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I am wondering about the efficacy of the differnt types of extracorporeal shock wave therapy in the treatment of shoulder calcific tendonitis,

I am also interested in the incidence of any negative after effects, such as renal calculi, or other potentially serious after effects, if the calcium deposits are relocated by the blood stream?

Joan Cleveland

2 months ago

Back to General Electrotherapy

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Prof Tim Watson
Prof Tim Watson

plenty of people have joined in on this one so I'll not replicate the evidence that they have presented. I have several additional papers, but it is not changing the thrust of the responses - the evidence supports radial shockwave - and in fact, the evidence is STRONGER when there IS calcification as opposed to when there is a chronic tendinopaty around the shoulder without the calcification.

As for the issue(s) about renal calculi and other 'stories', I can not find any evidence in the research literature of this kind of untoward effect(s). The trial need to report adverse effects or events and none have identified this as a 'real' risk. Again, as has been mentioned, the RADIAL shockwave is not making the calcific deposit 'breakdown' - but it is stimulating a tissue recovery response (the focussed shockwave may well have some physical breakdown effects - but that is a different issue)

Tim

fisioniki289
fisioniki289

RSWT destry the calcifications?

Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial. Pleiner J1, et all. Seven months post-treatment, calcifications dissolved completely in 19% of the treatment group and 8% of the control group, and a > 50% reduction was observed in 19% and 8% respectively. With regard to the reduction of pain, there was a significant improvement in the treatment group compared with the control group at the 1-week follow-up (p < 0.05). However, at the 3-month and 7-month visits, no significant between-group difference in pain could be detected.

THEY "DISSOLVE" but in long-mid term, the pain...is still there, like the control group. :/

Maybe we need to start to think beyond the anatomical alteration...

fisioniki289
fisioniki289

Anyway several studies said that rSWT is the best for the calcific disease.

Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis--a systematic review. Huisstede BM1, et all

A systematic review of shockwave therapies in soft tissue conditions: focusing the evidence British Journal of Sport Medicine 2014 Nov;48(21)

BUT IF WE TALK ABOUT PAIN... the Guideline for diagnosis and treatment of subacromial pain syndrome - A multidisciplinary review by the Dutch Orthopaedic Association Ron Diercks,  et all, in is 12 tips, a TO DO LIST, only at point 10 talk about ESWT , FOR CALCIFIC DISEASE,but after exercise, trigger points...

fisioniki289
fisioniki289

And what do you mean with efficacy?You mean NO PAIN or DELETE THE CALCIFICATION? Because we have a lot of o studies that put an important question mark about the real link between the PAIN and the CALCIFICATION. Some example:

Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Sansone V, et all Well, here 604 female shoulder are taken, the 17,8% of total is positive to Calcific Thendinopathy, but only the 15,7% of total has pain...INSIDE THIS POPULATION only the 33% has a real CT! Then they took the ASYMPTOMATIC population...well, the 67% was positive to CT :)

fisioniki289
fisioniki289

Efficacy and safety of extracorporeal shock wave therapy for orthopaedic conditions: a systematic review on studies listed in the PEDro database Christoph Schmitz,†* Nikolaus B. M. Császár,† ….

“There is no scientific evidence in favour of either rESWT or fESWT with respect to treatment outcome”

“The distinction between radial ESWT as ‘low-energy ESWT’ and focused ESWT as ‘high-energy ESWT’ is not correct and should be abandoned”

Cliff Eaton
Cliff Eaton

Hi Joan There is a falasy circulating that RC calcific deposits are 'blasted' by shockwave in a way that Lithotripsy treats kidney stomes. This is not the case. Low energy shockwave (most studies have used FSWT and some RPW) create a biological environment that heps the tissue reabsorb the calcific deposits. This is best achieved while it is still in its' toothpaste' like stage An extract from Avancin-Dobrovic et al's (2012) paper states: Only in patients treated with focused ESWT a statistical significant decrease of calcifications density was observed. Conclusion: In the treatment of shoulder calcific tendinitis the effectiveness of both types of shock waves has been proved, with statistically significantly better results from the focused shock wave Best wishes Cliff

Cliff Eaton
Cliff Eaton

Hi Joan There is a falasy circulating that RC calcific deposits are 'blasted' by shockwave in a way that Lithotripsy treats kidney stomes. This is not the case. Low energy shockwave (most studies have used FSWT and some RPW) create a biological environment that heps the tissue reabsorb the calcific deposits. This is best achieved while it is still in its' toothpaste' like stage An extract from Avancin-Dobrovic et al's (2012) paper states: Only in patients treated with focused ESWT a statistical significant decrease of calcifications density was observed. Conclusion: In the treatment of shoulder calcific tendinitis the effectiveness of both types of shock waves has been proved, with statistically significantly better results from the focused shock wave Best wishes Cliff

fisioniki289
fisioniki289

Well, i did 3 speech in 3 conference in China about it. If you can be more specific is better, i can give a lot of material :D

About the negative effects stay still: NO NEGATIVE EFFECTS. RSWT needs attention only if you work on growth cartilage on child. No study report renal calculi, calcium deposits relocation...

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