Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study.

OBJECTIVES

To evaluate the therapeutic effect of extracorporeal shock wave therapy (ESWT) in shoulders with chronic calcific tendinitis, to compare the functional outcomes of ESWT and transcutaneous electric nerve stimulation (TENS) therapy, and to investigate which types of calcium deposit effectively respond to ESWT.

DESIGN

Randomized controlled trial.

SETTING

Outpatient clinics of the departments of physical medicine and rehabilitation and of orthopedics and traumatology of a veterans hospital in Taiwan.

PARTICIPANTS

Sixty patients with continuous shoulder pain for 6 months or more and with radiographically and sonographically verified calcific tendinitis. Patients were randomly allocated to receive ESWT (33 shoulders) or TENS treatment (30 shoulders).

INTERVENTIONS

ESWT was performed with 2000 shock waves at 2Hz and energy level between.26 and.32mJ/mm(2) per session. Treatment was given in 2 sessions, 14 days apart. TENS therapy was given 3 times a week for 4 weeks.

MAIN OUTCOME MEASURES

Mean Constant score, visual analog scale (VAS), manual muscle test, and changes of sonographic size and shape of calcium deposits were calculated for 4 time points: at baseline, 2 weeks, 4 weeks, 12 weeks posttherapy.

RESULTS

In both groups, Constant score and VAS improved significantly at 2-, 4-, and 12-week follow-ups (P<.05), and the size of calcium deposits decreased significantly at the 4- and 12-week follow-ups. Moreover, the arc-shaped calcific plaques of the rotator cuff were markedly meliorated with ESWT.

CONCLUSIONS

ESWT is more effective in the treatment of chronic calcific tendinitis of the shoulder than is TENS therapy, especially for arc-type calcific plaque.