this consultation. The name and contents of the report and billings are true and correct to the
best of my knowledge, executed on this date.
______________________________________________________________
John Smith, M.D.
Diplomate, American Board of Physical Medicine and Rehabilitation
Diplomate, American Board of Electrodiagnostic Medicine
Patient:
XXXX, Regina
Test Date:
2/9/2010
p.
3
ELECTRODIAGNOSTIC RESULTS:
EMG
Side Muscle
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Nerve
Root
Ins Fibs Psw Amp Dur Poly
Act
Abd Poll Brev Median
C8-T1 Nml Nml Nml Nml Nml
0
1stDorInt
Ulnar
C8-T1 Nml Nml Nml Nml Nml
0
ExtIndicis
Radial (Post C7-8 Nml Nml Nml Nml Nml
0
Int)
ExtCarUln
Radial (Post C7-8 Nml Nml Nml Nml Nml
0
Int)
ExtCarRad
Radial
C6-7 Nml Nml Nml Nml Nml
0
BrachioRad
Radial
C5-6 Nml Nml Nml Nml Nml
0
Biceps
Musculocut C5-6 Nml Nml Nml Nml Nml
0
Triceps
Radial
C6-7-8 Nml Nml Nml Nml Nml
0
Deltoid
Axillary
C5-6 Nml Nml Nml Nml Nml
0
Upper Cervical Rami
Nml Nml
Mid Cervical
Rami
Nml Nml
Lower Cervical Rami
Nml Nml
Recrt
Nml
Nml
Nml
Int Comment
Pat
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Motor Nerves
Site
NR
Onset
(ms)
Norm
Onset
(ms)
O-P
Amp
(mV)
Norm
Amp
(mV)
Neg Segment Name
Dur
(ms)
DeltaO
(ms)
Dist
(cm)
Vel Norm
(m/s) Vel
(m/s)
Right Median (Abd Poll Brev)
Wrist
2.97
Elbow
6.72
<4.0
13.85
>5.0
13.51
5.39
Elbow-Wrist
3.75
23
61.33 >50.0
B Elbow-Wrist
3.59
21
58.50
>50
2.50
14
56.00
>50
5.63
Right Ulnar (Abd Dig Min)
Wrist
2.81
<4.0
12.30
>5.0
5.94
B Elbow
6.41
11.43
6.56 A Elbow-B Elbow
A Elbow
8.91
10.78
6.72
Right Radial (Ext Ind Prop)
Ext Ind
Prop1
1.95
>1.0
4.09
Ext Ind Prop1-Ext
7.34 Ind Prop1
0.00
Patient:
XXXX, Regina
Test Date:
2/9/2010
p.
4
Sensory Nerves
Site
NR
Peak
(ms)
Norm
Peak
(ms)
P-T
Amp
(µV)
Norm Segment Name
Amp
(µV)
DeltaP
(ms)
Dist
(cm)
Vel Norm
(m/s) Vel
(m/s)
Right Median Anti (2nd Digit)
Wrist
3.13
<3.7
92.39
>15.0 Wrist-2nd Digit
3.13
>50
<3.8
73.65
>15.0 Wrist-5th Digit
3.19
>50.0
Right Ulnar Anti (5th Digit)
Wrist
3.19
Right Median and Ulnar Ortho (Wrist)
Median
Palm
1.84
<2.3 124.03
Ulnar
Palm
1.78
<2.3
43.04
Right Radial Anti (Base 1st Dig)
Base 1st
Digit
2.00
<2.7
53.17
FWave/HReflex
NR
Lat1
(ms)
Lat2
(ms)
Delta
(ms)
Right Median-F (APB)
23.97
0.00
Right Ulnar-F (ADM)
23.97
26.69
0.00 26.69
Right Radial-F (Ext Ind Prop)
23.24
0.00
23.24
Amp
(µV)
>14 Median Palm-Wrist
1.84
>6 Ulnar Palm-Wrist
1.78
Base 1st Digit-Base 1st
>13 Dig
2.00
Patient:
XXXX, Regina
Test Date:
Right Median Anti Sensory
2/9/2010
p.
Right Ulnar Anti Sensory
5
Right Median and Ulnar Ortho Sensory
P
Median Palm
P
P
O
R
Wrist
R
Wrist
O
T
R
O
P
T
T
Ulnar Palm
T
O
20 (µV)
Right Radial Anti Sensory
2 (ms) 20 (µV)
Right Median Motor
R
2 (ms) 20 (µV)
Right Median-F
2 (ms)
P
Wrist
O
R
P
T
Base 1st Digit
P
O
R
T
Elbow
O
R
T
20 (µV)
Right Ulnar Motor
2 (ms) 5000 (µV)
Right Ulnar-F
5 (ms) 5000 (µV) / 200 (µV)
Right Radial Motor
5 (ms)
P
Wrist
P
O
R
T
P
B Elbow
O
P
Ext Ind Prop1
O
R
R
T
T
A Elbow
O
R
T
5000 (µV)
Right Radial-F
5 (ms) 5000 (µV) / 200 (µV)
5000 (µV) / 200 (µV)
5 (ms)
5 (ms) 5000 (µV)
5 (ms)
SAMPLE EMG/NCV REPORT - ABNORMAL STUDY
John Smith, M.D.
Diplomate, American Board of Physical Medicine and Rehabilitation
Diplomate, American Board of Electrodiagnostic Medicine
Precision Occupational Medical Group, Inc.
1805 E. Dyer Rd., Suite #110
Santa Ana, CA 92705
Tel: (949) 955-0022
Fax: (949) 955-0220
1/29/2009 12:41:04 PM
Patient: XXXX, Delfino
DOB:
12/24/1950 Physician: Smith
ID#:
XXXXXX_DELFIN_08071 SEX:
Male
Ref. Phys: Jones
________________________________________________________________
Patient Complaints:
Neck pain with associated numbness and tingling. Low back pain with radiation
into both lower extremities.
