Pilot Study In Calcified Tendinopathy Of The Shoulder: The Importance Of Targeted Ultrasound-Guided Shock Wave Treatment

Calcific tendinopathy of the shoulder is a degenerative disorder marked by calcium accumulation within the rotator cuff tendons, most commonly involving the supraspinatus tendon. This condition is a frequent source of persistent shoulder pain and reduced function, with reported prevalence among symptomatic individuals ranging from 2.5% to 54% (Uhthoff, Sarkar, & Maynard, 1976). A variety of non-surgical treatments are available, including nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, corticosteroid injections, and, in resistant cases, surgery. Recently, extracorporeal shock wave therapy (ESWT) has gained attention as a promising non-invasive treatment option (Brindisino, Marruganti, Lorusso, Cavaggion, & Ristori, 2024). This randomized, controlled, prospective study aimed to be a pilot study in assessing the therapeutic effectiveness of r-ESWT in managing calcific tendinopathy of the shoulder. Two ESWT techniques were compared: one guided by ultrasound to target calcific deposits directly, and the other based on anatomical landmarks focusing on the supraspinatus tendon origin. Materials and Methods: The study included twenty-one patients diagnosed with calcific tendinopathy, randomly divided into two treatment groups. Each participant received three ESWT sessions, with 2000 pulses delivered at 2.2 bars pressure, using an energy level of 5 and frequency of 8Hz. Clinical progress was evaluated using the Constant-Murley Shoulder Outcome Score (CMS) at 12 weeks and six months following treatment. Additionally, ultrasound imaging was used to monitor changes in the calcium deposits. Results: Patients treated with ultrasound-guided ESWT showed better clinical and imaging results than those who received the landmark-based treatment. The ultrasound-guided group experienced greater pain reduction and functional improvement, along with a significantly higher rate of complete resolution of calcific deposits. Conclusions: These results highlight the critical role of accurate targeting in maximizing the effectiveness of r-ESWT for shoulder calcific tendinopathy (Haake, Deike, Thon, & Schmitt, 2002).