EP2804573A1

EP2804573A1 - Apparatus for extra-corporal treatment using shock waves

Info

Publication number: EP2804573A1
Application number: EP13701954.3A
Authority: EP
Inventors: Robert DAUVISTER; Jean Malak
Original assignee: MD Concept
Current assignee: MD Concept
Priority date: 2012-01-20
Filing date: 2013-01-21
Publication date: 2014-11-26
Also published as: BE1020090A5; WO2013107898A1

Abstract

The present invention relates to an apparatus for use in the extra-corporal treatment of the body, said apparatus comprising: (a) a handle (1) via which the apparatus can be manipulated, (b) a drive member (3) arranged preferably inside the handle and allowing transmission to a coupling means (2) of a periodic reciprocating movement back and forth along a longitudinal axis Z at a frequency f of between 1 and 500 Hz and an amplitude A of between 0.4 and 40 mm, (c) a massage head (4a) fixed to a first end of a column (4b), the opposite second end of which is designed to be coupled securely to the coupling means (2) connected to the drive member (3) so that the column runs substantially parallel to the longitudinal axis of oscillation of the coupling means, the time-based curve representing the oscillation of the massage head (4b) being asymmetric and characterized by a displacement time to cover the distance H between an extreme end-of-travel position and its central half-travel position that is shorter than the displacement time taken to cover the same distance H between its central half-travel position and an extreme end-of-travel position.

Description

APPARATUS FOR EXTRACORPOREAL WAVE TREATMENT OF

SHOCK

Technical area

The invention relates to the field of extracorporeal shock wave treatment of the human or animal body. In particular, the invention relates to an apparatus for locally applying periodic stimulation to the surface of the skin. Description of the state of the art

The treatment of pain or simply relaxation by extracorporeal mechanical stimulation of the skin has always applied, ranging from simple caress, massage or acupressure. By mechanically stimulating points or areas of the body by applying pressure on the skin, one can relieve tension, inflammation, and other discomfort. The treatment can be done with the fingers or other parts of the hands and arms, and even in some cases with the feet or, alternatively, using an instrument having a specific shaped head to better reach certain parts of the body. body or accentuate the desired effect. Any mechanical treatment of the surface of the skin practiced by hand, even with the intermediary of a specific head, can be practiced only at very low frequencies, of the order of 1 to 5 Hz. demonstrated that treatments of the skin surface at higher frequencies can yield unexpected results. For example, in the 1980s, the first shockwave devices for lithotripsy were introduced, allowing the extracorporeal treatment of gallstones and kidneys by ESWL (= Extracorporeal Shock Wave Lithotripsy) technique. ESWL can be used to destroy calculations by specifically emitting a high-intensity acoustic wave propagating from the surface of the skin through the tissues to focus the calculations that need to be broken down and sprayed by the radiation wave. shock thus transmitted (see http://en.wikipedia.org/wiki/ExtracorporeaLshock_waveJithotripsy). Shock acoustic wave therapy was then used, at lower intensity, for the dissolution of calcium deposits in the joints such as the shoulder, the treatment of tendon insertion or the elimination of muscle nodes, in a series of treatments. usually called ESWT (= Extracorporeal Shock Wave Therapy) or simply AWT (Acoustic Wave Therapy). The AWT has meanwhile been applied to other areas, such as the treatment of cellulite, weakening of connective tissue, improvement of skin structure and anti aging effects.

The devices for AWT treatment include a high-energy acoustic wave generator that is transmitted to a plate, a real loudspeaker, which is applied in contact with or close to the skin in the area to be treated and which makes it possible to focus the acoustic wave to a point some distance away - a few cm below the skin, where the device is applied. There are two main types of devices with either a planar wave applicator or a radial wave applicator (see, for example, http://www.storzmedical.ch/en/disciplines/aesthetics/ product-overview / d-actor- 200.html).