Patient History:
Mr, XXXX is a 57 year-old male with a past medical history significant for cervical
strain, history of spondylolisthesis and spinal stenosis, status post lumbar
laminectomy and fusion L3-S1. Patient complains of neck pain, numbness and
tingling with radiation down both upper extremities (right > left). Patient reports
weakness in the legs, left more then the right. Patient also complains of low back
pain with radiation down both lower extremities (left > right). Patient denies
history of diabetes or thyroid disorder. The patient worked on cement and wood
floors which required repetitive bending, stooping, squatting and lifting
approximately 60lbs. Patient reports that on the date of injury, he was finishing a
cement floor. He was bending over using a 2 x 4 piece of wood to finish the floor
when he felt a pull in his lower back and his legs gave out. He fell to the ground
on his knees. His current medications include Naprosyn, Vicodin and Captopril.
Physical Exam:
GENERAL: No acute distress, well nourished and well developed
HEENT: Normal cephalic, PERRLA, EOMI
EXT: No clubbing, cyanosis or edema
MUSCULOSKELETAL: No asymmetry, mass or tenderness to palpation.
Strength is 5/5 in bilateral upper extremity.
NEURO: Patient is alert, awake and oriented x 3, muscle tone is normal without
any clonus. DTR is symmetrical and normal in bilateral upper extremity.
Sensation to light touch is decreased in the right L5 and S1 distribution in both
legs. Straight leg raise is positive on the right.
Patient:
XXXXX, Delfino
Test Date:
1/29/2009
SPINE: There is significant tenderness to palpation in the lower lumbar
paravertebrals.
Informed consent was obtained. Needle electromyography was performed with a
monopolar disposable needle electrode on selected muscles as shown below.
Nerve conduction study of was done today with the surface skin measure at 32
degree Celsius and above near the site of the recording electrodes. Nerve
conductions were performed using standard surface conduction techniques. The
patient tolerated the procedure without complications.
Impression:
Abnormal Electrodiagnostic Study.
1. There is evidence of an acute L5 and S1 lumbosacral radiculopathy in
both lower extremities (left > right). Clinical correlation is recommended.
2. There is evidence of a C6 acute cervical radiculopathy in both upper
extremities. Clinical correlation is recommended.
3. Bilateral ulnar motor CMAP amplitudes were reduced with normal onset
latencies. Clinical correlation is recommended. Recommend patient
return to complete bilateral ulnar inching study in both arms for further
evaluation of entrapment neuropathy at the elbows.
“I declare under penalty of perjury that this statement is true and correct to the
best of my knowledge and that I have not violated the Labor Code 139.3.”
_____________________________________
John Smith, M.D.
Diplomate, American Board of Physical Medicine and Rehabilitation
Diplomate, American Board of Electrodiagnostic Medicine
p.
2
Patient:
XXXXX, Delfino
Test Date:
1/29/2009
p.
3
ELECTRODIAGNOSTIC RESULTS:
EMG
Side
Muscle
Nerve
Root
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Abd Poll Brev
1stDorInt
ExtIndicis
ExtCarUln
ExtCarRad
BrachioRad
Biceps
Triceps
Deltoid
C1 Parasp
C2 Parasp
C3 Parasp
C4 Parasp
C5 Parasp
C6 Parasp
C7 Parasp
C8 Parasp
T1 Parasp
Abd Poll Brev
ABD DigMinimi
1stDorInt
ExtIndicis
ExtCarUln
ExtCarRad
PronatorTeres
BrachioRad
Biceps
Triceps
Deltoid
C1 Parasp
C2 Parasp
C3 Parasp
C4 Parasp
C5 Parasp
C6 Parasp
C7 Parasp
C8 Parasp
T1 Parasp
Median
Ulnar
Radial (Post Int)
Radial (Post Int)
Radial
Radial
Musculocut
Radial
Axillary
Rami
Rami
Rami
Rami
Rami
Rami
Rami
Rami
Rami
Median
Ulnar
Ulnar
Radial (Post Int)
Radial (Post Int)
Radial
Median
Radial
Musculocut
Radial
Axillary
Rami
Rami
Rami
Rami
Rami
Rami
Rami
Rami
Rami
C8-T1
C8-T1
C7-8
C7-8
C6-7
C5-6
C5-6
C6-7-8
C5-6
C1
C2
C3
C4
C5
C6
C7
C8
T1
C8-T1
C8-T1
C8-T1
C7-8
C7-8
C6-7
C6-7
C5-6
C5-6
C6-7-8
C5-6
C1
C2
C3
C4
C5
C6
C7
C8
T1
Ins
Act
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Fibs
Psw
Amp
Dur
Poly
Recrt
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
1+
1+
Nml
Nml
Nml
Nml
Nml
Nml
Nml
1+
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
1+
Nml
Nml
1+
Nml
Nml
Nml
Nml
Nml
1+
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Int Pat Comment
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Patient:
Side
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Right
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
Left
XXXXX, Delfino
Muscle
PostTibiailis
MedGastroc
AntTibialis
BicepsFemS
VastusMed
VastusLat
RectFemoris
L1 Parasp
L2 Parasp
L3 Parasp
L4 Parasp
L5 Parasp
S1 Parasp
PostTibiailis
MedGastroc
AntTibialis
BicepsFemS
VastusMed
VastusLat
RectFemoris
L1 Parasp
L2 Parasp
L3 Parasp
L4 Parasp
L5 Parasp
S1 Parasp
Nerve
Tibial
Tibial
Dp Br Peron
Sciatic
Femoral
Femoral
Femoral
Rami
Rami
Rami
Rami
Rami
Rami
Tibial
Tibial
Dp Br Peron
Sciatic
Femoral
Femoral
Femoral
Rami
Rami
Rami
Rami
Rami
Rami
Test Date:
Root
L5, S1
S1-2
L4-5
L5-S1
L2-4
L2-4
L2-4
L1
L2
L3
L4
L5
S1
L5, S1
S1-2
L4-5
L5-S1
L2-4
L2-4
L2-4
L1
L2
L3
L4
L5
S1
Ins Act
Incr
Incr
Incr
Incr
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Fibs
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Psw
1+
1+
1+
1+
Nml
Nml
Nml
Nml
Nml
Nml
Nml
1+
1+
1+
1+
1+
1+
Nml
Nml
Nml
Nml
Nml
Nml
Nml
1+
1+
1/29/2009
Amp
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Dur
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Poly
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
p.
