Focused extracorporeal shock wave therapy combined with supervised eccentric training for supraspinatus calcific tendinopathy.
BACKGROUND
Extracorporeal shockwave therapy (ESWT) is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Eccentric exercise has been introduced as an effective treatment choice for Achilles tendinopathy, but poor evidence exists about its role in the treatment of rotator cuff tendinopathy.


OBJECTIVE
To investigate if adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome of ESWT.


METHODS
Pre-post intervention pilot study with matched control-group.


METHODS
Outpatient, University Hospital.


METHODS
Twenty-two subjects affected by painful supraspinatus calcific tendinopathy.


METHODS
The study-group was assigned to receive focal ESWT (f-ESWT) plus a supervised eccentric training (SET) of the shoulder abductor muscles. The matched control-group received f-ESWT only. The post-treatment assessment at follow-up (T1) was performed nine weeks after the enrollment (T0). We assessed shoulder pain and function by the means of a numeric rating scale (p-NRS) and a DASH scale. As secondary outcome, we measured the isometric strength of the abductor muscles of the affected shoulder using a handheld dynamometer.


RESULTS
At T1, we recorded a significant decrease in pain (P<0.001) and an improvement in upper limb function (P<0.001) in both groups. However, we observed no statistical differences in favor of the study-group, in terms of p-NRS and DASH total score. A mild increase (+13% from baseline) of the maximum isometric abduction strength was noticed in the study group at T1.


CONCLUSIONS
Our findings did not support the hypothesis that adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome (pain and function) of shock wave therapy.


CONCLUSIONS
Our study confirmed that f-ESWT is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Adding a supervised eccentric training, focused on the abductor muscles, was useful to improve maximum isometric abduction strength, but appeared to give no advantage in the short-term outcome of shock wave therapy.
Unit of Rehabilitation, San Matteo Hospital Foundation, Institute for Research and Health Care, University of Pavia, Pavia, Italy - e.carlisi@smatteo.pv.it.
Ettore
E
Carlisi
Unit of Rehabilitation, San Matteo Hospital Foundation, Institute for Research and Health Care, University of Pavia, Pavia, Italy.
Claudio
C
Lisi
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Anna
A
Dall'angelo
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Serena
S
Monteleone
Unit of Rehabilitation, San Matteo Hospital Foundation, Institute for Research and Health Care, University of Pavia, Pavia, Italy.
Vincenza
V
Nola
Department of Clinical Biometrics and Epidemiology, San Matteo Hospital Foundation, Institute for Research and Health Care, Pavia, Italy.
Carmine
C
Tinelli
Unit of Rehabilitation, San Matteo Hospital Foundation, Institute for Research and Health Care, University of Pavia, Pavia, Italy.
Elena
E
Dalla Toffola
D000328:Adult; D002114:Calcinosis / Q000150:complications / Q000628:therapy*; D005081:Exercise Therapy; D000074059:Extracorporeal Shockwave Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016059:Range of Motion, Articular; D020069:Shoulder Pain / Q000209:etiology / Q000628:therapy*; D052256:Tendinopathy / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome