BTL 5000 Shockwave Series User manual

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BTL-5000
Shockwave Series
USER‘S MANUAL
101IE30/07/2008EN

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BEFORE YOU START
Thank you for showing your interest and buying our device
the BTL- 5000 SWT Series. We hope you will be satisfied
and thanks to you, this device will help many patients.
All of us at BTL wish you every success with your BTL- 5000
SWT Series. We pride ourselves on being as responsive as
possible to our customers’ needs. Your suggestions and
comments are always welcome since we believe an ongoing
relationship with our customers is critically important to our
future product line. Please call or email us your suggestions.
While we would like you to start using your equipment right
away, we encourage you to thoroughly read this manual in
order to fully understand the operational features of the
BTL-5000 SWT system.
Again, thank you for being a BTL customer. In the event of
any problem, or if you require service, please make an
initial call to your local distributor, who will decide whether
to refer the problem to our office.

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CONTENTS
1GENERAL CHARACTERISTICS OF THE DEVICE....................................................................................... 5
1.1 BTL – 5000 SWT System Series .................................................................................................................. 6
1.2 Shockwave and Its Character....................................................................................................................... 6
1.3 Shockwave Generation................................................................................................................................. 7
1.3.1 Ballistic Principle of the Shockwave Generation ......................................................................................7
1.4 Biological Effects of the Shockwave ............................................................................................................. 7
1.5 Advantages of the Shockwave Treatment .................................................................................................... 8
1.6 Possible Side Effects After the Shockwave Treatment................................................................................. 8
1.7 Indications for the Shockwave Treatment..................................................................................................... 8
1.8 Contraindications to the Shockwave Treatment ........................................................................................... 9
2INSTRUCTIONS FOR USE .......................................................................................................................... 10
2.1 Front Panel of the BTL- 5000 SWT............................................................................................................. 10
2.2 Rear Panel of the BTL- 5000 SWT ............................................................................................................. 11
2.3 Assembly and Putting into Operation.......................................................................................................... 12
2.4 OPERATING THE DEVICE ........................................................................................................................ 14
2.4.1 Touch Screen.........................................................................................................................................14
2.4.2 Numeric Keypad.....................................................................................................................................15
2.5 Therapy (Setting Principle) ......................................................................................................................... 16
2.5.1 Diagram of the Therapy Setting Process................................................................................................16
2.5.2 Welcome Screen and Selection of Channels, Tabs and Accessories ....................................................17
2.5.3 Setting Therapy Parameters Via the ‘diag’ Button..................................................................................18
2.5.4 Setting Therapy Parameters Via the 'prog' Button .................................................................................18
2.5.5 Setting Therapy Parameters Manually (User Setup) Via the ‘man' Button .............................................19
2.5.6 Therapy Parameters Screen – Ergonomic, Standard and Expert Mode.................................................20
2.5.7 Setting Number of Shocks......................................................................................................................20
2.5.8 Setting Therapy Intensity........................................................................................................................20
2.6 Course of Therapy...................................................................................................................................... 20
2.6.1 Start - Interruption - End of Therapy.......................................................................................................20
2.6.2 Running Therapy Screen .......................................................................................................................22
2.7 Therapy Parameters................................................................................................................................... 22
2.8 Encyclopaedia ............................................................................................................................................ 22
2.9 Therapy Saving .......................................................................................................................................... 23
2.9.1 Save Therapy and Add It to the Client Data ...........................................................................................24
2.9.2 End of Therapy / Shock Generation .......................................................................................................25
3DEVICE MENU............................................................................................................................................. 26
3.1 Accessories ................................................................................................................................................ 26
3.1.1 Installation of Accessories......................................................................................................................26
3.1.2 Information about Accessories ...............................................................................................................26