Recrt
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
4
Int Pat Comment
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Nml
Motor Nerves
Site
NR
Onset
(ms)
Norm
Onset
(ms)
Right Median (Abd Poll Brev)
Wrist
3.20
<4.0
Elbow
7.58
Right Ulnar (Abd Dig Min)
Wrist
2.66
<4.0
B Elbow
5.63
A Elbow
8.13
Right Radial (Ext Ind Prop)
Ext Ind
1.47
>1.0
Prop1
Left Median (Abd Poll Brev)
Wrist
3.36
<4.0
Elbow
8.05
Left Ulnar (Abd Dig Min)
Wrist
3.67
<4.0
B Elbow
7.27
A Elbow
9.77
Left Radial (Ext Ind Prop)
Ext Ind
1.88
>1.0
Prop1
Right Tibial (AHB)
Ankle
4.22
< 5.8
Knee
12.11
Left Tibial (AHB)
Ankle
5.16
< 5.8
Knee
13.20
Left Peroneal (EDB)
Ankle
4.92
<5.5
B Fib
11.25
O-P
Amp
(mV)
Norm
Amp
(mV)
Neg Segment Name
Dur
(ms)
DeltaO
(ms)
Dist
(cm)
Vel Norm
(m/s)
Vel
(m/s)
6.16
6.08
>5.0
3.91 Elbow-Wrist
5.08
4.38
27
61.64 >50.0
2.89
2.37
2.31
>5.0
5.23 B Elbow-Wrist
5.63 A Elbow-B Elbow
7.34
2.97
2.50
17
12
57.24
48.00
7.03 Ext Ind Prop1-Ext Ind
Prop1
0.00
59.70 >50.0
9.94
6.33
5.90
>5.0
5.70 Elbow-Wrist
5.78
4.69
28
2.84
2.37
1.50
>5.0
3.67 B Elbow-Wrist
2.42 A Elbow-B Elbow
7.66
3.59
2.50
20.5
15
6.95 Ext Ind Prop1-Ext Ind
Prop1
0.00
4.52
57.10
60.00
>50
>50
>50
>50
11.21
6.92
>4.0
4.14 Knee-Ankle
5.16
7.89
39
49.43 >41.0
10.59
7.17
>4.0
2.81 Knee-Ankle
3.05
8.05
45
55.90 >41.0
4.30
3.45
>2.5
3.98 B Fib-Ankle
4.45
6.33
31
48.97 >40.0
Patient:
XXXXX, Delfino
Right Peroneal (EDB)
Ankle
4.45
<5.5
4.87
B Fib
10.86
5.00
Test Date:
>2.5
1/29/2009
4.14 B Fib-Ankle
4.45
p.
6.41
31
5
48.36 >40.0
Sensory Nerves
Site
NR
Peak
(ms)
Norm
P-T
Peak
Amp
(ms)
(µV)
Right Median Anti (2nd Digit)
Wrist
3.19
<3.7
60.91
Right Ulnar Anti (5th Digit)
Wrist
3.41
<3.8
50.00
Right Median and Ulnar Ortho (Wrist)
Median
1.84
<2.3 144.89
Palm
Ulnar Palm
2.03
<2.3
24.68
Right Radial Anti (Base 1st Dig)
Base 1st
1.72
<2.7 134.47
Digit
Left Median Anti (2nd Digit)
Wrist
3.22
<3.7 106.74
Left Ulnar Anti (5th Digit)
Wrist
5.44
<3.8
75.26
Left Median and Ulnar Ortho (Wrist)
Median
2.22
<2.3
93.28
Palm
Ulnar Palm
1.97
<2.3
21.75
Left Radial Anti (Base 1st Dig)
Base 1st
2.34
<2.7
24.87
Digit
Left Dorsal Ulnar Cutaneous (Ulnar Dorsal)
Ulnar
1.69
< 2.8 175.84
Dorsal1
Right Sural (Lat Mall)
14 cm
3.56
<4.5
30.55
Right M Plantar (AHB)
Med Mall
2.59
< 3.7
21.47
Right L Plantar (ADM)
Med Mall
2.31
< 3.7
23.84
Left Sural (Lat Mall)
14 cm
2.81
<4.5 197.18
Left M Plantar (AHB)
Med Mall
2.28
< 3.7
25.58
Left L Plantar (ADM)
Med Mall
2.25
< 3.7
23.64
Right Saphenous (Ant Med Mall)
Med Tibia
2.91
< 4.3
15.75
Left Saphenous (Ant Med Mall)
Med Tibia
2.50
< 4.3
12.79
Norm
Amp
(µV)
Segment Name
Delta-P Dist
(ms)
(cm)
Vel
(m/s)
Norm
Vel
(m/s)
>15.0 Wrist-2nd Digit
3.19
>50
>15.0 Wrist-5th Digit
3.41
>50.0
>14 Median Palm-Wrist
1.84
>6 Ulnar Palm-Wrist
2.03
>13 Base 1st Digit-Base 1st Dig
1.72
>15.0 Wrist-2nd Digit
3.22
>50
>15.0 Wrist-5th Digit
5.44
>50.0
>14 Median Palm-Wrist
2.22
>6 Ulnar Palm-Wrist
1.97
>13 Base 1st Digit-Base 1st Dig
2.34
>17
> 6 14 cm-Lat Mall
3.56
>10
>8
> 6 14 cm-Lat Mall
2.81
>10
>8
> 3 Med Tibia-Ant Med Mall
2.91
> 3 Med Tibia-Ant Med Mall
2.50
Patient:
XXXXX, Delfino
Test Date:
FWave/HReflex
NR
Lat1
Lat2
Delta
(ms)
(ms)
(ms)
Right Median-F (APB)
28.69
0.00
28.69
Right Ulnar-F (ADM)
30.33
0.00
30.33
Right Radial-F (Ext Ind Prop)
23.97
0.00
23.97
Left Median-F (APB)
26.82
0.00
26.82
Left Ulnar-F (ADM)
29.42
0.00
29.42
Left Radial-F (Ext Ind Prop)
24.27
0.00
24.27
Right Tibial-F (AHB)
47.52
0.00
47.52
Left Tibial-F (AHB)
48.55
0.00
48.55
Right Peroneal-F (EDB)
44.73
0.00
44.73
Left Peroneal-F (EDB)
45.34
0.00
45.34
Right Tibial H (Gastroc)
29.30
0.00
29.30
Left Tibial H (Gastroc)
33.41
0.00
33.41
Amp
(µV)
1/29/2009
p.