US5923107 discloses a vibration apparatus adapted to stimulate the erogenous zones of a paralytic person. The apparatus comprises an electric motor allowing oscillation at a modulatable frequency, and optimally of the order of 100 Hz. WO201 1 128182 discloses a massage apparatus provided with a motor enabling, via a gearbox, to change the sinusoidal oscillation frequency of a massage head while maintaining its amplitude constant.

There are still many improvements to be made to extracorporeal shock wave treatments. The present invention provides an extracorporeal shock wave treatment apparatus particularly effective for a wide variety of therapeutic and cosmetic application fields. Summary of the invention

The present invention is defined in the independent claims. Preferred variants are defined in the dependent claims. In particular, the present invention relates to an apparatus for use in extracorporeal shock wave treatment of the human or animal body, said apparatus comprising:

(a) A handle (1) for handling the apparatus,

(b) a mechanical drive member (3) preferably arranged in said handle and for transmitting to a coupling means (2) a reciprocal reciprocal movement of reciprocation along a longitudinal axis, Z, at a frequency, f, between 1 and 500 Hz and an amplitude, A, of between 0.2 and 20 mm,

(c) A massage head (4a) attached to a first end of a column (4b), the opposite end of which is adapted to be integrally coupled to the coupling means (2) connected to the drive member ( 3), so that the column is substantially parallel to the longitudinal axis of oscillation of the coupling means;

Characterized in that, the oscillation time curve of the massage head (4b) is asymmetrically shaped and characterized by a travel time to travel the distance, H, between an extreme end position and its central position. half-stroke shorter than the travel time to travel the same distance, H, between its central half-stroke position and an extreme end-of-travel position.

The massage head may have different geometries depending on where the treatment is to be applied and the desired depth of treatment. For example, the massage head may have a face opposite its attachment point to the rounded column. Thus the head can form a sphere, a spherical cap, a cylinder or half-cylinder. The head can be fixed relative to the column or mounted so as to have one or more degrees of freedom in rotation. In a preferred variant, the side walls joining said opposite face to said attachment point comprise a recess extending over all or part of the perimeter of said sidewalls. This recess allows to act in areas more difficult to access such as between the fingers or toes. The handle can accommodate the drive member. Thus, it preferably comprises an elongate housing extending substantially in the axis of the column fixing the massage head, thus allowing the handling of the device as a pestle. Alternatively, a second portion may be coupled transversely to the elongate housing, such as a pistol grip. A control member is advantageously arranged in the handle for controlling the start and stop of the drive member. The controller may also allow modulation of the frequency and / or amplitude of oscillation of the massage head. The drive member may, in a first variant of the invention, be a pneumatic member comprising a piston housed in a cylinder and being integral with the coupling means. Said cylinder is housed in the handle and is substantially parallel to the longitudinal axis of oscillation. It comprises a proximal portion close to the coupling means and a distal portion remote from the coupling means. The cylinder is also in fluid communication with:

(a) at least one compressed gas rear injector and a compressed gas front injector, said front and rear injectors being located in the distal and proximal portions of the cylinder, respectively, and each being connectable to a source of compressed gas, preferably compressed air, and

(b) a rear exhaust gas system and a front exhaust gas system, said front and rear exhaust systems being located in the distal and proximal portions of the cylinder, respectively.

The oscillation of the piston is controlled by the injection of gas into the cylinder portion upstream of the piston and the coordinated evacuation of gas in the part of the cylinder downstream of the piston, where upstream and downstream of the piston depend on the direction of movement of the piston. The injection and evacuation of gas can be carried out by controlling the opening and closing of windows arranged on the walls of the cylinder communicating with the gas source for the injection and with the exhaust gas system for the evacuation of gases. For example, the closure of such windows can be effected by the piston body itself, as it passes in front and thus closes said window.

