Tendinosis Calcarea/Tendinoz Kalkera
Title: Extracorporeal shockwave therapy (ESWT) in tendinosis calcarea of the rotator cuff. Long-term results and efficacy
Author: W Daecke 1, D Kusnierczak, M Loew
Abstract
Calcifying tendinitis (TC) of the rotator cuff is a transient shoulder disease with a high rate of spontaneous resorption of the deposit. Therefore, primary treatment should be conservative. In cases of persistent pain despite conservative treatment, extracorporeal shock wave therapy (ESWT) can be performed as an alternative minimally invasive method. Various short-term studies have demonstrated the efficiency of ESWT for TC. To evaluate the short- and long-term results, complications, and the number of operations avoided by ESWT, a prospective study with 115 patients was performed over a period of 4 years. The patients had received high-energy ESWT once (group A: n = 56) or twice (group B: n = 59). Six months after therapy, 47% in group A and 77% in group B showed evidence of disappearance or disintegration of the calcium deposits. Pain relief was achieved in 45% of group A and 53% of group B. Four years after treatment, 20% of the patients had undergone surgery on the shoulder involved. Of the remaining patients, 59% (68 patients) were seen for follow-up. Subjectively, 78% of group A and 87% of group B judged the treatment to be successful. X-ray examination revealed complete or partial resorption of the calcium deposit in 93% in both groups. The Constant score increased from 45 before treatment to 88 in group A and 85 in group B after treatment. ESWT was successful for about 70% of the treated patients with no long-term complications seen.
Keywords: Tendinosis Calcarea
Radial shock wave therapy in calcifying tendinitis of the rotator cuff--a prospective study
Title: Radial shock wave therapy in calcifying tendinitis of the rotator cuff–a prospective study
Authors: P Magosch 1, S Lichtenberg, P Habermeyer
Abstract
Aim: The aim of the study is to evaluate the influence of radial shock wave therapy (RSWT) on the course of calcifying tendinitis of the rotator cuff.
Material and methods: 35 patients with a mean age of 47.5 years suffering from calcifying tendinitis stage Gaertner 2 with a mean size of 16.6 mm in typical location (true-ap view) for a mean of 28 months were treated by low-energy RSWT three times The acromio-humeral distance averaged 10.4 mm measured at the true-ap view. All patients were clinically and radiologically followed-up at 4 weeks, 3, 6 and 12 months after the last treatment.
Results: The Constant score improved significantly (p < 0.0001) during the first 4 weeks after RSWT from a mean of 68.5 to a mean of 80.5 points and remained approximately constant at 3, 6 and 12 months follow-up. After 4 weeks 25.7% of the patients had no pain, 54.3% reported about pain relief. In the course of the follow-up a significant improvement of pain was observed: up to 80.8% painless and 19.2% pain relief after 12 months RSWT. Radiologically 4 weeks after RSWT the X-ray examination showed in 17.6% no calcific deposit, in 20.5% a disintegration and in 61.5% no changes of the calcific deposit. At follow further-up we found a complete resorption of the calcific deposit in 75% up to 12 months after RSWT and 25% had no change in calcific deposit. Overall three patients (8.5%) had to undergo surgical treatment 3-7 months after RSWT.
Conclusion: The low-energy RSWT leads within the first 4 weeks to a significant pain relief and an improvement of shoulder function. In consideration of the long history, the size and the spontaneous resorption rate of the calcific deposit, an inductive effect of RSWT on the resorption of the calcific deposit can be assumed.
Title: Extracorporeal shockwave therapy in tendionosis calcarea of the rotator cuff: comparison of different treatment protocols
Authors: R Seil 1, S Rupp, D S Hammer, S Ensslin, T Gebhardt, D Kohn
Abstract
Aim of the study: Extracorporeal shock wave therapy (ESWT) is a new therapeutic procedure for chronically painful calcifying tendinitis of the rotator cuff. The therapy may vary with the number of applied impulses or with impulse energy. Shock waves with an energy of 0.04 to 0.12 mJ/mm2 define low-dose ESWT, in contrast to high-dose ESWT (> 0.12 mJ/mm2). The aim of the study was to verify the hypothesis that either high-dose or low-dose ESWT could be effective if the total amount of applied energy was similar.