6
Patient:
XXXXX, Delfino
Test Date:
Right Median Anti Sensory
R
O
Wrist
P
Wrist
R
T
T
20 (µV)
2 (ms 20 (µV)
Right Median and Ulnar Ortho Sens Right Radial Anti Sensory
P
p.
Right Ulnar Anti Sensory
P
O
1/29/2009
2 (ms
R
O
Median Palm
Base 1st Digit
P
T
O
P
T
R
Ulnar Palm
R
T
O
20 (µV)
Right Median Motor
2 (ms 20 (µV)
Right Median-F
2 (ms
P
Wrist
O
R
T
P
Elbow
O
TR
5000 (µV)
5 (ms 5000 (µV) / 200 (µV)
5 (ms
7
Patient:
XXXXX, Delfino
Right Ulnar Motor
P
Test Date:
Right Ulnar-F
1/29/2009
p.
Wrist
O
R
T
P
B Elbow
O
R
T
A Elbow
P
O
T
R
5000 (µV)
Right Radial Motor
P
5 (ms 5000 (µV) / 200 (µV)
Right Radial-F
5 (ms
Ext Ind Prop1
R
T
5000 (µV)
Left Median Anti Sensory
5 (ms 5000 (µV) / 200 (µV)
Left Ulnar Anti Sensory
5 (ms
P
Wrist
R
P
T
20 (µV)
Wrist
O
O
T
2 (ms 20 (µV)
2 (ms
8
Patient:
XXXXX, Delfino
Test Date:
1/29/2009
Left Median and Ulnar Ortho Senso Left Radial Anti Sensory
R
Base 1st Digit
P
R
Median Palm
P
p.
T
O
R
P
T
Ulnar Palm
T
O
O
20 (µV)
2 (ms 20 (µV)
Left Dorsal Ulnar Cutaneous Senso Left Median Motor
2 (ms
P
P
Wrist
O
TR
O
P
Elbow
O
TR
10 (µV)
Left Median-F
2 (ms 5000 (µV)
Left Ulnar Motor
5 (ms
P
Wrist
O
TR
P
B Elbow
O
TR
P
O
5000 (µV) / 200 (µV)
5 (ms 2000 (µV)
A Elbow
T R
5 (ms
9
Patient:
XXXXX, Delfino
Left Ulnar-F
Test Date:
Left Radial Motor
P
1/29/2009
p.
Ext Ind Prop1
O
R
T
5000 (µV) / 200 (µV)
Left Radial-F
5 (ms 5000 (µV)
Right Tibial Motor
5 (ms
P
Ankle
O
R
T
P
Knee
O
R
T
5000 (µV) / 200 (µV)
Right Tibial-F
5 (ms 5000 (µV)
Right Sural Sensory
5 (ms
R
14 cm
P
O
5000 (µV) / 200 (µV)
5 (ms 20 (µV)
T
2 (ms
10
Patient:
XXXXX, Delfino
Right Tibial H
Test Date:
Left Tibial H
1/29/2009
2000 (µV) / 200 (µV)
Right M Plantar Sensory
10 (m 2000 (µV) / 200 (µV)
Right L Plantar Sensory
p.
10 (m
R
R
Med Mall
Med Mall
P
O
T
P
T
O
20 (µV)
Left Tibial Motor
2 (ms 20 (µV)
Left Tibial-F
2 (ms
P
Ankle
R
O
T
P
Knee
O
R
T
5000 (µV)
5 (ms 5000 (µV) / 200 (µV)
5 (ms
11
Patient:
XXXXX, Delfino
Left Sural Sensory
Test Date:
1/29/2009
Left M Plantar Sensory
p.
R
P
O
14 cm
Med Mall
P
T
R
O
T
20 (µV)
Left L Plantar Sensory
2 (ms 20 (µV)
Left Peroneal Motor
R
P
Ankle
O
R
T
Med Mall
2 (ms
P
B Fib
O
T R
P
O
T
20 (µV)
Right Peroneal Motor
2 (ms 5000 (µV)
Right Peroneal-F
5 (ms
P
Ankle
O
R
T
P
B Fib
O
5000 (µV)
T
R
5 (ms 5000 (µV) / 200 (µV)
5 (ms
12
Patient:
XXXXX, Delfino
Right Saphenous Sensory
Test Date:
Left Peroneal-F
1/29/2009
p.
Med Tibia
P
T
R
O
20 (µV)
Left Saphenous Sensory
R
2 (ms 5000 (µV) / 200 (µV)
Med Tibia
P
T
O
20 (µV)
2 (ms
5 (ms
13
Precision Occupational Medical Group, Inc.
