Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial.
BACKGROUND
Calcific tendonitis of the shoulder is often associated with chronic pain and impairment of function. Extracorporeal shockwave therapy (ESWT) is considered to be a treatment option. We compared the effects of two different ESWT regimens.


METHODS
43 patients (57 shoulders) with symptomatic calcific tendonitis of the shoulder for more than six months were included in a double-blinded study. Thirty-one shoulders were treated at the area of maximum pain with application of 2 x 2000 impulses of 0.28 mJ/mm2 at an interval of two weeks (treatment group) and 26 shoulders with 2 x 2000 impulses of < 0.07 mJ/mm2 at an interval of two weeks (control group), without pretreatment analgesia. Shoulder function (Constant score) and pain (visual analogue scale, VAS) were assessed before treatment and at one week, three months and seven months after treatment. Shoulder X-rays were performed at the 3- and 7-month follow-up visits.


RESULTS
Improvement in Constant score was significantly higher in the treatment group at all follow-up visits (p < 0.05). Seven months post-treatment, calcifications dissolved completely in 19% of the treatment group and 8% of the control group, and a > 50% reduction was observed in 19% and 8% respectively. With regard to reduction of pain, there was significant improvement in the treatment group compared with the control group at the 1-week follow-up (p < 0.05). However, at the 3-month and 7-month visits, no significant between-group difference in pain could be detected.


CONCLUSIONS
As applied, ESWT with an energy flux density of 0.28 mJ/mm2 led to a significantly greater improvement in shoulder function and a slightly higher, nonsignificant, rate of > 50% disintegration of calcific deposits compared with the control group. However, this did not result in reduction of pain.
Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria. johannes.pleiner@meduniwien.ac.at
Johannes
J
Pleiner
Richard
R
Crevenna
Herbert
H
Langenberger
Mohammad
M
Keilani
Martin
M
Nuhr
Franz
F
Kainberger
Michael
M
Wolzt
Günther
G
Wiesinger
Michael
M
Quittan
D000203:Activities of Daily Living; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D020069:Shoulder Pain / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016037:Single-Blind Method; D052256:Tendinopathy / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*