Focused Extracorporeal Shock Wave Therapy in Calcifying Tendinitis of the Shoulder: A Meta-Analysis

Abstract

Background:The objective of this study is to assess the effectiveness of extracorporeal shock wave therapy in the management of calcifying tendinitis of the shoulder. Furthermore, a dose-response relationship was sought as a secondary confirmation of effectiveness.Hypothesis:Focused extracorporeal shock wave therapy has a high, dose-responsive effectiveness in the management of calcifying tendinitis of the shoulder.Study Design:Meta-analysis.Methods:Studies were identified from online databases (MEDLINE, EMBASE, and Cochrane Controlled Trials Register), manual searches, and personal communication with experts in the field. After assessment of heterogeneity, a random effects model was generated. The primary end points were identified as pain and function by using the visual analog scale and the Constant-Murley Score, respectively. These end points were pooled and the weighted mean differences and 95% confidence intervals were estimated. Odds ratios of the secondary end point deposit resorption were pooled.Results:In 14 studies, shock wave therapy led to a significantly higher reduction of pain (weighted mean difference, −2.8 points; 95% confidence interval, −4.2 to −1.5 points) and improvement of function (weighted mean difference, 19.8 points; 95% confidence interval, 13.4-26.3 points), compared to other treatments and placebo. High-energy treatment produced significantly better results than low-energy treatment for pain reduction (weighted mean difference, 1.7 points; 95% confidence interval, 0.7-2.6 points) and improvement of function (weighted mean difference, 10.7 points; 95% confidence interval, 7.2-14.1 points). These results are consistent with a dose-response relationship supporting the effectiveness of shock wave therapy.Conclusion:Shock wave therapy for calcifying tendinitis of the shoulder is effective in pain relief, function restoration, and deposit resorption; however, these conclusions are susceptible to bias arising from the limitations of the included studies.

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

“…They studied only the results 6 months after treatment. Even with these differences, the conclusions by Vavken et al [24] are similar to those in our study. Fig.…”

“…6). These findings are in line with the findings of Ioppolo et al [15] and Vavken et al [24]. Ioppolo et al [15] performed a meta-analysis on the clinical improvement and resorption of calcifications after shock wave therapy compared with sham treatment.…”

“…The mean difference was 9.88 (25.82 versus 15.94, 95% CI, 9.04-10.72; p \ 0.001). These findings are in line with those of Huisstede et al [13] and Vavken et al [24]. Huisstede et al [13] performed a systematic review on the effectiveness of ESWT on calcific and noncalcific rotator cuff tendinitis and two studies [1,9] were included and presented narratively that compared high-energy ESWT with low-energy ESWT.…”

“…In one case the causative relationship was questionable and in the second case the indication for ESWT was questionable [6]. There are high-and low-energy options, but the best treatment intensity has not been set yet [20,24]. High-energy ESWT is much more painful and more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist [9,21].…”

“…Huisstede et al [13] performed a systematic review on the effectiveness of ESWT on calcific and noncalcific rotator cuff tendinitis and two studies [1,9] were included and presented narratively that compared high-energy ESWT with low-energy ESWT. Vavken et al [24] performed a meta-analysis in which they chose a new, nonevidencebased, cutoff point (0.20 mJ/mm 2 ). Less than this intensity was labeled low-energy and greater than 0.20 mJ/mm 2 was considered high-energy.…”