Shockwave Treatment Request Form
Work Comp - MTUS/ACOEM - FDA Diagnoses
PATIENT INFORMATION:
Last Name: _____________________________________
First Name: _____________________________________________
Address: _______________________________________
City: ___________________________________ Zip: __________
M
Sex:
F
DOB: ____/____/____ SSN ___________ Phone# (H) ______________________ (W) ___________________
Treating Physician: _________________________________ Practice Name: ____________________________________________
Address: _____________________________________ City: _________________________ Zip: _________ Phone: ____________
Location of Clinic where patient is to be treated: ______________________________________________________________
DIAGNOSIS:
R
R
R
R
R
R
L
L
L
L
L
L
B
B
B
B
B
B
Please Circle: R = right,
726.11
726.10
726.2
726.32
726.31
726.50
L = left,
B = bilateral
– Calcifying Tendinitis of the Shoulder
– Non-Calcifying Tendinitis of the Shoulder
– Shoulder Impingement
– Lateral Epicondylitis
– Medial Epicondylitis
– Trochanteric Tendinitis
*Bilateral each area treated on different dates.
R
R
R
R
R
L
L
L
L
L
B
B
B
B
B
726.64
726.71
726.71
726.73
728.71
–
–
–
–
–
Patellar Tendinitis
Achilles Tendinitis
Achilles Bursitis
Calcaneal Spur
Plantar Fasciitis
TREATMENT INFORMATION:
Treatment Area:
SHOULDER
ELBOW
HIP
Has this patient previously received ESWT treatment?
KNEE
YES
ANKLE
HEEL
NO On this area
FOOT
Yes
OTHER ______________________
No Date: ____/____/____
Date of Injury: ____/____/____ Claim #: _________________________________ ______________________________
Referring Physician
_______________________________________________ _____________________________________________________
Employer’s Name & Phone#
Adjuster’s Name
Phone#
Fax#
_______________________________________________ _____________________________________________________
Carrier’s Name & Phone#
Carrier’s Address
City
State
Zip
AUTHORIZATION CRITERIA
ESWT is medically necessary for treatment of patients, and as an alternative to surgery, when the following criteria have been met:
1. Symptoms have persisted for several months.
2. History of at least three unsuccessful conservative treatments. (Listed Below)
THE PATIENT HAS FAILED TO RESPOND TO THE FOLLOWING CONSERVATIVE TREATMENTS:
Immobilization
Rest
Physical Therapy
NSAIDS
Splints
Strapping
Ice
Cortisone Shots
Orthotics
Brace(s)
The patient has met the criteria for ESWT treatment and in my medical judgment will benefit with the Sonocur ESWT device.
Additionally, _____________________________________________________________________________________________
The patient information listed above was completed by my office staff, or myself, and it is to the best of my knowledge true and
factual.
Physician Signature:
_______________________________________
Physician Name: (Print) _______________________________________ Date: _____________________
SEND RX, DEMOS, PR-2, AND THIS FORM TO FAX: (949) 743-0567 OR EMAIL TO REFERRALS@POMG.NET,
or PHONE: 888-98-PAINFREE
(edited 12/07/12)
s
Relieving Chronic Pain in Orthopedics
SONOCUR Basic
Effective Shock Wave Therapy
Improving
the Quality
of Life
SONOCUR Basic
Improving the Quality of Life
Eliminating the patient’s chronic
pain is the number one task of
SONOCUR® Basic. For more
than a decade, Siemens has
been successfully developing
and producing shock wave
technology for lithotripsy. This
clinically proven technology has
been modified in SONOCUR
Basic for the treatment of tendinopathies and other specific
types of localized painful
musculoskeleton conditions.
This therapeutic system is
optimally designed with the
patient in mind. As an alternative to surgery and ongoing
therapy, SONOCUR Basic
provides a risk-free and effective therapy. Plus, the patient
receives the benefits of noninvasive and anesthesia-free
treatment. How does it work?
A specific number of finely
tuned low energy shock waves
is administered to the point
of pain. The variable energy
settings permit each patient to
be treated with the appropriate
energy levels that best suit
the individual case. Since
SONOCUR Basic treats areas
of the shoulder as well as the
foot, the system is designed
to easily access all parts of
the body. The articulating arm
suspends the shock wave head
and moves in three planes,
thereby sustaining smooth
positioning and coupling to
the patient. The coupling head
allows the focal point of the
shock wave head to be adjusted
to various depths below the
skin. This function exactly
positions the treatment energy
to the best therapeutic location.
SONOCUR Basic- effective
and risk-free therapy that your
patients await!
Primary orthopedic applications currently include:
Shoulder
Treatment of impingement
syndrome of the shoulder,
including tendinosis calcarea
Positioning:
Patient lies on table in
supine position
Treatment:
Energy level
1-5
Number of pulses:
2000
Pulse frequency:
4 Hz
Suggested physical therapy
for surrounding tissues.
Advantages of
SONOCUR Basic
• Non-invasive application
• Anesthesia-free
treatment
• Short procedure time
• High patient throughput
• Easy handling
• Compact and mobile
design
Technical Data
55 mm ± 10%
Constant focus:
Depth of penetration:
0 to 50 mm
Shock wave density in focal region:
adjusted through
8 energy level settings
.04 mJ/mm2
to .5 mJ/mm2
Elbow
Treatment of epicondylitis
humeri ulnaris and radialiscommonly known as golf and
tennis elbow
Positioning:
Arm lies on arm support
Treatment:
Energy level
1-3
Number of pulses:
2000
Pulse frequency:
4 Hz
Frequency of shock wave
impulse: selectable from 1 Hz to 4 Hz
Line voltage:
115 V, 230 V ± 10%
50/60 Hz
Power consumption:
maximum of
1.0 kVA
Weight:
Dimensions:
155 kg
80 cm x 55 cm
Foot
Treatment of plantar fasciitiscommonly known as heel spur
Positioning:
Patient lies on table in prone
position
Treatment:
Energy level
2-5
Number of pulses:
2000
Pulse frequency:
4 Hz
Technical specifications are subject to change.
Siemens reserves the right to modify the design and
specifications contained herein without prior notice.
Please contact your local Siemens Sales
Representative for the most current information.