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3.1.3 Information about Connectors ................................................................................................................26
3.2 Unit Settings ............................................................................................................................................... 27
3.2.1 Password Setting ...................................................................................................................................27
3.2.2 Sound Setting.........................................................................................................................................27
3.2.3 Screen Saver and Auto Switch-Off.........................................................................................................28
3.2.4 Colour Setting ........................................................................................................................................28
3.2.5 Setting of Display Contrast.....................................................................................................................28
3.2.6 Date and Time Setting............................................................................................................................28
3.2.7 Language Setting ...................................................................................................................................28
3.2.8 Operation Mode......................................................................................................................................28
3.2.9 Touch Panel Calibration .........................................................................................................................28
3.2.10 User Options ..........................................................................................................................................28
3.2.11 Style of Operation...................................................................................................................................29
3.2.12 Setting of HW Key..................................................................................................................................29
3.2.13 Unit Information......................................................................................................................................29
3.2.14 Unlock Code...........................................................................................................................................29
3.2.15 Service Functions...................................................................................................................................29
3.3 Specific Settings ......................................................................................................................................... 30
3.3.1 Shockwave Setting.................................................................................................................................30
3.3.2 Applicator Kit Replacement Wizard........................................................................................................31
4USER OPTIONS........................................................................................................................................... 32
4.1 Clients......................................................................................................................................................... 32
4.2 User Sequences ......................................................................................................................................... 32
4.3 User Diagnoses/Programs.......................................................................................................................... 33
4.4 List of Recent Therapies............................................................................................................................. 33
5APPLICATION OF SHOCKWAVES............................................................................................................. 34
6ACCESSORIES............................................................................................................................................ 36
7MAINTENANCE AND SAFETY INSTRUCTIONS........................................................................................ 37
7.1.1 Shock Transmitter Replacement Procedure...........................................................................................38
7.1.2 Procedure of Worn-out Tube and Projectile Replacement .....................................................................39
7.2 Safety of the Device.................................................................................................................................... 42
7.3 Warranty Conditions ................................................................................................................................... 43
8TECHNICAL PARAMETERS ....................................................................................................................... 44
8.1 Applicable Standards.................................................................................................................................. 45
8.2 Manufacturer .............................................................................................................................................. 46
9DEVICE CONFIGURATION ......................................................................................................................... 47

GENERAL CHARACTERISTICS OF THE DEVICE | PAGE 5 OF 47
1GENERAL CHARACTERISTICS OF THE DEVICE
The BTL -5000 SWT Series is a modern device enabling the application of therapies by using no invasive
shockwaves. Shockwaves are one of the most effective ways of treatment of pain connected to the
musculoskeletal system. Today, this is the second most frequent reason of absence from work.
The devices are equipped with a colour touch screen on the main unit, and considerably simplifies the use of the
device. The touch screen is equipped with a touch pen for easy operation of the device. A vertically positioned
device enables you to see the information on the screen clearly from different servicing positions. In addition, the
brightness of the display can be adjusted to suit the light conditions in the office or the health centre. The
information displayed on the screen will guide you throughout the whole therapy, simply adjust the parameters by
pressing the touch screen buttons and turning the knobs on the device.
Selecting a diagnosis from a list of alphabetically organized treatment protocols, or selecting a program, will make
an easy and efficient start to the therapy. You can adjust any treatment parameter manually by the simple use of
the touch screen buttons. Throughout the whole therapy, the device informs you about the therapeutical method
used, type of treatment, number of applied shocks, total and remaining shocks, frequency used, intensity and
other necessary data.
Save your time by using the predefined programs of the main unit. Based on detailed research and practical use
of the device, the well-organized predefined protocols will present recommendations for treatment of various
conditions.
The BTL- 5000 SWT allows you to insert the names of your clients and other relevant information into the internal
memory of the device and connect the client data with predefined or your own protocols. When your clients call
again, simply recall their name and apply the pre-set therapy.
With every BTL-5000 SWT you can purchase a trolley specially designed for the BTL products. Its design offers
maximum comfort of storage and use of the device. Four steady wheels provide simple movement of the device in
the office or the health care centre.
The trolley includes a range of accessory containers and baskets.
Please visit our corporate website at http://www.btlnet.com for the latest information on BTL products and
services.