In a preferred variant, the exhaust means located downstream of the piston stroke have closed before the piston reaches the end of its stroke in a first direction, in order to create a compressed air cushion cushion downstream of the piston. piston, thus progressively slowing down its stroke in said first direction until it stops. The distal and proximal portions of the cylinder may further be provided with resilient means, such as a helical spring or blade, to further dampen the stroke end of the piston. Such a system makes it possible to damp the piston stroke and thus reduce the noise and vibrations in the handle. It also makes it possible to obtain a form of oscillation in the direction, Z, such as the travel time to travel the distance, H, between a first end position at the end of the race and its halfway central position, ie longer in the direction away from said half-stroke center position than in the opposite direction approaching said mid-stroke center position. This form of oscillation, between a sinusoidal wave and a square wave, seems to give a more pleasant feeling to patients and especially seems to give very good results.

The drive member may, in a second variant of the invention, be electrical. There are many possibilities for driving oscillatory linear motion by an electric motor. For example, the motor can be a linear electromagnetic motor that allows a very fine control of the shape, amplitude and frequency of the oscillatory movement transmitted to the massage head. A piezoelectric can also be used, transforming a supply of electrical energy into motion. Another example is to couple the column of the massage head to a rotary electric motor via a cam. The amplitude of the oscillatory motion depends on the dimensions of the cam. The Asymmetrical shape of the oscillation time curve of the massage head according to the present invention can then be obtained by programming a corresponding variation of the rotation speed of the motor. An apparatus according to the present invention is particularly suitable for the therapeutic treatment of the body. In particular it allows the extracorporeal treatment of pathologies such as myo-arthropathy, tendinopathy, and muscle, joint and dermatological problems in general. It is also particularly suitable for the cosmetic treatment of cutaneous laxity, steatomeries, adiposities and dermal fibrosis and other dermatological treatments.

Brief description of the drawings

Fig. 1 is a schematic axial sectional view of an apparatus according to the present invention.

Fig. 2 shows different types of massage head mountable on an apparatus according to the present invention.

Fig. 3 schematically shows the operation of a pneumatic drive member adapted to drive the oscillatory movement of the massage head.

Fig. 4 shows the trajectory in time followed by a massage head driven by a pneumatic motor of the type illustrated in FIG. 3, compared to a sinusoid (broken line).

Fig. 5 schematically shows the operation of an electric drive member adapted to drive the oscillatory movement of the massage head.

Detailed description of the invention

As illustrated in FIG. 1, an apparatus according to the present invention comprises a handle (1) allowing the manipulation of the apparatus and preferably housing the driving member (3), symbolized by an 'M' in FIG. 1. The handle (1) may have the shape of an elongated body in the axis of the reciprocal movement or, as illustrated in Figure 1, further include a transverse handle, in the manner of a pistol grip. Other forms of handles may be used depending on the type of application, without departing from the present invention. The mechanical drive member (3), which is preferably arranged in said handle, makes it possible to transmit to a coupling means (2) a reciprocal periodic movement back and forth along a longitudinal axis, Z, at a frequency , f, and amplitude, A, data. A massage head (4a) attached to a first end of a column (4b), the second opposite end of which is integrally (but detachably) coupled to the coupling means (2) connected to the drive member (3) , so that the column is substantially parallel to the longitudinal axis, Z, of oscillation of the coupling means

