Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder.
BACKGROUND
There are several treatment modalities for calcifying tendinitis of the shoulder. If the pain becomes chronic after several months of conservative treatment, open or arthroscopic removal is usually recommended. Recently, extracorporeal shock wave therapy has shown encouraging results in treating calcific deposits.


METHODS
We report a retrospective study to compare the outcome after arthroscopic extirpation (group I, 22 cases) with the effect of low extracorporeal shock wave therapy (group II, 24 cases) in patients with a chronic homogeneous calcific deposit in the supraspinatus tendon. Patients included in the study had undergone unsuccessful conservative therapy in the previous six months with no evidence of subacromial impingement of the rotator cuff independent of the calcium deposit or rupture of the rotator cuff detected by sonography or magnetic resonance imaging. AP and LL radiographies were performed for all of the patients at least one week before the treatment and 24 months after the treatment. To keep the possibility of spontaneous resorption low, the deposit had to be sharply outlined and densely structured on the radiograph (types I and II in the Gärtner classification). In group II, the patients underwent an average of three treatment sessions of extracorporeal shock waves therapy with 1,500 impulses/session of 0.10-0.13 mJ/mm(2).


RESULTS
Preoperative symptoms (P = 0.09), sex (P = 0.17), operated (P = 0.11) and dominant (P = 0.33) limbs, and age (P = 0.99) of the two groups did not show a significative difference between groups. According to the University of California Los Angeles (UCLA) rating system, the mean score in group I improved from 9.36 (+/-5.2) to 30.3 (+/-7.62) points after 24 months, with 81.81% reporting good or excellent results (P < 0.001). In group II the mean score after 24 months rose from 12.38 (+/-6.5) to 28.13 (+/-9.34) points, with 70.83% reporting good or excellent results (P < 0.001). Radiologically, after two years of follow up, there was no calcific deposit in 86.35% (P < 0.001) of the patients of group I and in 58.33 % (P < 0.001) of the patients of group II. According to the UCLA scores, there was no significant difference between the groups at two years of follow-up (P = 0.38).


CONCLUSIONS
We conclude that shock wave therapy is equivalent to arthroscopy, and so shock wave therapy should be preferred because of its noninvasiveness.
Rebuzzi
Enrico
E
Operative Unit of Orthopaedics, Oderzo Hospital, Treviso, Italy. enricorebuzzi@alice.it
Coletti
Nicolò
N
Schiavetti
Stefano
S
Giusto
Fernando
F