Extracorporeal Shock Wave Therapy (ESWT) as a treatment for recurrent Neurogenic Heterotopic Ossification (NHO)

Primary objective: To describe the effects of extracorporeal shock wave therapy (ESWT) on neurogenic heterotopic ossification (NHO). Research design: A single case study was considered the most appropriate methodology in this situation. Methods and procedures: The subject was a 43 year old female 10 years post-traumatic brain injury with recurring NHO around the hip joint. Baseline assessments of pain using a 10-point VAS, range of motion of the hip using a goniometer and walking ability (number of steps over a standard distance) were conducted. Four applications of ESWT using a Minispec™ Extracorporeal Shock Wave Lithotripsy machine (Medispec Int. USA) administered over 6 weeks to the anterolateral aspect of the right hip. Follow-up assessments were conducted weekly over the period of intervention and then monthly for 5 months. Main outcomes and results: Immediately following treatment, pain was reduced to 0 on the VAS scale; hip range of motion increased and the number of steps over a standard distance reduced, indicating increased step length. At 5-month follow-up, without further ESWT intervention, these results were maintained. Conclusion: This case study suggests that ESWT may be a non-invasive, low risk intervention for the management of NHO.