As illustrated in FIG. 4, the half-travel, H, of the reciprocal movement of the coupling means (2) and the massage head (4b) is defined as the distance along the axis, Z, between a extreme of the stroke of the head and the center between the two opposite extremes of the running back and forth of said head. The amplitude, A, of oscillation separating the two opposite extremes of the back-and-forth stroke of said head (4b) is therefore twice the half-stroke. Depending on the type of treatment and the type of massage head used, the frequency, f, and the vibration amplitude transmitted to the massage head (4b) by the drive member (3) may vary. According to the present invention, it has been found that the best results are obtained when the frequency is between 1 and 500 Hz. Preferably, the oscillation frequency of the massage head is between 5 and 200 Hz, more preferably between 10 and 100 Hz. An oscillation frequency between 15 and 50 Hz gives good results in a wide range of treatments. The half-stroke, H, of the oscillation movement is between 0.2 and 20 mm (amplitude, A = 0.4 - 40 mm). For half-strokes less than 0.2 mm the therapeutic and beneficial effects are less marked and for higher half-strokes, there is a risk of hurting the person treated. The half-stroke, H, of the oscillation can be between 0.3 and 13 mm (A = 0.6 - 26 mm), preferably between 0.5 and 10 mm (A = 1 - 20 mm), more preferably between 1 and 9 mm (A = 2 - 18 mm). With half a race between 3 and 6 mm (A = 6-12 mm) a sufficiently deep treatment is obtained for many types of treatment, without injuring or bruising the patient. The motor of an apparatus according to the present invention transmits to the coupling means (2) and to the massage head (4b) coupled to the latter by the column (4a) a displacement corresponding to a cycle of the periodic movement of va-and - Comes as shown in Figure 4 with a continuous thick line (100A). FIG. 4 illustrates two types of unidirectional movements periodic in time parallel to the Z direction: a sinusoidal curve (100B) (thin line) as described, for example, in WO201 1 128182 and a 'damped' curve (100A) according to FIG. present invention, (continuous thick line). It has been found by testing an apparatus according to the present invention that the asymmetrical trajectory of the massage head is perceived by the patients to be more pleasing and, apparently, more effective than sinusoidal movement of the head allows. . Indeed, if the massage is perceived by the body as being too aggressive, it causes the contraction of the muscles around the treated area, which is totally counterproductive for many types of treatments, especially therapeutic. It is therefore possible to treat an area of the body with an amplitude, A, penetration of the head deeper without the body feels "assaulted" with the same sinusoidally oscillating head.

The massage head (4b) can have different geometries depending on the type of treatment and the area of the body being treated. Figure 2 illustrates some non-exhaustive examples of geometries of massage heads (4b). In particular, for many applications, it is preferable that the portion of the head coming into contact with the patient's skin be rounded. For example, as illustrated in Figure 2 (b), (c) & (g) the massage head may be spherical or hemispherical. Such heads may be integral with the column (4a) to which they are attached or they may be fixed so as to be able to rotate in one or two axes parallel and / or normal to the column (4a) or, alternatively, rotate freely around their geometric center in all directions. In Figure 2 (a), (d), (e) & (f) cylindrical or semicylindrical heads are shown. The head shown in Figure 2 (e) is rotatable about an axis of rotation substantially normal to the column, such as a rolling pin. The ends of the cylinder of the head shown in Figure 2 (f) are substantially hemispherical in order to be able to pivot the Z axis of the apparatus without injuring the patient. The massage heads may be coupled to the column rigidly or alternately so as to allow one or more degrees of freedom in rotation of the head. For example, the head may be coupled to the column with a hinge, a ball bearing, or an elastomeric diabolo, allowing it to pivot at an angle in one or more directions, to follow the curves of the body area. treated.

A massage head (4b) adapted for the present invention may have other shapes than spherical or cylindrical, depending on the type of application. For example, the sidewalls of the head joining the attachment point to the column and the face opposite thereto may include a recess extending over all or a portion of the perimeter of said sidewalls, as shown in FIG. (boy Wut). This recess allows for example to treat the between fingers without irritating this sensitive part of the hand. The massage head (4b) may be metal, wood, polymer, elastomer or ceramic material, depending on the type of application and the desired effect. The surfaces of the head may be smooth or have a structure, such as recesses, as in a golf ball, or protrusions to create more intense areas of acupressure. Similarly, the column (4a) is preferably rigid, for example metal, wood, or rigid polymer. In a variant of the invention, the column may also be flexible, for example be made of an elastomeric material or comprising a damped telescopic system, in order to reduce the pressure applied by the massage head on particularly sensitive areas of the body. . A control member (5) is preferably arranged in the handle (1) to enable the starting and stopping of the drive member (3). In a more sophisticated version, the control member (5) also makes it possible to modulating the frequency and / or the amplitude of the oscillation of the massage head (4b). As shown in Figure 1, the control member (5) may be in the form of a squeeze trigger, or alternatively a button to be pressed, a lever to rotate, or a wheel to rotate. In another variant, the control member (5) can be separated from the body of the apparatus so that it can be controlled by the foot, using for example a pedal. This solution has the disadvantage of limiting the mobility of the operator around a patient, but has the advantage of freeing the hand from the load to control the functions of the device.