Siemens AG, Medical Solutions
Henkestr. 127, D-91052 Erlangen
Germany
Telephone +49 913184-0
www.siemens.com/medical
0123
© 06.2005, Siemens AG
Order-No.: A91100-M1570-E906-1-7600
Printed in Germany
CCA 61906 WS 06051.
ACOEM | Medical Practice Guidelines
Page 1 of 3
ACOEM Practice Guidelines
Extracorporeal Shockwave Therapy is Recommended for Chronic Plantar Fasciitis
(Insufficient Evidence (I))
Extracorporeal shockwave therapy (ESWT) is recommended as a treatment for chronic plantar
fasciitis in select patients with chronic recalcitrant conditions.
Indications:
Chronic plantar heel pain consistent with plantar fasciitis. In most studies of ESWT used for treatment of plantar
fasciitis, patients often have at least 6 months of symptoms and fail physical or occupational therapy with active
and passive exercises, NSAIDs, and glucocorticosteroid injection(s). (Malay 06, Kudo 06, Rompe 03, Theodore
04, Cosentino 01, Mehra 03, Ogden 04, Rompe 96, Rompe 02; Ogden 01) The presence or absence of heel spur
does not impact decision for use of ESWT. (Cosentino 01)
Frequency / Dose:
Treatment protocols vary; 1 to 3 treatment sessions with reported efficacy are 1,500 impulses at 0.22 mJ/mm2
to 3,800 impulses at 0.36 to 0.64mJ/mm2. (Ogden 01, Ogden 04, Theodore 04, Kudo 06, Malay 06) Serial
sessions of 1,000 to 2,100 impulses at 0.16 mJ/mm2 or lower repeated over 3 sessions spaced in weekly or
biweekly intervals is also reported. (Rompe 03, Cosentino 01, Mehra 03)
Indications for Discontinuation:
Resolution, intolerance, non-compliance.
Citation(s):
Hegmann K (ed), Occupational Medicine Practice Guidelines, 3rd Ed (2011) - p. 1206, Vol. 4
References:
1. Mehra, A., Zaman, T., Jenkin, A. I. The use of a mobile lithotripter in the treatment of tennis elbow and
plantar fasciitis. Surgeon. 2003;1(5);290-2.
2. Haake, M., Buch, M., Schoellner, C., Goebel, F., Vogel, M., Mueller, I., Hausdorf, J., Zamzow, K., SchadeBrittinger, C., Mueller, H. H. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled
multicentre trial. Bmj. 2003;327(7406);75.
3. Speed, C. A., Nichols, D., Wies, J., Humphreys, H., Richards, C., Burnet, S., Hazleman, B. L. Extracorporeal
shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res. 2003;21
(5);937-40.
4. Buchbinder, R., Ptasznik, R., Gordon, J., Buchanan, J., Prabaharan, V., Forbes, A. Ultrasound-guided
extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. Jama. 2002;288
(11);1364-72.
http://apg-i.acoem.org/Browser/ViewRecommendation.aspx?rcm=2919&te...
11/7/2012
ACOEM | Medical Practice Guidelines
Page 2 of 3
5. Gollwitzer, H., Diehl, P., von Korff, A., Rahlfs, V. W., Gerdesmeyer, L. Extracorporeal shock wave therapy for
chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new
electromagnetic shock wave device. J Foot Ankle Surg. 2007;46(5);348-57.
6. Malay, D. S., Pressman, M. M., Assili, A., Kline, J. T., York, S., Buren, B., Heyman, E. R., Borowsky, P.,
LeMay, C. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar
fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. J Foot
Ankle Surg. 2006;45(4);196-210.
7. Gerdesmeyer, L., Frey, C., Vester, J., Maier, M., Weil, L., Jr., Weil, L., Sr., Russlies, M., Stienstra, J., Scurran,
B., Fedder, K., Diehl, P., Lohrer, H., Henne, M., Gollwitzer, H. Radial extracorporeal shock wave therapy is
safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory
randomized placebo-controlled multicenter study. Am J Sports Med. 2008;36(11);2100-9.
8. Kudo, P., Dainty, K., Clarfield, M., Coughlin, L., Lavoie, P., Lebrun, C. Randomized, placebo-controlled, double
-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy
(ESWT) device: a North American confirmatory study. J Orthop Res. 2006;24(2);115-23.
9. Marks, W., Jackiewicz, A., Witkowski, Z., Kot, J., Deja, W., Lasek, J. Extracorporeal shock-wave therapy
(ESWT) with a new-generation pneumatic device in the treatment of heel pain. A double blind randomised
controlled trial. Acta Orthop Belg. 2008;74(1);98-101.
10. Rompe, J. D., Decking, J., Schoellner, C., Nafe, B. Shock wave application for chronic plantar fasciitis in
running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med. 2003;31(2);268-75.
11. Theodore, G. H., Buch, M., Amendola, A., Bachmann, C., Fleming, L. L., Zingas, C. Extracorporeal shock wave
therapy for the treatment of plantar fasciitis. Foot Ankle Int. 2004;25(5);290-7.
12. Cosentino, R., Falsetti, P., Manca, S., De Stefano, R., Frati, E., Frediani, B., Baldi, F., Selvi, E., Marcolongo, R.
Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis. Ann Rheum Dis. 2001;60
(11);1064-7.
13. Ogden, J. A., Alvarez, R. G., Levitt, R. L., Johnson, J. E., Marlow, M. E. Electrohydraulic high-energy shockwave treatment for chronic plantar fasciitis. J Bone Joint Surg Am. 2004;86-A(10);2216-28.
14. Ogden, J. A., Alvarez, R., Levitt, R., Cross, G. L., Marlow, M. Shock wave therapy for chronic proximal plantar
fasciitis. Clin Orthop Relat Res. 2001(387);47-59.
15. Rompe, J. D., Hopf, C., Nafe, B., Burger, R. Low-energy extracorporeal shock wave therapy for painful heel: a
prospective controlled single-blind study. Arch Orthop Trauma Surg. 1996;115(2);75-9.