Method: Fifty patients were assigned at random to 2 groups. The treatment consisted of 3 x 5000 low-dose impulses without anesthesia (group 1) and 1 x 5000 high-dose impulses with intravenous analgesia (group 2). The patients were examined at 6 weeks, 3 and 6 months after treatment. X-rays were performed at each visit.
Results: The Constant Score improved from 64.5 to 77.5 (group 1) and from 67.2 to 79.4 (group 2) before and 6 months after treatment (p < 0.05). The values on the visual analog scale which ranges from 0 (no pain) to 100 (maximal pain) improved from 76.8 to 48.8 (group 1) and from 75.4 to 45.6 (group 2) before and 6 months after treatment respectively. The final results for both Constant Score and visual analog scale were obtained after 3 months. X-rays showed a complete or subtotal calcific resorption in 8 (group 1, 32%) and 12 (group 2, 48%) patients.
Conclusion: Extracorporeal shock wave therapy may be an alternative treatment of calcifying tendinitis of the shoulder. Both treatment protocols gave equivalent results.
Title: Comparing Ultrasound-Guided Needling Combined With a Subacromial Corticosteroid Injection Versus High-Energy Extracorporeal Shockwave Therapy for Calcific Tendinitis of the Rotator Cuff: A Randomized Controlled Trial
Authors: Jan K G Louwerens 1, Inger N Sierevelt 2, Erik T Kramer 3, Rob Boonstra 4, Michel P J van den Bekerom 5, Barend J van Royen 6, Denise Eygendaal 7, Arthur van Noort 2
Abstract
Purpose: To compare clinical and radiographic outcomes after treatment with standardized high-energy extracorporeal shock wave therapy (ESWT) and ultrasound-guided needling (UGN) in patients with symptomatic calcific tendonitis of the rotator cuff who were nonresponsive to conservative treatment.
Methods: The study was designed as a randomized controlled trial. The ESWT group received ESWT (2000 pulses, energy flux density 0.35 mJ/mm2) in 4 sessions with 1-week intervals. UGN was combined with a corticosteroid ultrasound-guided subacromial bursa injection. Shoulder function was assessed at standardized follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant Murley Score (CMS), the Disabilities of the Arm, Shoulder, and Hand questionnaire, and visual analog scale for pain and satisfaction The size, location, and morphology of the deposits were evaluated on radiographs. The a priori sample size calculation computed that 44 participants randomized in each treatment group was required to achieve a power of 80%.
Results: Eighty-two patients were treated (56 female, 65%; mean age 52.1 ± 9 years) with a mean baseline CMS of 66.8 ± 12 and mean calcification size of 15.1 ± 4.7 mm. One patient was lost to follow-up. At 1-year follow-up, the UGN group showed similar results as the ESWT group with regard to the change from baseline CMS (20.9 vs 15.7; P = .23), Disabilities of the Arm, Shoulder, and Hand questionnaire (-20.1 vs -20.7; P = .78), and visual analog scale for pain (-3.9 and -2.6; P = .12). The mean calcification size decreased by 13 ± 3.9 mm in the UGN group and 6.7 ± 8.2 mm in the ESWT group (<P = .001). In total, 22% of the UGN and 41% of the ESWT patients received an additional treatment during follow-up because of persistent symptoms.
Conclusions: This RCT compares the clinical and radiographic results of UGN and high-energy ESWT in the treatment of calcific tendinitis of the rotator cuff. Both techniques are successful in improving function and pain, with high satisfaction rates after 1-year follow-up. However, UGN is more effective in eliminating the calcific deposit, and the amount of additional treatments was greater in the ESWT group.
Level of evidence: II, randomized controlled trial.