The drive member (3) can be of any type capable of transmitting a periodic linear movement back and forth of desired frequencies and amplitudes without preferably having noise-type disadvantages or excessive vibrations of the housing in the hand of the operator. In a first variant the drive member (3) can be an electric motor. For example, a rotary electric motor (M) can be coupled to the coupling means (2) via a cam (3A) and a transmission shaft (3B) for transmitting the rotary movement of the axis of the motor by means of coupling (2) in the form of a periodic linear movement back and forth. Bearings make it possible to ensure the linearity along the axis, Z, of the movement of the coupling means and therefore of the massage head.

A piezoelectric can also be used to transform electrical energy into a movement of the coupling means (2). The amplitude of the movement obtained by a piezoelectric is however limited to low values. In another variant, a linear electromagnetic motor may be used. This type of motor makes it possible to control very precisely the shape, the amplitude and the frequency of the periodic movement transmitted to the coupling means (2). This silent solution is therefore particularly preferred. Another particularly advantageous variant of a drive member is a pneumatic member. As shown in FIG. 3, a pneumatic drive member (3) may comprise a piston (22) housed in a cylinder and being integral with the coupling means (2), said cylinder being substantially parallel to the longitudinal axis, Z, and comprising a proximal portion close to the coupling means (2) and a distal portion remote from the coupling means. The cylinder is in fluid communication with:

(a) at least one rear injector (24b) of compressed gas and one front injector (26b) of compressed gas, said front and rear injectors being located in the distal and proximal portions of the cylinder, respectively, and being each relatable to a source compressed gas, preferably compressed air, and

(b) a rear exhaust system (24) for the gases and a front exhaust system (31) for the gases, said front and rear exhaust systems being located in the distal and proximal portions of the cylinder, respectively.

Thus, the member comprises a gas intake circuit, preferably compressed air, before (26) equipped with a front injector (26b) located in the proximal portion of the cylinder and a rear intake circuit ( 24) equipped with a rear injector (24b) located in the distal zone of the cylinder. Each of the front and rear circuits (24, 26) is furthermore equipped with a central injector (24a, 26a) located in the central zone of the cylinder. The injectors (24a, 24b, 26a, 26b) make it possible to inject gas at different points of the cylinder at precise moments according to the position of the piston (22). The gas is supplied via an inlet channel (27) in connection with the injectors. Exhaust gas is provided by an exhaust system having a front portion (25) and rear (31). In Figure 3 the exhaust circuits are brought back into the drawing plane while they can form an angle (eg 90 °) with the intake circuits. A selector (23) is housed in a recess in the outer wall of the piston (22). The displacement of the piston (22) inside the drive member is guided by means of the bearings. The exhaust circuits (25) and (31) are connected to a pipe (30) for the release of the exhaust gas. It has been found that the noise emitted by the apparatus can be considerably reduced by increasing the diameter of the tubing exhaust gas, so that it is greater than the diameter of the injectors (24, 26).

