Extracorporeal shock wave therapy in calcific tendinitis of the shoulder

Objective: To investigate clinical (pain, mobility) and radiological (resolution of calcium deposits) efficacy of different energy levels of extracorporeal shock wave therapy (ESWT) in calcific tendinitis of the shoulder. Design and patients: There were 90 study subjects with radiographically verified calcific tendinitis of one shoulder, mean age 52+/-6 years (range 29-65 years; females:males=55:35), all of whom had had symptoms for at least 6 months and substantial restriction of shoulder mobility and pain that required taking anti-inflammatory drugs. Calcium deposits were of type I or type II (clearly circumscribed and dense) and ranged from 1 cm to 3 cm in diameter. Subjects were divided into three groups to receive ESWT at one of two energy levels (E-1=0.15 mJ/mm(2), E-2=0.44 mJ/mm(2)) or sham treatment. Treatment was given at 6 weekly intervals until symptoms resolved, five treatments had been given or the subject dropped out of the programme. Results: All subjects in groups E-1 and E-2 completed the programme. Those in group E-1 had significantly less pain during treatment but more treatments than those in group E-2, and at 6 month follow-up had residual calcification and recurrence of pain (87%). Subjects in group E-2 had no residual calcification or recurrence of pain. Sham treatment had no effect. There were no side effects except a small number of haematomas (2 in E-1, 6 in E-2; maximum size 2 cm). Conclusions: ESWT in calcific tendinitis of the shoulder is very effective. It does not have significant side effects at an energy level of E=0.44 mJ/mm(2), which can therefore be recommended.