16. Hammer, D. S., Adam, F., Kreutz, A., Kohn, D., Seil, R. Extracorporeal shock wave therapy (ESWT) in patients
with chronic proximal plantar fasciitis: a 2-year follow-up. Foot Ankle Int. 2003;24(11);823-8.
17. Rompe, J. D., Schoellner, C., Nafe, B. Evaluation of low-energy extracorporeal shock-wave application for
treatment of chronic plantar fasciitis. J Bone Joint Surg Am. 2002;84-A(3);335-41.
18. Dorotka, R., Sabeti, M., Jimenez-Boj, E., Goll, A., Schubert, S., Trieb, K. Location modalities for focused
extracorporeal shock wave application in the treatment of chronic plantar fasciitis. Foot Ankle Int. 2006;27
(11);943-7.
19. Rompe, J. D., Meurer, A., Nafe, B., Hofmann, A., Gerdesmeyer, L. Repetitive low-energy shock wave
application without local anesthesia is more efficient than repetitive low-energy shock wave application with
local anesthesia in the treatment of chronic plantar fasciitis. J Orthop Res. 2005;23(4);931-41.
20. Hammer, D. S., Rupp, S., Kreutz, A., Pape, D., Kohn, D., Seil, R. Extracorporeal shockwave therapy (ESWT)
in patients with chronic proximal plantar fasciitis. Foot Ankle Int. 2002;23(4);309-13.
21. Porter, M. D., Shadbolt, B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for
plantar fasciopathy. Clin J Sport Med. 2005;15(3);119-24.
http://apg-i.acoem.org/Browser/ViewRecommendation.aspx?rcm=2919&te...
11/7/2012
ACOEM | Medical Practice Guidelines
Page 3 of 3
22. Greve, J. M., Grecco, M. V., Santos-Silva, P. R. Comparison of radial shockwaves and conventional
physiotherapy for treating plantar fasciitis. Clinics (Sao Paulo). 2009;64(2);97-103.
23. Wang, C. J., Wang, F. S., Yang, K. D., Weng, L. H., Ko, J. Y. Long-term results of extracorporeal shockwave
treatment for plantar fasciitis. Am J Sports Med. 2006;34(4);592-6.
24. Tornese, D., Mattei, E., Lucchesi, G., Bandi, M., Ricci, G., Melegati, G. Comparison of two extracorporeal
shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled
study. Clin Rehabil. 2008;22(9);780-7.
DISCLAIMER
The American College of Occupational and Environmental Medicine provides this segment of guidelines for
practitioners and notes that decisions to adopt particular courses of actions must be made by trained
practitioners on the basis of the available resources and the particular circumstances presented by the individual
patient. Accordingly, the ACOEM disclaims responsibility for any injury or damage resulting from actions taken by
practitioners after considering these guidelines.
Copyright ©1996-2009 - American College of Occupational and Environmental Medicine
http://apg-i.acoem.org/Browser/ViewRecommendation.aspx?rcm=2919&te...
11/7/2012
ACOEM | Medical Practice Guidelines
Page 1 of 2
ACOEM Practice Guidelines
Extracorporeal Shockwave Therapy is Recommended for Chronic Calcific Tendinitis
(Strong Evidence (A))
Extracorporeal shockwave therapy is strongly recommended for treatment of calcific rotator cuff
tendinitis.
Indications:
Symptomatic calcific rotator cuff tendinitis that has been diagnosed with imaging. Patients should have failed at
least 6 months of time with symptoms without resolution as well as failed physical or occupational therapy with
both active and passive exercises, NSAIDs, and glucocorticosteroid injection(s). (Gerdesmeyer 03; Peters 04;
Albert 07; Hsu 08; Hearnden 09; Pleiner 04; Cacchio 06; Sabeti 07)
Frequency / Dose:
Treatment frequency and duration patterns varied in quality studies. These ranged from a single session
(Hearnden 09; Sabeti 07; Krasny 05) to a second session in 1 week (Haake 02) to weekly sessions for 4 weeks
(Cacchio 06) to an average of 4 sessions every 6 weeks over 6 months. (Peters 04) Most commonly and
including the highest quality studies, patients treated with 2 sessions that were approximately 14 days apart.
(Gerdesmeyer 03; Albert 07; Hsu 08; Pleiner 04; Pan 03) Thus, up to 2 sessions, approximately 2 weeks apart
are recommended. Energy levels with documented success varied as well, ranging from 0.28 to 0.55 mJ/mm2 in
the most successful quality sham-controlled trials. (Gerdesmeyer 03; Peters 04; Albert 07; Hsu 08; Hearnden 09;
Pleiner 04) There is evidence that low energy levels such as 0.15 mJ/mm2 are less effective. (Peters 04) Thus,
while an optimal dose is unclear, the recommended dose ranges from 0.28 to 0.55 mJ/mm2. There is quality
evidence the focus should be on the calcium deposits and not the tendon insertion. (Haake 02) Some protocols
combined this therapy with an exercise program.
Indications for Discontinuation:
Resolution, intolerance, non-compliance.
Citation(s):
Hegmann K (ed), Occupational Medicine Practice Guidelines, 3rd Ed (2011) - p. 109, Vol. 3
References:
1. Gerdesmeyer, L., Wagenpfeil, S., Haake, M., Maier, M., Loew, M., Wortler, K., Lampe, R., Seil, R., Handle, G.,
Gassel, S., Rompe, J. D. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis
of the rotator cuff: a randomized controlled trial. Jama. 2003;290(19);2573-80.
2. Peters, J., Luboldt, W., Schwarz, W., Jacobi, V., Herzog, C., Vogl, T. J. Extracorporeal shock wave therapy in
calcific tendinitis of the shoulder. Skeletal Radiol. 2004;33(12);712-8.
http://apg-i.acoem.org/Browser/ViewRecommendation.aspx?rcm=2797&te...