The sequence of the operations of the driver is illustrated in FIG. 3, beginning with FIG. 3 (a) in which the piston (22) is in a rearward position (the "back" or "distal" portion of the apparatus being shown on the left and the "front" or "proximal" part, comprising the coupling means (2) being represented on the right). As the piston movement shown in Figure 3 (a) in Figure 3 (c) propagates from left to right, one element is said to be downstream of another component if it is to its right. and, conversely, it is said to be upstream of it if it is to its left. In Figure 3 (a) compressed gas is supplied to the intake channel and enters through a central injector (24a) belonging to the rear intake circuit (24), said central injector (24a) being located substantially in the middle of the cylinder downstream of the selector (23). Since the central injector (24a) is downstream of the selector (23), the introduced gas will exert a pressure on the selector (23) thus causing a displacement, δ1, of the latter towards the rear of the organ ( see Figure 3 (b)). The displacement, δ1, towards the rear of the selector (2) further opens the intake towards the rear intake circuit (24) as illustrated in FIG. 3 (b), where the selector (23) is then in the rear position. The rear intake circuit (24) can now quickly be filled with compressed gas which thereby travels towards the rear of the intake circuit (24). The movement of the selector has also opened the rear injector (24b) thus also causing a supply of compressed gas to the rear of the piston (22). The force exerted by the gas on the rear of the piston will now cause its displacement towards the front of the drive member. The displacement of the piston in turn causes the gas present at the front of the piston to be pushed into the front exhaust system (31).

When moving the piston (22), it passes in front and closes the intake window to the front exhaust system (31) as shown in Figure 3 (c). The gas which then remains in the space between the bearing (29) and the piston (22) is compressed as the piston advances and thus dampens the piston stroke. A pneumatic damper is thus obtained which prevents the piston from striking the bearing (29). Advancing forwards the piston (22) also compresses the gas present in the front intake circuit (26) through the front injector (26b). The gas thus circulates in the front intake circuit (26) to reach the rear of the circuit. The judicious location of the exhaust nozzles has the effect of producing a limit damper, which limits the displacement of the piston and prevents it from striking the bearings. This function is also used as an overpressure and makes it possible to increase the compression of the gas in the intake circuit opposite to the exhaust circuit (31 to 24, 25 to 26). This reduces the filling time of the intake circuit for the next phase and thus provides a higher operating frequency and a saving in gas consumption.

Arrived at this equilibrium position, the assembly is then in a configuration that allows it to start in the opposite direction towards the rear of the cylinder (ie, to the left in Figure 3), with steps corresponding to those described for the forward movement:

(a) injection of compressed gas by a central (26a) and front (26b) injector both belonging to the front intake system,

(b) moving the selector (23) forward to further open the front intake circuit (26),

(c) gas accumulation upstream of the piston (22),

(d) moving the piston (22) towards the rear of the cylinder, with evacuation of the gas included in the cylinder downstream of the cylinder by the exhaust system (25) through the pipe (30),

(e) closing by the piston (22) the windows of the front intake circuit (26) and those of the rear exhaust circuit (25),

(f) compressing the gas still present in the cylinder downstream of the piston (22) and decelerating it until it stops, corresponding to the initial situation shown in FIG. 3 (a) and described above. The movement of the piston (22) by a distance A in a first direction, then in the opposite direction described above, transmits to the coupling means (2) and to the massage head (4b) coupled to the latter by the column ( 4a) a displacement corresponding to a cycle of periodic reciprocating movement as shown in Figure 4 with a continuous thick line (100A). The piston end limit damping system (22) by closing the exhaust circuits (25, 31) and compressing the gas trapped in the cylinder downstream of the piston has the effect of "flattening" a sinusoidal curve at its ends, giving it the desired asymmetrical shape according to the present invention, which is between a sinusoidal curve and a square curve, shown in Figure 4 (continuous thick curve (100A)). In addition to the therapeutic benefits discussed above associated with the asymmetrical shape of the oscillation curve of the massage head, this damping system also has the advantage of reducing the noise and wear of the apparatus.

In a preferred variant, the two proximal and distal ends of the cylinder of the drive member are equipped with resilient means (40) for damping the end of stroke of the piston. This makes it possible to damp the end of stroke of the piston in its reciprocating movement as well as to recover a part of the kinetic energy of the piston absorbed by the resilient means during the slowing down of the piston, and returned to the piston while he goes back the other way. The resilient means may be a coil spring, a leaf spring, or any other resilient means capable of damping the stroke of a piston and starting it in the other direction. Such resilient means can be used in any drive member in which a piston moves in both directions along the axis of revolution of a cylinder, including for example a linear electric motor, a pneumatic member with or without the gas accumulation means upstream of the piston described above. In the latter case, the use of resilient means makes it possible to further dampen the end of stroke of the piston, further flattening the shape of the curve of the movement of the latter at the end of the stroke (see FIG. to raise the piston in the other direction, thus increasing its speed at the beginning of the race and stiffening the curve of Figure 4 just after stopping the piston. The noise and vibrations of the handle felt by the operator are reduced accordingly.

