Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff

Background: Low-energy extracorporeal shock wave therapy is an alternative treatment, with limited evidence for effectiveness, for calcific tendinitis of the rotator cuff. Hypothesis: Objective localization of the calcium deposit by 3-dimensional, computer-assisted navigation reveals superior clinical and radiographic outcomes compared to localization through patient-to-therapist feedback. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: A prospective, randomized, single-blind study was carried out on 50 patients. The population was divided into 2 groups of equal numbers (navigation group and feedback group). In all patients, treatment-resistant pain was evident for longer than 6 months. A total of 3 therapy sessions of constant low-energy focused shock wave therapy was administered in weekly intervals in both groups. Local anesthesia was not applied. Radiographs and clinical assessment, including the Constant and Murley shoulder scoring system and the visual analog scale for pain, were performed both before therapy and after 12 weeks. In the navigation group; the calcium deposit was localized using a radiographically guided, 3-dimensional, computer-assisted device. The feedback group was treated after locating the point of maximum tenderness through palpation by the therapist with feedback from the patient. Results: Both groups had significant improvements in the Constant and Murley score and the visual analog scale after 12 weeks. The results from the navigation group were statistically significantly superior to those of the feedback group. In the navigation group, 6 calcium deposits disappeared and 9 altered, compared to 1 disappearance and 12 alterations in the feedback group. No severe complications occurred. Conclusion: Three-dimensional, computer-assisted navigation reveals significantly better results and is therefore recommended when extracorporeal shock wave therapy is used in the treatment of calcific tendinitis of the rotator cuff.