11/7/2012
ACOEM | Medical Practice Guidelines
Page 2 of 2
3. Albert, J. D., Meadeb, J., Guggenbuhl, P., Marin, F., Benkalfate, T., Thomazeau, H., Chales, G. High-energy
extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. J Bone Joint
Surg Br. 2007;89(3);335-41.
4. Hsu, C. J., Wang, D. Y., Tseng, K. F., Fong, Y. C., Hsu, H. C., Jim, Y. F. Extracorporeal shock wave therapy
for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg. 2008;17(1);55-9.
5. Hearnden, A., Desai, A., Karmegam, A., Flannery, M. Extracorporeal shock wave therapy in chronic calcific
tendonitis of the shoulder--is it effective?. Acta Orthop Belg. 2009;75(1);25-31.
6. Pleiner, J., Crevenna, R., Langenberger, H., Keilani, M., Nuhr, M., Kainberger, F., Wolzt, M., Wiesinger, G.,
Quittan, M. Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A
randomized controlled trial. Wien Klin Wochenschr. 2004;116(15-16);536-41.
7. Cacchio, A., Paoloni, M., Barile, A., Don, R., de Paulis, F., Calvisi, V., Ranavolo, A., Frascarelli, M., Santilli, V.,
Spacca, G. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind,
randomized clinical study. Phys Ther. 2006;86(5);672-82.
8. Sabeti, M., Dorotka, R., Goll, A., Gruber, M., Schatz, K. D. A comparison of two different treatments with
navigated extracorporeal shock-wave therapy for calcifying tendinitis - a randomized controlled trial. Wien
Klin Wochenschr. 2007;119(3-4);124-8.
9. Pan, P. J., Chou, C. L., Chiou, H. J., Ma, H. L., Lee, H. C., Chan, R. C. Extracorporeal shock wave therapy for
chronic calcific tendinitis of the shoulders: a functional and sonographic study. Arch Phys Med Rehabil.
2003;84(7);988-93.
10. Krasny, C., Enenkel, M., Aigner, N., Wlk, M., Landsiedl, F. Ultrasound-guided needling combined with shockwave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg Br. 2005;87(4);5017.
11. Haake, M., Deike, B., Thon, A., Schmitt, J. Exact focusing of extracorporeal shock wave therapy for calcifying
tendinopathy. Clin Orthop Relat Res. 2002(397);323-31.
DISCLAIMER
The American College of Occupational and Environmental Medicine provides this segment of guidelines for
practitioners and notes that decisions to adopt particular courses of actions must be made by trained
practitioners on the basis of the available resources and the particular circumstances presented by the individual
patient. Accordingly, the ACOEM disclaims responsibility for any injury or damage resulting from actions taken by
practitioners after considering these guidelines.
Copyright ©1996-2009 - American College of Occupational and Environmental Medicine
http://apg-i.acoem.org/Browser/ViewRecommendation.aspx?rcm=2797&te...
11/7/2012
ACOEM | Medical Practice Guidelines
Page 1 of 2
ACOEM Practice Guidelines
Extracorporeal Shockwave Therapy is Recommended for Chronic Achilles
Tendinopathy (Limited Evidence (C))
Extracorporeal shockwave therapy is recommended as an adjunct to an eccentric exercise for
chronic, recalcitrant Achilles tendinopathy.
Indications:
Moderate to severe, recalcitrant Achilles tendinopathy. Patients should have failed NSAIDs, eccentric exercises,
physical or occupational therapy, and local injection(s). (Rompe J Bone Joint Surg Am 08, Rompe 09)
Frequency / Dose:
Three to 4 weekly sessions over 3 to 4 consecutive weeks, using 2,000 shocks at 0.1 to 0.2 J/mm2 (Rasmussen
08; Rompe 07; Rompe J Bone Joint Surg Am 08; Rompe 09) administered in conjunction with an eccentric
exercise program.
Indications for Discontinuation:
Completion of course, resolution of symptoms, adverse effects, intolerance, non-compliance.
Citation(s):
Hegmann K (ed), Occupational Medicine Practice Guidelines, 3rd Ed (2011) - p. 1141, Vol. 4
References:
1. Costa, M. L., Shepstone, L., Donell, S. T., Thomas, T. L. Shock wave therapy for chronic Achilles tendon pain:
a randomized placebo-controlled trial. Clin Orthop Relat Res. 2005;440;199-204.
2. Rompe, J. D., Furia, J., Maffulli, N. Eccentric loading compared with shock wave treatment for chronic
insertional achilles tendinopathy. A randomized, controlled trial. J Bone Joint Surg Am. 2008;90(1);52-61.
3. Rompe, J. D., Nafe, B., Furia, J. P., Maffulli, N. Eccentric loading, shock-wave treatment, or a wait-and-see
policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med.
2007;35(3);374-83.
4. Rasmussen, S., Christensen, M., Mathiesen, I., Simonson, O. Shockwave therapy for chronic Achilles
tendinopathy: a double-blind, randomized clinical trial of efficacy. Acta Orthop. 2008;79(2);249-56.
5. Rompe, J. D., Furia, J., Maffulli, N. Eccentric loading versus eccentric loading plus shock-wave treatment for
midportion achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37(3);463-70.
DISCLAIMER
The American College of Occupational and Environmental Medicine provides this segment of guidelines for
practitioners and notes that decisions to adopt particular courses of actions must be made by trained
http://apg-i.acoem.org/Browser/ViewRecommendation.aspx?rcm=2842&te...
11/7/2012
ACOEM | Medical Practice Guidelines
Page 2 of 2
practitioners on the basis of the available resources and the particular circumstances presented by the individual
patient. Accordingly, the ACOEM disclaims responsibility for any injury or damage resulting from actions taken by
practitioners after considering these guidelines.
Copyright ©1996-2009 - American College of Occupational and Environmental Medicine
http://apg-i.acoem.org/Browser/ViewRecommendation.aspx?rcm=2842&te...
11/7/2012