A rotary electric motor may also be used to transmit periodic oscillation movement to the massage head by means of a cam or shafts (3A, 3B) as shown in Figure 5. If the engine is running at a constant speed, the shape of the curve will be sinusoidal. In order to obtain an asymmetrical shape curve according to the present invention, it suffices to vary the speed of rotation of the motor at the time intervals corresponding to a position of the massage head approaching its end position in + H or - H along the Z axis (see curve in Figure 4).

An apparatus according to the present invention is particularly suitable for the therapeutic treatment of the body. In particular it allows the extracorporeal treatment of pathologies such as myo-arthropathy, tendinopathy, and muscle, joint and dermatological problems in general. The shape and especially the amplitude of the movement of back and forth of the massage head allows a much more in-depth treatment of the treated area than do acoustic devices of the AWT type. Indeed, these derive ESWL devices whose objective is to destroy pebbles by focusing the wave on them in the context of the treatment of kidney stones or gallstones. However, the treatment of the pathologies mentioned above do not normally require the concentration of the waves emitted on a very precise focal point, and especially not the destruction of a body located at this focal point but, on the contrary, an intense treatment but acting on a wider area and without destroying.

Without wishing to be bound by any theory, we believe that the therapeutic virtues of a treatment according to the present invention are at least in part due to a stimulation of the vascular system with formation of new vessels in the treated area, which allow better feeding. treated cells thus promoting self-healing of the area affected by the body. An apparatus according to the present invention is also suitable for the cosmetic treatment of cutaneous looseness, steatomeries, adiposities and skin fibrosis and other dermatological treatments. It is deduced that the vibrations transmitted by the massage head thus make it possible to stimulate the molecular displacements in the extracellular fluid, to increase the microcirculation, as much in the blood vessels as in the lymphatic vessels, to cause physiological modifications resulting for example the release of various mediators. These effects make it possible to reinvigorate and improve the aesthetic appearance of the epidermis.

An apparatus according to the present invention makes it possible to diagnose a number of osteomuscular pathologies. For example, a 62-year-old patient with pain descending from the lumbar region to the posterior aspect of a thigh, with severe difficulty walking, was operated on for a right L4-L5 disc herniation diagnosed by her X-ray doctor showing that said vertebrae rested directly on each other and that the disc no longer existed there. This diagnosis was provisionally accepted by the neurosurgeon who was going to operate until confirmed by a rapid NMR examination. By gently scanning the apparatus of the present invention in the lumbar region, the patient lying on her stomach felt no particular pain. By extending the scan on the affected thigh, a first painful muscle point was identified in the posterior lower third of the thigh, and a second mid-upper point of the external face of this same thigh. After 10 minutes of treatment with the apparatus of the present invention, the two sore spots disappeared and the patient had regained mobility of her leg and lumbar region. There was no herniated disc, but two micro-tears muscle at the thigh of the patient. In discussion with the patient, it appeared that she had almost fallen about fifteen days ago, corresponding to the moment when the pains appeared, without making the connection between the two events. Following the treatment described above, the NMR examination and especially the operation were canceled to the great relief of the patient.

