Extracorporeal Shock-Wave Therapy for Supraspinatus Calcifying Tendinitis: A Randomized Clinical Trial Comparing Two Different Energy Levels

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treatment of people with supraspinatus calcifying tendinitis (SCT), but there is limited evidence for the useful range of ESWT doses.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>The aim of this study was to compare 2 different ranges of energy flux density in treatment of SCT with ESWT.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This study was designed as a single-blind randomized clinical trial.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>This study was performed in a university hospital.</jats:p></jats:sec><jats:sec><jats:title>Patients</jats:title><jats:p>Forty-six patients with SCT were randomly assigned to 2 groups that received different therapeutic energy doses of ESWT: (1) group A received ESWT at an energy level of 0.20 mJ/mm2, and (2) group B received ESWT at an energy level of 0.10 mJ/mm2.</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p>The treatment protocol consisted of 4 sessions performed once a week.</jats:p></jats:sec><jats:sec><jats:title>Measurements</jats:title><jats:p>The change in mean Constant Murley Scale (CMS) scores at 3 and 6 months was the primary endpoint. The change in the mean visual analog scale (VAS) scores from baseline to 3 and 6 months after the intervention and radiographic change in size of calcium deposits were evaluated as secondary endpoints. At 12 months, pain relief was assessed using a numeric rating scale.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Significant clinical improvement based on mean CMS scores was observed after 6 months in group A (X̅=79.43, SD=10.33) compared with group B (X̅=57.91, SD=6.53). Likewise, after 6 months, a significant decrease in VAS scores was found in group A (X̅=2.09, SD=1.54) compared with group B (X̅=5.36, SD=0.78). Calcific deposits disappeared in the same percentage of patients in both groups.</jats:p></jats:sec><jats:sec><jats:title>Limitations</jats:title><jats:p>The small sample size and lack of a control group were limitations of the study.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In ESWT for SCT, an energy level of 0.20 mJ/mm2 appears to be more effective than an energy level of 0.10 mJ/mm2 in pain relief and functional improvement.</jats:p></jats:sec>

Rotator Cuff Calcifying Tendinitis

“…An open or an arthroscopic approach may be used. An energy level of 0.20 mJ/mm [ 2 ] appears to be more effective than an energy level of 0.10 mJ/mm [ 2 ] in pain relief and functional improvement [ 9 ] I A single high-level ESWT may be as effective as two applications of a lower-dosed ESWT [ 10 ] II Calcifying tendonitis of the shoulder -evidence according to treatment Treatment Evidence Level of evidence Acetic acid iontophoresis and physiotherapy Treatment with both modalities did not result in better clinical or radiologic effects than those observed in subjects treated with physiotherapy alone [ 11 ] I Acromion morphology…”

The Effectiveness of High-Energy Extracorporeal Shockwave Therapy Versus Ultrasound-Guided Needling Versus Arthroscopic Surgery in the Management of Chronic Calcific Rotator Cuff Tendinopathy: A Systematic Review

“…Nine studies (8 RCTs), including a total of 346 patients, used high-energy ESWT as the treatment modality. 23,24,[29][30][31][32][33][34]36 Although these trials all used highenergy ESWT, the reported EFD (0.2 to 0.55 mJ/mm 2 ), number of pulses applied (1,000 to 2,400), and number of sessions (1 to 4) varied. The shockwave energy was focused on the calcific deposit in 6 trials and on the maximum point of tenderness in 2 trials.…”

“…The ConstantMurley Scale (CMS) 42 was the most commonly reported shoulder function outcome measure. In addition to the CMS, 5 studies used the American Shoulder and Elbow Surgeons (ASES) 43 29 and Ioppolo et al 31 described the change in size in square millimeters.…”

Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: A Narrative Review

“…Both groups were found to have improved outcomes at each time point; however, the VAS scores were statistically reduced and the CMS were higher at 6 months in the higher energy group (0.20 mJ/mm 2 ). The authors also noted that clinical improvement did not correlate with a reduction in size of calcifications [73].…”

“…Ioppolo et al [73] studied patients with calcific tendinitis of the supraspinatus tendon. Forty‐six patients were randomized to either receive 4 weekly sessions of ESWT using 2400 pulses at 0.20 or 0.10 mJ/mm 2 , and a control group was not present.…”