Shock-wave therapy is effective for chronic calcifying tendinitis of the shoulder

Abstract

We report a prospective study of the effects of extracorporeal shock-wave therapy in 195 patients with chronic calcifying tendinitis. In part A 80 patients with chronic symptoms were randomly assigned to a control and three subgroups which had different treatment by low-energy and high-energy shock waves. In part B 115 patients had either one or two high-energy sessions. We recorded subjective, functional and radiological findings at six months after treatment.The results showed energy-dependent success, with relief of pain ranging from 5% in our control group up to 58% after two high-energy sessions. The Constant scores and the radiological disintegration of calcification were also dose-dependent.Shockwave therapy should be considered for chronic pain due to calcific tendinitis which is resistant to conservative treatment.

High-energy Versus Low-energy Extracorporeal Shock Wave Therapy for Calcifying Tendinitis of the Shoulder: Which is Superior? A Meta-analysis

“…5). Pooled analysis [1,17,21] of the 163 patients showed those in the high-energy group had a greater chance of complete resorption compared with patients in the low-energy group (odds ratio, 3.40; 95% CI, 1.35-8.58; p = 0.009) (Fig. 6).…”

“…The high-quality studies were those of Albert et al [1], Gerdesmeyer et al [9], and Pleiner et al [21]. The lowquality studies were those of Loew et al [17] and Rompe et al [22].…”

“…Radiologic resorption of the calcium deposits was subdivided by four studies [1,17,21,22] into complete disappearance, partial disappearance, and no change in the calcific deposits. Gerdesmeyer et al [9] described the change in calcification in actual mm 2 decrease, thus we did not include this article in the quantitative analysis.…”

“…The results of each study showed that high-energy ESWT results in a greater chance of resorption after 3 months. The difference in the rate of complete resorption across the different studies in patients treated with high-energy ESWT versus low-energy ESWT ranged from 10% [1,21] to 35% [17] (Table 6).…”

“…However, when this fails, extracorporeal shock wave therapy (ESWT) can be a good and less-invasive treatment option before surgery [10,12]. The exact mechanisms of action of the ESWT are largely unknown; Loew et al [17] postulated that the shock waves lead to a three-way mechanism of action: (1) mechanical effect resulting in deposit fragmentation; (2) molecular effect resulting in deposit phagocytosis; and (3) analgesic effect resulting in denervation of pain receptors. Shock wave therapy can be divided into three categories based on its energy levels: low-energy (\ 0.08 mJ/mm 2 ), middle-energy (0.08-0.28 mJ/mm 2 ), and high-energy ([ 0.28 mJ/mm 2 ) [1,15,20].…”