Claims

1. Apparatus for use in extracorporeal shock wave treatment of the human or animal body, said apparatus comprising:

(a) A handle (1) allowing the device to be manipulated,

(b) A drive member (3) preferably arranged in said handle and making it possible to transmit to a coupling means (2) a periodic reciprocal movement back and forth along a longitudinal axis, Z, at a frequency, f , between 1 and 500 Hz and an amplitude, A, between 0.4 and 40 mm,

(c) A massage head (4a) fixed to a first end of a column (4b), the second opposite end of which is adapted to be integrally coupled to the coupling means (2) connected to the drive member ( 3), so that the column is substantially parallel to the longitudinal axis of oscillation of the coupling means;

Characterized in that the temporal oscillation curve of the massage head (4b) is of asymmetrical shape and characterized by a movement time to cover the distance, H, between an extreme end position and its central position of half-travel shorter than the travel time to travel the same distance, H, between its central half-travel position and an extreme end-of-travel position.

Apparatus according to claim 1, in which the drive member (3) is a pneumatic member comprising a piston (22) housed in a cylinder and being integral with the coupling means (2), said cylinder being substantially parallel to the longitudinal axis, Z, of oscillation and comprising a proximal part close to the coupling means

(2) and a distal part remote from the coupling means, and the cylinder being in fluid communication with:

(a) at least one rear injector (24b) of compressed gas and one front injector (26b) of compressed gas, said front and rear injectors being located in the distal and proximal parts of the cylinder, respectively, and each being connectable to a source of compressed gas, preferably compressed air, and

(b) a rear gas exhaust system (24) and a front gas exhaust system (31), said front and rear exhaust systems being located in the distal and proximal parts of the cylinder, respectively.

3. Apparatus according to claim 2, comprising means for closing the communication with the exhaust means (24, 26) located downstream of the stroke of the piston (22) before the piston reaches the end of its stroke in a first direction, in order to create a compressed air damping cushion downstream of the piston, thus gradually slowing down its stroke in said first direction until it stops.

Apparatus according to the preceding claim, where said closing means consist of at least one window in the wall of the cylinder located downstream of the piston at the start of its stroke in a first direction, and which is closed by a portion of the piston before that -it does not reach the end of its travel in said first direction.

Apparatus according to claim 2 or 3, wherein the proximal and distal ends of the cylinder are equipped with resilient means for cushioning the end of stroke of the piston.

Apparatus according to claim 1, in which the drive member (3) is an electrical member, preferably of one of the following types:

(a) Linear electromagnetic motor;

(b) Motor driven by a piezoelectric;

(c) Electric rotation motor coupled to a cam (3A).

7. Apparatus according to any one of the preceding claims, where the frequency, f, of vibration transmitted to the massage head (4b) by the drive member (3) is between 5 and 200 Hz, preferably between 10 and 100 Hz, more preferably between 15 and 50 Hz and its amplitude, A, is between 1.0 and 20.0 mm, preferably between 2.0 and 18.0 mm, more preferably between 6.0 and 12.0 mm.

8. Apparatus according to any one of the preceding claims, in which the massage head (4b) has a face opposite its point of attachment to the column (4a) of rounded shape, and preferably forms a sphere, a spherical cap , a cylinder or half-cylinder, and in which the side walls joining said face opposite said attachment point preferably comprise a recess extending over all or part of the perimeter of said side walls.

9. Apparatus according to any one of the preceding claims, in which the handle (1) comprises a first portion substantially parallel to the longitudinal axis of oscillation in which the mechanical drive member (3) is housed and comprises preferably a second portion (1a) transverse to said axis and being adapted to be held in the hand.

10. Apparatus according to any one of the preceding claims, in which a control member (5) is arranged in the handle (1) making it possible to control the starting and stopping of the drive member (3) and preferably also allowing modulation of the frequency and/or amplitude of the oscillation of the massage head (4b).

1 1 . Apparatus according to any preceding claim for use in extracorporeal therapeutic treatment of the body.

12. Apparatus according to the preceding claim, for use in the extracorporeal treatment of myoarthropathy, tendinopathy, and muscular, dermatological and joint problems in general.

13. Use of a device according to any one of claims 1 to 1 1 for the extracorporeal cosmetic treatment of skin sagging, steatomeria, adiposity and dermal fibrosis.