Ilia Iosif, Miuta Caius Calin, Osser Gyongyi, Osser Brigitte, Toth Csongor, Pop Manuela Simona, Suciu Ramona Nicoleta, Huplea Veronica, Niculescu Victor, Bondar Laura Ioana
Department of Kinesitherapy and Special Motricity, Faculty of Physical Education and Sport, "Aurel Vlaicu" University of Arad, 310130 Arad, Romania.
Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
Diagnostics (Basel). 2025 Apr 30;15(9):1142. doi: 10.3390/diagnostics15091142.
: Calcific tendinopathy of the shoulder is a degenerative condition characterized by calcium deposits within the rotator cuff tendons, particularly the supraspinatus. It is a frequent cause of chronic shoulder pain and functional limitation, adversely affecting quality of life. While conservative treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and corticosteroid injections are commonly used, extracorporeal shock wave therapy (ESWT) has emerged as a promising non-invasive alternative. This interventional clinical trial compared the efficacy of ultrasound-guided versus landmark-based ESWT in treating calcific tendinopathy. : Eighty-four patients with ultrasound-confirmed calcific tendinopathy were randomized into two groups. Group 1 received ultrasound-guided ESWT with real-time targeting of the deposit; Group 2 received landmark-based ESWT based on anatomical palpation. Both groups underwent three sessions (2000 impulses at 2.2 bars, energy level 5, 8 Hz). Clinical outcomes were assessed using the Constant-Murley score (CMS) at baseline, 12 weeks, and 6 months. Calcific deposit resorption was evaluated via ultrasound imaging. : The ultrasound-guided group showed a significant improvement in CMS from a median of 50 (range: 30-75) at baseline to 97 (52-100) at 6 months. The landmark-based group also improved, from 48 (32-74) to 79 (40-96). At 6 months post-treatment, 90.9% of patients in the ultrasound-guided group achieved successful outcomes (CMS ≥ 86), compared to 50% in the landmark-based group. Complete calcific resorption occurred in 65.9% of patients in Group 1, compared to 50% in Group 2; 15% of patients in Group 2 showed no resorption. : Ultrasound-guided ESWT was significantly more effective than landmark-based ESWT in improving shoulder function, reducing pain, and promoting calcific deposit resorption. These findings support ultrasound guidance as a preferred approach for optimizing ESWT outcomes in patients with calcific tendinopathy of the shoulder.
肩部钙化性肌腱病是一种退行性疾病，其特征是肩袖肌腱内，尤其是冈上肌出现钙沉积。它是慢性肩部疼痛和功能受限的常见原因，对生活质量产生不利影响。虽然非甾体类抗炎药（NSAIDs）、物理治疗和皮质类固醇注射等保守治疗方法常用，但体外冲击波疗法（ESWT）已成为一种有前景的非侵入性替代方法。这项干预性临床试验比较了超声引导下与基于体表标志的ESWT治疗钙化性肌腱病的疗效。
84例经超声确诊为钙化性肌腱病的患者被随机分为两组。第1组接受超声引导下的ESWT，实时定位沉积物；第2组接受基于解剖触诊的体表标志引导下的ESWT。两组均接受三个疗程（2.2巴、能量水平5、8赫兹，2000次脉冲）。在基线、12周和6个月时，使用Constant-Murley评分（CMS）评估临床结果。通过超声成像评估钙化沉积物的吸收情况。
超声引导组的CMS从基线时的中位数50（范围：30 - 75）显著改善至6个月时的97（52 - 100）。体表标志引导组也有所改善，从48（32 - 74）提高到79（40 - 96）。治疗后6个月，超声引导组90.9%的患者取得成功结果（CMS≥86），而体表标志引导组为50%。第1组65.9%的患者钙化完全吸收，第2组为50%；第2组15%的患者无吸收。
超声引导下的ESWT在改善肩部功能、减轻疼痛和促进钙化沉积物吸收方面明显比体表标志引导下的ESWT更有效。这些发现支持超声引导作为优化肩部钙化性肌腱病患者ESWT治疗效果的首选方法。