GENERAL CHARACTERISTICS OF THE DEVICE | PAGE 6 OF 47
1.1 BTL – 5000 SWT SYSTEM SERIES
The device consists of three units: the main unit, the compressor unit and the applicator.
Main system – BTL- 5000 unit, which includes the main microcomputer and software for control of the whole
equipment, including user encyclopaedia and the therapy guide.
Compressor – apart from the compressor there is also the complete electronics attached for the regulation of
the ballistic pressure.
Applicator – ergonomical applicator simplifies the „course of" the therapy, following the instructions of the
main unit.
The system enables the connection of two applicators. Each applicator can contain a different transmission
element, differing in its size and characteristic. Thereby the system features an advantage of service abilities for
two different therapies, with no need to change the transmission elements. However, only one applicator can be
active at a time. It is not possible to use two applicators together, at the same time.
1.2 SHOCKWAVE AND ITS CHARACTER
The shockwave is defined as a wave with a rapid increase of pressure in a very short time and gradual decline
with a phase of small negative pressure.
Shockwaves are aimed at the affected areas that are the cause of chronic pain. The influence of shockwaves
leads to for example dissolution of calcic deposits and better vascularisation, and in its final effect it causes relief
of pain.
Outside the client's body (extracorporeally), a pressure pulse with a high amplitude is generated, and its energy is
concentrated into the target area in the body. The pressure pulse without major losses travels through a water
medium to the client and penetrates soft tissue.
The pressure course of the shockwave in time expressively differs from the pressure course of the harmonic
sound wave. The shockwave is compared to the ultrasonic waves particularly characterized by a pressure jump
change, higher amplitude and non-periodicity.
In the shockwave, the positive amplitude is generally much bigger than the negative amplitude. The frequency
rate of the shockwaves is usually low (Hz units) and eventual cavitation (disturbance of material
consistency – rise of cavities) will relax. Consequently there is no threat of energy exhaustion on cavitations as in
the case of continuous ultrasound.
A substantial part of the shockwave energy penetrates into liquid (of the organism) with a great positive pressure
pulse. Its diffusion is only limited by the actual tissue absorption and eventual reflections on acoustic
inhomogeneities.
The shockwave is defined as a pressure pulse with these characteristics:
• High positive pressure amplitude – 10 to 1000 MPa = 100 to 1000 Bar (100x atmospheric pressure)
• Low negative pressure amplitude – 1 to 10 MPa
• Short time duration – 1 µs to 20 µs
• Rapid pressure increase – < 100 ns
• Broad frequency spectrum – 1 Hz to 1 MHz

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For therapeutical application, these values are lower, especially the maximum pressure amplitude, which is about
15 MPa, pulse length is 10 to 20 µs, and frequency of the applied shockwave is 1 to 25Hz. The treatment is
generally carried out without local anaesthetic and lasts about 15 to 30 minutes. During the first week after the
treatment, the client should avoid all activities that could excessively strain the treated area.
1.3 SHOCKWAVE GENERATION
Several types of generators were developed for the shockwave therapy, providing shockwaves with varied
characteristics. Shockwaves in their time span and spatial arrangement carry the imprint of the generation
method.
The BTL 5000 SWT uses the ballistic principle of the shockwave generation.
1.3.1 BALLISTIC PRINCIPLE OF THE SHOCKWAVE GENERATION
A pressure wave is formed via a projectile by accelerated compressed air, which is generated by an electronically
controlled ballistic-pressure compressor. Using elastic impact, the kinetic energy of the projectile is transferred
into a probe of the applicator and into the client's body via this probe. Consequently, during the treatment, the end
of the applicator must be in immediate contact with the skin and subcutaneous tissue.
1.4 BIOLOGICAL EFFECTS OF THE SHOCKWAVE
The shockwave effects mainly occur at sites, where there is a change in impedance, such as the bone-soft tissue
interface.
There is an improvement of regeneration and repair of tissues in the following areas and achievement of the
following effects:
•cellular effect – increase in transmittance of a cell membrane (improvement of ionic channels activity),
stimulation of cell division, stimulation of cellular cytokines production,
•reproduction of vessels in the area of tendons and muscles, improvement of blood circulation and MTB-
increase in concentration of growth factor beta 1 – chemotactic and mitogenic effect on osteoblasts,
•effect on nitrogen oxide system (bone healing and re-modelling),
•improvement of micro - circulation and metabolism,
•dissolution of calcic fibroblasts,
•support of collagen production,
•reduction of tissue tension,
•analgetic effect:
−destruction of afferent nerves and nerve receptors,
−CNS stimulants, sensed as pain; are also inflammation transmitter substances,
−regression of pain caused by local ischemia,
−gate control theory of pain.

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1.5 ADVANTAGES OF THE SHOCKWAVE TREATMENT
•by targeted operation of the shockwave, strain of surrounding tissues is quite insignificant
•the body is not strained by pharmaceuticals (except a short term effect of local anaesthesia)
•possibility to prevent from necessity of surgical intervention and relevant hazard
•thanks to ambulatory treatment the absence from work reduces to a minimum, as well as the absence from
training routine of sportsmen
•for some indications (e.g. tennis elbow) there is basically no other effective treatment
1.6 POSSIBLE SIDE EFFECTS AFTER THE SHOCKWAVE TREATMENT
•erythema or swelling can temporarily occur in the treated area
•loss of bodily sensation or itching can temporarily occur in the treated area
•momentary increase of pain can appear immediately after the treatment
•haematoma
•petechia
•skin damage after previous corticoid therapy
•shockwave application can cause undesirable heart activity
1.7 INDICATIONS FOR THE SHOCKWAVE TREATMENT
•plantar fasciitis
•achillodynia – achillobursitis
•inflammations and calcification of shoulder joint tendons
•pain in the groin area
•epicondylitis (tennis and golf elbow)
•the apex patellae syndrome and tibial stress syndrome
•pain in the area of the hip and the iliotibial tract
•jumper's knee / patellar tendinitis
•pain in the hamstring insertions
•pain on the palmar side of the wrist
•exostoses of small hand joints in case of grade 1 arthrosis
•acupuncture
•pain trigger points - painful points in muscles

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1.8 CONTRAINDICATIONS TO THE SHOCKWAVE TREATMENT
•application to certain tissues (eyes and their surroundings, myocardium, spinal cord, gonad, kidneys, liver)
•coagulation of blood disorders
•polypus in the area of treatment
•pregnancy
•coagulation of blood disorders and the use of anticoagulants
•thrombosis
•tumour disease
•polyneuropathy
•acute inflammation
•growing cartilage in children
•therapy using corticoids
•inapplicable in areas and organs with possible gas content
•inapplicable on areas in proximity to large nerves, vessels, spinal cord and head

BTL-5000 SWT USER’S MANUAL | PAGE 10 OF 47
2INSTRUCTIONS FOR USE
2.1 FRONT PANEL OF THE BTL- 5000 SWT
1. diag button to select diagnosis
2. prog button to select therapy program
3. man button to set therapy parameters manually
4. menu button (to set date, time, language, display contrast, sounds, user options, etc.)
5. user button (lists of clients, user diagnoses, programs and sequences, recent therapies, etc.)
6. touch screen
7. ON/OFF power switch (“ON” status indicated by the blue backlight)
8. enter key (to confirm selection or setting)
9. select knob (to select and set individual parameters)
10. esc key (to cancel selection or setting and return to the previous status)
11. time / stop knob (to set therapy time, and to start and stop therapy)
12. intensity knob (to set intensity)
13. hand rest of the applicator
14. shock transmitter of the applicator
15. shock transmitter screw cap of the applicator
16. connector of the applicator
17. guide mark of the connector
18. applicator button for therapy start
19. power activation indicator of the compressor
20. indicator signalling - ready to generate shockwaves ready
21. active tab indicator for the applicator output out A
22. active tab indicator for the applicator output out B
23. handles for easy transport of the compressor unit